Predicting Quality of Life and Domestic Violence Against Women During COVID-19 Quarantine Based on Resilience and Coping Styles

authors:

avatar Zhaleh Koohboomi 1 , avatar Mohammad Ghamari 2 , * , avatar Simin Hosseinian ORCID 3

Department of Counseling, Science and Research Branch, Islamic Azad University, Tehran, Iran
Department of Counseling, Abhar Branch, Islamic Azad University, Abhar, Iran
Department of Counseling, Alzahra University, Tehran, Iran

how to cite: Koohboomi Z, Ghamari M , Hosseinian S. Predicting Quality of Life and Domestic Violence Against Women During COVID-19 Quarantine Based on Resilience and Coping Styles. J Kermanshah Univ Med Sci. 2022;26(2):e120264. https://doi.org/10.5812/jkums-120264.

Abstract

Background:

Restrictive measures caused by the COVID-19 have exposed the families' structure to some critical issues such as reduced quality of life and increased domestic violence. For this reason, the study of psychological factors are essential in this regard.

Objectives:

The study aimed to predict the quality of life and violence against women during COVID-19 quarantine based on resilience and coping styles.

Methods:

This descriptive correlation study was conducted on all married women in Karaj from October 1 to November 30, 2020. A total of 241 people were randomly selected as the sample and answered the questionnaires about coping styles, quality of life, violence against women, and resilience scale. The data were analysized by Pearson correlation test and regression analysis.

Results:

There was a significant positive relationship between resilience, efficient coping style, and quality of life, as well as a significant negative relationship between inefficient coping style and quality of life (P < 0.01). A significant negative relationship was observed between coping style with domestic violence, as well as a significant positive relationship between dysfunctional coping style and domestic violence (P < 0.01). Resilience and effective coping style predicted the quality of life, domestic violence, and ineffective coping style of domestic violence against women (P < 0.01).

Conclusions:

According to the results, individual and psychological factors of people could play a significant role in the occurrence of violence and thus reduce their quality of life. In educational-therapeutic sessions, counselors and family therapists increased the quality of life and reduced violence by examining coping styles and resilience to use educational strategies in this area.

1. Background

COVID-19 causes stress in people and leads to significant health problems (1). According to Bo et al., traumatic conditions caused by the COVID-19 can lead to dysfunctional relationships and even violence between couples (2). COVID-19 epidemics have been linked to increased rates of domestic violence in many countries (3), a significant health problem for women and a latent epidemic (4). Studies have shown that the negative psychological effects of domestic violence and quarantine have multiplied during the COVID-19 epidemic, which has devastating effects on the health and quality of life of victims and their families (5, 6). Domestic violence against women reduces their quality of life and mental health (7, 8).

Coping styles are one of the structures that directly affect the quality of life of people and consequently domestic violence. A lack of appropriate coping styles among couples can result in increased stress and inability to communicate and solve problems when events and conflicts cause anxiety. Couples utilize different styles as part of their vulnerability profile, and inappropriate strategies are more likely to create problems (9). For example, violence occurs when the balance between pressure and internal restraint is upset (10). According to Woolfolk & Richardson (11), stress responses are not a direct result of environmental factors because they are neutral and can not cause stress reactions. Stress results from the organism evaluating, understanding, and interpreting situations and events (12). Coping styles reduce stress and resolve conflict (13, 14), and conflicting groups use inefficient coping methods (15). Effective and ineffective coping strategies predict the quality of life (16), and coping strategies with violence against women have a significant correlation (17).

