1 08-19-18 Connor-Davidson Resilience Scale (CD-RISC) © Manual Further information about the scale can be obtained from the author at [email protected] and at the www.cd-risc.com website. Cite as: Davidson JRT. Connor-Davidson Resilience Scale (CD- RISC) Manual. Unpublished. 08-19-2018, accessible at www.cd- risc.com. Contents Introduction, Authorized and Unauthorized Versions of the CD-RISC .......................................................... 3 Directions for Scale Administration, Scoring and Interpretation of Score ...................................................... 5 Reading Ease and Reading Grade Level .......................................................................................................... 7 Demographic Features of the CD-RISC .......................................................................................................... 7 Mean Scores of CD-RISC in Different Populations ...................................................................................... 10 Table 1a. Mean (SD) CD-RISC 25-Item Scores in General Population Samples ..................................... 11 Table 1b. Mean (SD) CD-RISC 10-Item Scores in General Population Samples ..................................... 11 Table 1c Mean (SD) CD-RISC 2-Item Scores in General Population Samples ........................................ 12 Table 2a. Mean (SD) CD-RISC 25-Item Scores in Students and Young Adults ...................................... 15 Table 2b. Mean (SD) CD-RISC 10-Item Scores in Students and Young Adults ...................................... 17 Table 2c. Mean (SD) CD-RISC 2-Item Scores in Students and Young Adults ........................................ 17 Table 3a. Mean (SD) CD-RISC 25-Item Scores in Post-Traumatic Stress Disorder & Subjects Exposed to Severe Trauma ........................................................................................................................................... 18 Table 3b. Mean (SD) CD-RISC 10-Item Scores in Post-Traumatic Stress Disorder & Subjects Exposed to Severe Trauma ....................................................................................................................................... 20 Table 3c. Mean (SD) CD-RISC 2-Item Scores in Post-Traumatic Stress Disorder & Subjects Exposed to Severe Trauma ........................................................................................................................................... 20 Table 4. Mean (SD) CD-RISC 25-Item Scores in Subjects with Depression, Suicide Attempts or Suicidality .................................................................................................................................................. 21 Table 5a. Mean (SD) CD-RISC 25-Item Scores in Groups with Other Psychiatric Disorders ................. 23 Table 5b. Mean (SD) CD-RISC 10-Item Scores in Groups with Other Psychiatric Disorders ................. 24 Table 5c. Mean (SD) CD-RISC 2 Item Scores in Groups with Other Psychiatric Disorders .................... 24 Table 6a. Mean (SD) CD-RISC 25-Item Scores in Groups with Medical Problems ................................ 26 1 2 Table 6b. Mean (SD) CD-RISC 10-Item Scores in Groups with Medical Problems ................................ 27 Table 6c. Mean (SD) CD-RISC 2-Item Scores in Groups with Medical Problems .................................. 28 Table 7a. Mean (SD) CD-RISC 25-Item Scores in Non-Treatment Seeking Trauma Survivors .............. 31 Table 7b. Mean (SD) CD-RISC 10-Item Scores in Non-treatment Seeking Trauma Survivors ............... 32 Table 7c. Mean (SD) CD-RISC 2-Item Scores in Non-treatment Seeking Trauma Survivors ................. 32 Table 8a. Mean (SD) CD-RISC 25-Item Scores in Other Groups, Those Under Stress and/or Mainly Healthy Subjects ........................................................................................................................................ 34 Table 8b. Mean (SD) CD-RISC 10-Item Scores in Other Groups, Those Under Stress and/or Mainly Healthy Subjects ........................................................................................................................................ 35 Table 8c. Mean (SD) CD-RISC 2-Item Scores in Other Groups, Those Under Stress and/or Mainly Healthy Subjects ........................................................................................................................................ 36 Table 9. Mean (SD) CD-RISC 10-Item Summary Scores ......................................................................... 39 Table 10. Mean (SD) CD-RISC 2-Item Summary Scores ......................................................................... 43 Factor Analysis .............................................................................................................................................. 