Medicine, Faculty of
Non UBC
Occupational Science and Occupational Therapy, Department of
DSpace
BMC Psychiatry. 2023 Sep 07;23(1):660
Providence Health Care (Vancouver, B.C.). Research Institute
BioMed Central Ltd., part of Springer Nature
Nesbitt, Amy E.
Sabiston, Catherine M.
deJonge, Melissa L.
Barbic, Skye
Kozloff, Nicole
Nalder, Emily J.
Introduction: The study of resilience among transition-age youth (aged 16–29 years) living with serious mental illness (SMI) has provided a promising new direction for research with the capacity to explore individuals’ strengths and resources. However, variability in how resilience is defined and measured has led to a lack of conceptual clarity. A comprehensive synthesis is needed to understand current trends and gaps in resilience research among this population. The purpose of the current study was to map how resilience has been conceptualized and operationalized among transition-age youth with SMI, explore resilience factors and outcomes that have been studied, and recommend areas for future research. Methods: A six-stage scoping review methodology was used to systematically identify relevant empirical literature across multiple databases (MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, Scopus), addressing transition-age youth diagnosed with SMI and resilience. Topic consultation and reaction meetings were conducted to gather feedback from transition-age youth with SMI, researchers, and clinicians during the review process to enhance the applicability of the review findings. A meta-narrative approach was used to organize included studies into research traditions (i.e., paradigms of inquiry with similar storylines, theoretical and methodological orientations). Resilience factors and outcomes, and the consultative meetings, were analyzed using content analysis. Results: Twenty-four studies met inclusion criteria (14 quantitative, 9 qualitative, 1 mixed-method). Four research traditions were identified, each contributing a unique storyline which conceptualized and operationalized resilience in slightly different ways: Stress Adaptation, Person-Environment Interactions, Recovery-Focused, and Critical and Cultural Perspectives. Resilience factors and outcomes were most commonly evaluated at the individual-level or within the immediate environment (e.g., personal characteristics, social support networks). Limited research has explored the influence of macro-level systems and health inequalities on resilience processes. Results from the consultative meetings further demonstrated the importance of health services and sociocultural factors in shaping processes of resilience among youth. Conclusion: The present results may be used to inform future work, as well as the development of age-appropriate, strengths-based, and resilience-oriented approaches to service delivery. Interdisciplinary and intersectional research that prioritizes community and youth engagement is needed to advance current understandings of resilience among transition-age youth with SMI.
Nesbitt et al. BMC Psychiatry (2023) 23:660 https://doi.org/10.1186/s12888-023-05158-0RESEARCH Open Access© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecom-mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.BMC PsychiatryA scoping review of resilience among transition-age youth with serious mental illness: tensions, knowledge gaps, and future directionsAmy E. Nesbitt1*, Catherine M. Sabiston2, Melissa L. deJonge2, Skye P. Barbic3,4,5, Nicole Kozloff6,7 and Emily J. Nalder1,8 Abstract Introduction The study of resilience among transition-age youth (aged 16–29 years) living with serious mental illness (SMI) has provided a promising new direction for research with the capacity to explore individuals’ strengths and resources. However, variability in how resilience is defined and measured has led to a lack of conceptual clarity. A comprehensive synthesis is needed to understand current trends and gaps in resilience research among this popu-lation. The purpose of the current study was to map how resilience has been conceptualized and operationalized among transition-age youth with SMI, explore resilience factors and outcomes that have been studied, and recom-mend areas for future research.Methods A six-stage scoping review methodology was used to systematically identify relevant empirical literature across multiple databases (MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, Scopus), addressing transition-age youth diagnosed with SMI and resilience. Topic consultation and reaction meetings were conducted to gather feedback from transition-age youth with SMI, researchers, and clinicians during the review process to enhance the applicability of the review findings. A meta-narrative approach was used to organize included studies into research traditions (i.e., paradigms of inquiry with similar storylines, theoretical and methodological orientations). Resilience factors and out-comes, and the consultative meetings, were analyzed using content analysis.Results Twenty-four studies met inclusion criteria (14 quantitative, 9 qualitative, 1 mixed-method). Four research traditions were identified, each contributing a unique storyline which conceptualized and operationalized resil-ience in slightly different ways: Stress Adaptation, Person-Environment Interactions, Recovery-Focused, and Criti-cal and Cultural Perspectives. Resilience factors and outcomes were most commonly evaluated at the individ-ual-level or within the immediate environment (e.g., personal characteristics, social support networks). Limited research has explored the influence of macro-level systems and health inequalities on resilience processes. Results from the consultative meetings further demonstrated the importance of health services and sociocultural factors in shaping processes of resilience among youth.