Resilience is one of the variables that influence couples' relationships and can be influenced by coping styles (18). Resilience in family and spouse relationships is a trait to help individuals and spouses be less affected by adverse events. Unmarried spouses cannot adjust to the unfortunate situation and stress caused by marital problems, increasing marital dissatisfaction (19). People with higher resilience reported higher levels of family cohesion, more effective communication, and fewer problems in family functioning, but people with low resilience report more problems in family relationships (20). Resilience is significantly effective in predicting the quality of life (21).

studies have revealed that domestic violence against a partner exposes him/her to significant physical and psychological harm with devastating and lasting effects on the health and quality of life of victims and their families (6). Accordingly, it is possible to identify the factors affecting the quality of life and domestic violence and their various aspects based on the access of victims of domestic violence to support systems and health services, which have been limited during COVID-19 outbreak. The support systems provide education, intervention, and treatment for victims and their families.

2. Objectives

Therefore, this study aimed to predict the quality of life and violence against women during COVID-19 quarantine based on resilience and coping styles.

3. Methods

This descriptive correlation study included all married women in Karaj from October 1 to November 30, 2020. The available sample and internet implementation methods were used due to traffic and social communication restrictions. the e-mail address of the questionnaires was published for two months through social networks (Telegram and WhatsApp) for women in Karaj after determining the geographical location of Karaj. A total of 344 people answered the questionnaires, which were examined in SPSS software version 25, and participants who did not meet the inclusion criteria according to demographic information were excluded. Finally, the questionnaires of 241 women were analyzed as the final sample of the research using Pearson correlation tests and simultaneous regression analysis by SPSS software.

The inclusion criteria were age range of 20 - 50 years, being non-divorced, and lack of the death of a spouse, having a diploma or higher, and informed consent to participate in the study.

The measurement tools used in the research were the resilience Scale developed by Connor and Davidson (22) with 25 items. The answers to the questions are set on a 5-point Likert scale (completely incorrect = zero to always true = 4), and the score ranges from zero to 100. The scale validity by factor analysis method showed that the coefficients of other questions were reported between 0.14 and 0.64 except for three questions. Ebadatpour et al. calculated Cronbach's alpha method and reported as much as 0.90 (23). In the present study, the reliability of Cronbach's alpha method was 0.91.

Violence Toward Women Inventory (VTWI) Questionnaire was prepared by Haj-Yahia (24), which contains 32 items based on a 3-point scale (never = 1; once = 2; twice or more = 3). The range of scores is between 32 and 96. Haj-Yahia reported the reliability of Cronbach's alpha method for psychological violence (0.71), physical violence (0.86), sexual violence (0.93), and economic violence (0.92) (25) (Etesamipour, 2012). Cronbach's total alpha is reported as much as 0.76 (26). In the present study, the reliability of Cronbach's alpha method was 0.94.

World Health Organization quality of life (WHOQOL-BREF) questionnaire was regulated by the World Health Organization (27) with 26 questions. The answer to the questions is set to 5 options (basically = 1 to very high = 5), and questions 3, 4, and 26 are scored negatively. The range of scores is between 125 - 25. The reliability in Iran was evaluated by retesting method (with a three-week interval), halving, and Cronbach's alpha, and all three cases indicated the desirability of the scale. The validity of this scale for physical health, mental health, social relations, and living environment was reported as much as 0.70, 0.77, 0.65, and 0.77, respectively (28). In the present study, the reliability of Cronbach's alpha method was as much as 0.92.

Coping Styles Questionnaire was developed by Billings, & Moos (29), consisting 32 items and two types of effective and ineffective coping strategies. The response to the items is set to four Likert options (never = zero to always = 3). The reliability coefficient of the questionnaire was 0.79, and its internal consistency was reported from 0.41 to 0.66. In another study, the Cronbach's alpha was reported for the effective coping strategy (0.72) and an inefficient coping strategy (0.75) (30). In the present study, the reliability of Cronbach's alpha method was as much as 0.76.

4. Results

According to Table 1, out of a total of 241 participats, 63 (26%) had the highest frequency in the age range of 35-39 years, and 9 (4%) had the lowest frequency in the age range of 20 - 24 years. In addition, 61 (25%) of them had a diploma, 16 (7%) had an associate, 102 (42%) had a bachelor, 53 (22%) had a master, and 9 (4%) had a doctorate. The findings also showed that 82% of participants reported high levels of domestic violence, and 16% reported moderate levels of domestic violence during quarantine due to COVID-19. Moreover, 58% of participants had an average quality of life, and 36% had low quality of life. The mean and standard deviation of the variables are presented in Table 1.