44 Culture, Nationality and Ethnicity: Studies with the CD-RISC .................................................................... 51 Validity .......................................................................................................................................................... 54 CD-RISC: Predictive Validity, Treatment and Change over Time ............................................................... 83 Table 11a. Changes in CD-RISC 25 Associated with Intervention or Treatment ..................................... 84 Table 11b. Changes in CD-RISC 10 and CD-RISC 2 Associated with an Intervention ........................... 86 Test Retest Reliability .................................................................................................................................... 94 Biological and Other Mechanistic Studies of the CD-RISC .......................................................................... 95 Translations of the CD-RISC ....................................................................................................................... 101 Citations that Mention the CD-RISC or Report Original Research ............................................................. 102 2 3 Introduction Our interest in resilience arose from long experience treating men and women with posttraumatic stress disorder (PTSD), as well as from our broad-range research into the disorder, which covered treatment assessment, diagnosis, biological characterization, cross-cultural study, epidemiology, risk factors and the development of measures for PTSD and other forms of anxiety. Among the measures that we felt needed a stronger presence in the field of PTSD assessment was that of resilience. Although several scales addressing aspects of resilience have existed for some time, they had largely failed to penetrate into the world of clinical practice, treatment-outcome and biological research. We were further stimulated after including a brief single-item measure of stress vulnerability into one of our treatment outcome studies in PTSD. The results showed that an active medication allowed patients to deal better with stress than did a placebo. To the best of our knowledge, this was the first demonstration of such an effect, i.e., that a treatment for anxiety could boost stress coping/resilience more than a placebo control. Authorized Versions of the CD-RISC After a search of the resilience literature, which at that time was heavily influenced by contributions from the developmental psychology and child psychiatry fields, but with some important work in adults as well, we selected 17 domains, as outlined in Table 1 of our publication in 2003, and developed a 25-item scale (Connor KM, Davidson JRT. Depression and Anxiety 2003; 18: 71-82). This report presented psychometric data establishing validity and reliability of the scale (known as the Connor- Davidson Resilience Scale or CD-RISC), as well as briefly describing each of the 25 items (see Table 2 of that citation), and giving general scoring directions. However, the complete wording for each item and full directions did not appear in the report and the scale cannot be adequately reconstructed from the information given in this publication. 3 4 In the original validation study, mean scores in specific populations were reported as follows: US general population 80.7 Primary care patients 71.8 Psychiatric outpatients 68.0 Generalized anxiety 62.4 PTSD samples 47.8/52.8 Many other studies have reported normative scores on the CD-RISC, the results of which are given below and summarized in Tables 1a-c for the 25-, 10-, and 2-item scales respectively. The mean and median scores as given for the US general population in Connor and Davidson (2003) are based on a sample of those who furnished complete responses to all items of the CD- RISC. In the entire sample (i.e., complete responses and those with missing items), the mean score was 79.0 (12.9) and median (1,3 Q) was 81 (71, 89) (Davidson and Lee, unpublished data 2011). Besides the full 25-item CD-RISC (or CD-RISC 25), there are two briefer versions, the 10-item (CD-RISC 10) and 2-item (CD-RISC 2) scales. The 10-item version (score range 0-40) comprises items 1, 4, 6, 7, 8, 11, 14, 16, 17, and 19 from the original scale, and was developed by Drs. Campbell- Sills and Stein, at the University of California, San Diego, on the basis of factor analysis. In a community survey of 764 US adults, a mean score of 31.8 (SD = 5.4) was obtained for the CD-RISC 10 [Campbell-Sills L, Forde DR, Stein MB. J Psychiatric Research (2009), doi:10.1016/j.jpsychires.2009.01.013]. An almost identical mean score was obtained by Davidson (unpublished) in the US general population