*Correspondence:Amy E. Nesbittamy.nesbitt@mail.utoronto.caFull list of author information is available at the end of the articlePage 2 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 Conclusion The present results may be used to inform future work, as well as the development of age-appropriate, strengths-based, and resilience-oriented approaches to service delivery. Interdisciplinary and intersectional research that prioritizes community and youth engagement is needed to advance current understandings of resilience among transition-age youth with SMI.Keywords Adolescent, Young adult, Resilience, Mental health, Review, Advisory groupBackgroundOver 20% of transition-age youth (age 16–29 years old) are living with serious mental illness (SMI), defined as mental health conditions that cause substantial disrup-tions to everyday functioning (e.g., depression, bipo-lar disorder, schizophrenia spectrum disorders) [1, 2]. The onset of SMI for transition-age youth occurs dur-ing a critical period of development, characterized by increased independence and responsibility in social and occupational roles, identity formation, and many com-plex life transitions [3]. Consequently, the experience of SMI can have a pronounced impact on young people’s developmental trajectory, quality of life, physical health, and community engagement [4–6]. Aligning with a shift towards strengths-based, recovery-oriented, and early intervention service approaches over the past two dec-ades, there has been a surge of research focused on the concept of resilience among transition-age youth [7, 8]. Broadly, resilience refers to positive adaptation in the face of significant adversity and is considered an impor-tant component of one’s personal recovery process [8, 9]. Finding new pathways and services that foster young peo-ple’s recovery and resilience is a crucial priority in recent national and global mental health strategies [10–12].Resilience among transition‑age youthThe study of resilience provides a unique framework for understanding the complex personal factors and sys-tems that contribute to youth mental health. Particularly, adopting a resilience perspective may re-frame and de-pathologize conceptions of youth SMI, turning our atten-tion towards one’s strengths, values, and resources, in contrast to a sole focus on individual risks or impairment [13, 14]. Additionally, a focus on building transition-age youth resilience may inform transdiagnostic models of care by identifying protective factors and mechanisms that foster positive indices of development and well-being among young people with diverse experiences and diagnoses [15–18].Importantly, the concept of resilience has evolved over time, from early views of resilience as an exceptional or fixed trait within an individual [19], to more recent research applying a process-oriented perspective [20, 21]. From this point of view, resilience is considered a complex, fluid, and malleable process that unfolds over time, encom-passing both aspects unique to the individual (e.g., personal qualities) and wider social-ecological features of their envi-ronment (e.g., one’s social support network and cultural context) [18, 22, 23]. Recent work adopting this process-oriented perspective has begun to address critiques to the study of resilience as potentially placing increased pressure or responsibility on young people to simply “be resilient”, without enough emphasis on the sociocultural and sys-temic conditions that contribute to resilience via person-environment interactions [24, 25]. This has also sparked new research among transition-age youth with SMI explor-ing a wide range of biological and psychosocial protective factors in connection to clinical outcomes, the effectiveness of resiliency-informed interventions, and environmental circumstances that facilitate resilience processes during this transitional stage of life [26–28].While a resilience approach clearly shows value and promise to understanding transition-age youth’s expe-rience of SMI, there remains a lack of clarity on the meanings, processes, and outcomes of resilience among this population. This is, in part, due to the large vari-ety of ways in which resilience has been conceptu-alized within the youth mental health literature, as this directly impacts the research questions that are addressed, and how the concept is understood, opera-tionalized, and applied [29]. Additionally, there is no single resilience theory or model specifically tailored to the unique experiences of transition-age youth liv-ing with SMI to guide further research and practice [7]. Prior reviews have synthesized the evolution of resilience