Table 1.

Demographic Information of the Sample Group and Descriptive Indicators of Research Variables (n = 241) a

VariablesFrequency (%)/Mean ± SD
Age range
20 - 249 (4)
25 - 2924 (10)
30 - 3453 (22)
35 - 3963 (26)
40 - 4437 (15)
45 - 5055 (23)
Education
Diploma61 (25)
Associate degree16 (7)
Bachelor102 (42)
Masters53 (22)
Ph.D9 (4)
Duration of marriage
1 - 550 (21)
6 - 1052 (22)
11 - 1550 (21)
16 - 2037 (14)
21 - 2527 (11)
26 - 3021 (9)
31 - 354 (2)
Domestic violence situation
Low6 (2)
Medium38 (16)
High197 (82)
Quality of life status
Low86 (36)
Medium140 (58)
High15 (6)
Coping styles
Efficient3.79 ± 25.26
Inefficient8.05 ± 63.56
Resilience16.04 ± 92.66
Quality of life
Total15.05 ± 60.41
Physical health4.86 ± 17.64
Mental health4.06 ± 18.81
Community relations2.48 ± 8.7
Perception of the environment5.63 ± 20.35
Domestic violence
Total12.26 ± 84.39
Psychological7.99 ± 39.78
Physical3.76 ± 31.26
Sexual1.53 ± 8.11
Economical1.21 ± 5.31

Table 2 presents the correlation matrix of research variables.

Table 2.

Correlation Matrix of Research Variables

1234
1. Domestic violence1
2. Resilience-0.188**1
3. Quality of life-0.284**-0.638**1
4. Efficient coping style0.077-0.325**-0.325**1
5. Inefficient coping style0.285**0.493**-0.336**0.131**
P-Value> 0.05*> 0.01**

According to Table 2, the variables of resilience, quality of life, and dysfunctional coping styles are significantly correlated to domestic violence (0.01).

The results of the simultaneous regression analysis used to predict quality of life and domestic violence against women based on tolerance and coping styles are summarized in Table 3.

Table 3.

Summary of Regression Analysis Results for Predicting the Quality of Life and Domestic Violence

Predictive Variables of Simultaneous ModelMRRSFP-ValueNon-standard CoefficientsStandard Coefficients
BErrorβtP-Value
Quality of life0.6510.42358.0130.0001
Resilience0.6290.0650.6029.7270.0001
Efficient style0.0910.2730.0200.3320.740
Inefficient style-0.2720.105-0.136-2.5960.010
Domestic violence0.3020.0917.900.0001
Resilience0.0900.062-0.1131.4540.147
Efficient style-0.0600.261-0.017-0.2300.818
Inefficient style0.3790.1000.2493.7810.0001

According to Table 3, the resilience and coping styles (efficient, inefficient) are significantly correlted to quality of life and domestic violence, respectively. In addition, the ineffective coping style and resilience predict quality of life, but only ineffective coping style predicts domestic violence against women. Domestic violence has been predicted from variance. The predictor variables for domestic violence are resilience and dysfunctional lifestyle.

5. Discussion

This study aimed to predict the quality of life and violence against women during COVID-19 quarantine based on resilience and coping styles. Generally, the results showed resilience and an effective coping style of quality of life and predicted the dysfunctional style of domestic violence against women during the COVID-19 quarantine.

The first finding found a significant positive relationship between dysfunctional coping styles and domestic violence and predicted dysfunctional coping styles of domestic violence against women. This result is consistent with those of Mirhashemi and Sabori (17) and Moosavi and Homaei (16). Individuals can overcome many difficulties related to social, physical, and psychological relationships by using coping styles. Coping styles refer to methods of dealing with problems. People who employ an escape-avoidance style in stressful situations lose the opportunity to solve problems. These conditions not only keep the problem going but also bring the stress back to life over and over again. However, the most detrimental variables for intimate relationships are mild and chronic external stressors, which are transmitted to intimate relationships. These stressors cause tension and conflict between couples and alienation between them, increasing the likelihood of divorce (31). According to Altheimer, escape strategies, avoidance, and acceptance of responsibility are part of the dysfunctional coping to balance emotions and control emotional reactions. According to Lang & Scott’s theory (32), dysfunctional coping is moderately stable because the individual is less affected by situational factors. The use of avoidance coping strategies means the woman's efforts to escape the problematic situation and escape from reality. According to Carver (33), this type of coping can be effective in the early stages of coping with a stressful situation. As a result of using an avoidance strategy, a person avoids stress and stressful situations, so when they do not face the stressor, they are less likely to be violent (17).

The second finding revealed a positive and significant relationship between effective coping style and quality of life and a negative and significant relationship between inefficient coping style and quality of life, and effective coping style predicts women's quality of life. This finding is consistent with those of Moosavi and Homaei (16). Individuals rely on coping styles in stressful situations to utilize adaptive resources and care strategies to protect themselves against the negative effects of stress (34). In the copying process, individuals make behavioral and cognitive efforts to prevent, regulate, and suppress stress. Coping styles are the process by which a person manages demands beyond personal resources and capabilities in threatening situations and changes according to the success of efforts from the effects of stress and injury (35). Individuals estimate or evaluate stressful situations and reduce the production of negative emotions by internal and external desires through effective coping skills (36). Effective coping style leads to prevention, management, and reduction of stress by creating cognitive and behavioral efforts, which can reduce the impact of stress on mental health and increase mental health and mental and social adjustment (37), contributing to a healthy lifestyle as a result of the quality of life.

The third finding revealed a significant negative relationship between resilience and domestic violence. These findings are consistent with those of Moosavi and Homaei (16). The growth trajectory is protected from problematic behaviors and psychological damage by resilience and leads to adaptive consequences despite adverse conditions. Stress is a factor that helps people cope with difficult life situations and protects them from mental disorders and problems (38). However, resilience protects people against stressful situations and improve their social ability when facing problem. Domestic violence is also considered a threatening situation, and people with high resilience can better overcome their problems. People with low resilience take a conservative and inflexible approach when dealing with stressful situations and behave inconsistently. In contrast, people with high resilience experience more positive emotions and flexibility and greater self-confidence and resilience (39).

The fourth finding stated a significant positive relationship between resilience and the quality of life of women during COVID-19 quarantine, and resilience predicts the quality of life of women during COVID-19 quarantine. This findings are consistent with those of Razmpush et al. (21). Resilience is considered a two-dimensional concept, i.e., the importance of adversity and positive adjustment, which can affect the quality of life and its dimensions (40). Individuals who are resilient reduce the magnitude of the threat when assessing it and expect that their efforts will be fruitful. People with high resilience can cope better with stress and redefine and interpret their conflicting experiences (41). Resilient people can reach a proper balance and position through the necessary competencies to solve problems in crisis and stressful situations by using positive emotions and reducing negative emotions. According to Garmezy (42), resilient people are able to take responsibility for their circumstances and problems and are optimistic about life with positive self-knowledge (43). Therefore, people with these characteristics use effective solutions to stressful situations to improve their quality of life.

The results of the research showed that the quality of life and domestic violence against women are influenced by coping styles (either efficient or inefficient) and resilience. The results of this study indicated that the personal and psychological factors of the abused person can play a significant role in the occurrence of violence and reduce the quality of life. Therefore, measures can be taken to improve the individual and psychological characteristics of women in society, such as effective coping styles and resilience to better deal with this phenomenon, thus increasing the quality of life and reducing violence against women.

One of the limitations of the study was conducting the research in absentia, and it was not possible to control intervening variables such as cultural factors, which may affect resilience, quality of life, and domestic violence. Similar studies are suggested to be conducted in person under normal circumstances in different cultures. Couples and family practitioners should use educational programs to raise women's awareness of the factors and cognitive characteristics of women in the family and their relation to their husbands to reduce the risk of violence against them in the family.

References

  • 1.

    Taylor S, Landry CA, Paluszek MM, Fergus TA, McKay D, Asmundson GJG. COVID stress syndrome: Concept, structure, and correlates. Depress Anxiety. 2020;37(8):706-14. [PubMed ID: 32627255]. [PubMed Central ID: PMC7362150]. https://doi.org/10.1002/da.23071.

  • 2.

    Bo HX, Li W, Yang Y, Wang Y, Zhang Q, Cheung T, et al. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychol Med. 2021;51(6):1052-3. [PubMed ID: 32216863]. [PubMed Central ID: PMC7200846]. https://doi.org/10.1017/S0033291720000999.

  • 3.

    Tekle AL, Dereje T, Aklilu A. A narrative synthesis on COVID-19 risks and concerns in developing countries: The case of Ethiopia. J Public Health Epidemol. 2020;12(2):86-97. https://doi.org/10.5897/jphe2020.1221.

  • 4.

    Alesina A, Brioschi B, Ferrara EL. Violence against women: A cross-cultural analysis for Africa. Natl Bur Econ Res. 2016. https://doi.org/10.3386/w21901.

  • 5.

    Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020;14(5):779-88. [PubMed ID: 32526627]. [PubMed Central ID: PMC7255207]. https://doi.org/10.1016/j.dsx.2020.05.035.

  • 6.

    Telles LEB, Valenca AM, Barros AJS, da Silva AG. Domestic violence in the COVID-19 pandemic: a forensic psychiatric perspective. Braz J Psychiatry. 2021;43(3):233-4. [PubMed ID: 32491034]. [PubMed Central ID: PMC8136389]. https://doi.org/10.1590/1516-4446-2020-1060.

  • 7.

    Vachher AS, Sharma A. Domestic violence against women and their mental health status in a colony in delhi. Indian J Community Med. 2010;35(3):403-5. [PubMed ID: 21031106]. [PubMed Central ID: PMC2963879]. https://doi.org/10.4103/0970-0218.69266.

  • 8.

    Setayesh N, Ezoji K, Bakhshizadeh M, Nojomi M. Domestic violence and physical and mental state of women. Razi J Med Sci. 2017;24(154):20-6.

  • 9.

    Alaghband L, Sharifi HP, Farzad V, Aghayousefi A. [Predicting emotional divorce based on emotional literacy, coping styles, quality of life, resilience mediation]. J Psychol Sci. 2020;19(90):733-43. Persian.

  • 10.

    Kaplan H, Sadock B, Sadock V. Rezaei F, translator. [Synopsis of psychiatry: behavioral sciences/clinical psychiatry]. 2nd ed. Tehran, Iran: Arjmand Publications; 2007. Persian.

  • 11.

    Woolfolk RL, Richardson FC. Behavior therapy and the ideology of modernity. Am Psychol. 1984;39(7):777-86. https://doi.org/10.1037/0003-066X.39.7.777.

  • 12.

    Khodayarifard M, Parand A. Stress and Coping Styles. University of Tehran Press; 2012.

  • 13.

    Das S, Das B, Nath K, Dutta A, Bora P, Hazarika M. Impact of stress, coping, social support, and resilience of families having children with autism: A North East India-based study. Asian J Psychiatr. 2017;28:133-9. [PubMed ID: 28784366]. https://doi.org/10.1016/j.ajp.2017.03.040.

  • 14.

    Sarani A, Azhari S, Mazlom SR, AghammohamadiansHerbaf HR. The Relationship between Coping Strategies During Pregnancy with Perceived Stress Level in Pregnant Mothers. J Babol Univ Med Sci. 2016;18(7):7-13. https://doi.org/10.22088/jbums.18.7.7.

  • 15.

    Lee JH, Seo M, Lee M, Park SY, Lee JH, Lee SM. Profiles of Coping Strategies in Resilient Adolescents. Psychol Rep. 2017;120(1):49-69. [PubMed ID: 28558526]. https://doi.org/10.1177/0033294116677947.

  • 16.

    Moosavi A, Homaei R. [The relationship between coping strategies, cognitive emotion regulation and mindfulness with quality of life in mothers of children with intellectual disabilities Afshin Moosavi]. J Except Educ. 2019;2(157):9-20. Persian.

  • 17.

    Mirhashemi M, Sabori S. [Prediction of Violence Dimentions upon Coping Strategies in Women of Domestic Violence Victim]. Fam Pathol Couns Enrich J. 2015;1(2):1-13. Persian.

  • 18.

    Li X, Ye L, Tian L, Huo Y, Zhou M. Infertility-Related Stress and Life Satisfaction among Chinese Infertile Women: A Moderated Mediation Model of Marital Satisfaction and Resilience. Sex Roles. 2019;82(1-2):44-52. https://doi.org/10.1007/s11199-019-01032-0.

  • 19.

    Darnhofer I, Lamine C, Strauss A, Navarrete M. The resilience of family farms: Towards a relational approach. J Rural Stud. 2016;44:111-22. https://doi.org/10.1016/j.jrurstud.2016.01.013.

  • 20.

    Carbonella JY, Timpano KR. Examining the Link Between Hoarding Symptoms and Cognitive Flexibility Deficits. Behav Ther. 2016;47(2):262-73. [PubMed ID: 26956657]. https://doi.org/10.1016/j.beth.2015.11.003.

  • 21.

    Razmpush M, Ramezani K, Maredpoor A, Koulivand PH. The Role of Self-Efficacy and Resilience in Nurses' Quality of Life. Neurosci J Shefaye Khatam. 2019;7(1):34-42. https://doi.org/10.29252/shefa.7.1.34.

  • 22.

    Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82. [PubMed ID: 12964174]. https://doi.org/10.1002/da.10113.

  • 23.

    Ebadatpour B, Navabinejad S, Shafiabadi A, Falsafinejad MR. [Formulation of a pattern for marital burn out based on family function, individual resilience and spiritual beliefs]. J Psychol Models Methods. 2013;3(13):29-45. Persian.

  • 24.

    Haj-Yahia MM. Wife abuse and its psychological consequences as revealed by the first Palestinian National Survey on Violence Against Women. J Fam Psychol. 1999;13(4):642-62. https://doi.org/10.1037/0893-3200.13.4.642.

  • 25.

    Etesami Pour R. [Comparison of spouse abuse, low self- esteem and sexual disorders in married women in city and village]. J Res Heal. 2013;2(2):191-9. Persian.

  • 26.

    Khojasteh Mehr R, Amanelahi A, Zohrei E, Rajabi GR. [Attachment styles, causal attribution and responsibility attribution as predictors of violence against women]. Fam Psycho. 2014;1(1):41-52.

  • 27.

    No authors listed. The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Soc Sci Med. 1998;46(12):1569-85. [PubMed ID: 9672396]. https://doi.org/10.1016/s0277-9536(98)00009-4.

  • 28.

    Aslani K, Khodadadi Andariyeh F, Amanelahi A, Rajabi GR, Stith SM. [The effectiveness of domestic violence; focused couple therapy on violence against women: Intervention in maladjusted couple relationships living in Ahvaz]. Fam Couns Psychother. 2020;9(2 (28)):213-32. Persian.

  • 29.

    Billings AG, Moos RH. Coping, stress, and social resources among adults with unipolar depression. J Pers Soc Psychol. 1984;46(4):877-91. [PubMed ID: 6737198]. https://doi.org/10.1037//0022-3514.46.4.877.

  • 30.

    Homayoon Nia Firoozjah M, Sheikh M, Hemayat Talab R. The relationship between behavioral disorders, coping strategies and emotional intelligence in young athletes. Mot Behav. 2014;6(17):141-56.

  • 31.

    Piri Z, Amiri Majd M, Bazzazian S, Ghamari M. The Mediating Role of Coping Strategies in the Relationship of Difficulties in Emotion Regulation With Internet Addiction Among College Students. Q Horiz Med Sci. 2020;26(1):38-53. https://doi.org/10.32598/hms.26.1.3108.

  • 32.

    Wong PT, Wong LC, Scott C. Beyond Stress and Coping: The Positive Psychology of Transformation. Handbook of multicultural perspectives on stress and coping. Boston, Massachusetts: Springer; 2006. p. 1-26. https://doi.org/10.1007/0-387-26238-5_1.

  • 33.

    Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92-100. [PubMed ID: 16250744]. https://doi.org/10.1207/s15327558ijbm0401_6.

  • 34.

    Kamp Dush CM, Taylor MG, Kroeger RA. Marital Happiness and Psychological Well-Being Across the Life Course. Fam Relat. 2008;57(2):211-26. [PubMed ID: 23667284]. [PubMed Central ID: PMC3650717]. https://doi.org/10.1111/j.1741-3729.2008.00495.x.

  • 35.

    Aggarwal S, Kaur J, Kaur S. To assess the coping strategies used among significant family members of patients with end stage renal failure undergoing hemodialysis. Baba Farid Univ Nurs J. 2017;12(1):49-52.

  • 36.

    Peyambari M, Sadeghi M, Rashidi M, Ahmadi Tahour M. The effect of cognitive- behavioral training on depression and psychological hardiness of Patient With cardiovascular diseases. Iran J Health Educ Promot. 2019;7(4):289-99. https://doi.org/10.29252/ijhehp.7.4.289.

  • 37.

    Trump LJ, Mendenhall TJ. Couples coping with cardiovascular disease: A systematic review. Fam Syst Health. 2017;35(1):58-69. [PubMed ID: 27685321]. https://doi.org/10.1037/fsh0000232.

  • 38.

    Lee J, Han I, Kang BR, Kim SH, Sul WJ, Lee TK. Degradation of crude oil in a contaminated tidal flat area and the resilience of bacterial community. Mar Pollut Bull. 2017;114(1):296-301. [PubMed ID: 27671845]. https://doi.org/10.1016/j.marpolbul.2016.09.043.

  • 39.

    Benadé P, du Plessis E, Koen MP. Exploring resilience in nurses caring for older persons. Health SA Gesondheid. 2017;22:138-49. https://doi.org/10.1016/j.hsag.2017.01.003.

  • 40.

    Chatman JD. Risk and resiliency among inner city minority adolescents: A study of coping and ethnic identity. California, USA: University of California, Los Angeles; 2006.

  • 41.

    Bigbee JL. Hardiness: a new perspective in health promotion. Nurse Pract. 1985;10(11):51. 54-6. [PubMed ID: 4069460]. https://doi.org/10.1097/00006205-198511000-00006.

  • 42.

    Garmezy N. Vulnerability and resilience. In: Funder DC, Parke RD, Tomlinson-Keasey C, Widaman K, editors. Studying lives through time: Personality and development. American Psychological Association; 1993. 377–398 p.

  • 43.

    Veselska Z, Geckova AM, Orosova O, Gajdosova B, van Dijk JP, Reijneveld SA. Self-esteem and resilience: the connection with risky behavior among adolescents. Addict Behav. 2009;34(3):287-91. [PubMed ID: 19056183]. https://doi.org/10.1016/j.addbeh.2008.11.005.