theory, measures, and outcomes, as well as the wide range of biological, psychosocial, environ-mental and cultural factors that are theorized to influ-ence resilience among youth and adults [18, 30–34]. None of these focused specifically on transition-age youth with SMI. As such, current trends and gaps within resilience research among this population remain unclear. Additionally, researchers have argued that engaging community members through consulta-tions and/or partnerships is an imperative step in resil-ience research to improve current practices and avoid “de-contextualizing” youth’s experiences [35]. This is an important limitation to recent reviews of resil-ience literature undertaken among broader youth and Page 3 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 adult populations [30–34]. Integrating the perspec-tives of youth, clinicians, and researchers can provide valuable insights to the study of resilience and improve the applicability and uptake of research findings. Taken together, a comprehensive synthesis of exist-ing research is needed to explore how the concept of resilience has been studied among transition-age youth with SMI.Present investigationA scoping review of published research from the last 22 years was conducted to enhance conceptual clarity in this area, identify factors and outcomes that are relevant to transition-age youth’s resilience, and recommend areas for future research. The review was informed by com-munity advisory group consultations, a meta-narrative approach, and current process-oriented models of resil-ience within rehabilitation sciences.A meta-narrative review approach [36] was used to map how conceptualizations of resilience have evolved over time and across different research traditions. According to Greenhalgh et al. (2005), research traditions are con-sidered paradigms of inquiry that share similar theoreti-cal orientations, methodological approaches, conceptual papers, and perspectives, which are portrayed through an overarching storyline or lens. Meta-narrative review is recommended for synthesizing complex, heterogene-ous bodies of literature where a key concept has evolved over time and conceptual clarity is needed. This approach is particularly useful for exploring potential tensions and knowledge gaps that exist across research traditions [36].McLarnon and Rothstein’s (2013) conceptual model of resilience [20] and Nalder et al.’s (2019) traumatic brain injury resiliency model [21] also guided the focus and scope of the present investigation. These models pro-vided a framework for exploring the transactional nature of multi-modal resilience factors and processes believed to contribute to resilience over time. Resilience processes are depicted as the subjective experience of how individ-uals negotiate and “bounce back” from adversities within their specific context. Based on these process-oriented models [20, 21], the following core elements of resilience make up the focus of the current review: (1) adversity, (2) personal characteristics, (3) environmental resources, (4) self-regulatory strategies, and (5) resilience-related out-comes (see Table 1 for detailed descriptions).MethodsThe scoping review process followed an established six-stage method [42, 43]. Guidelines and criteria for con-ducting and reporting scoping reviews were applied [44] (see online supplementary file 1 for the PRISMA-ScR checklist), as well as recent recommendations for meta-narrative review [45] and engaging community advisory groups [46]. An iterative and team-based approach was used with frequent meetings among the multidisciplinary review team, incorporating multiple perspectives while refining the research design and results. A protocol was developed and registered in advance [41].Stage 1: identifying the research questionThe scoping review was guided by two research ques-tions: (1) How has resilience been conceptualized and operationalized (i.e., defined and measured) in the tran-sition-age youth mental health literature? (2) What fac-tors influence resilience among transition-age youth with SMI, and what outcomes have been studied within the context of transition-age youth’s mental health recov-ery? Questions were specifically developed to address the population, concept, and context of interest (PCC mne-monic) [47]. Each component was defined a priori in the Table 1 PCC criteria defining the scope of the current reviewPCC Element DefinitionPopulationAgeSMITransition-age youth who have experienced SMIMiddle adolescence (age 15) to the “upper limit” of young adulthood (age 36) [3, 37, 38]Mental illnesses that cause substantial functional impairment (e.g., major depressive disorders, bipolar disorders, personality disorders, anxiety disorders, eating disorders and schizophrenia spectrum disorders) [39, 40]ConceptResilienceCore elementsResilience, including five core elements [20, 21]“A dynamic process that unfolds over time, involving multiple resilience factors that interact to enable individuals to negotiate or recover from stressful life events / adversity” [41](1) Adversity: subjective experiences of stress, hardships, trauma, challenges, or other adverse circumstances. (2) Personal charac-teristics: internal protective / risk factors reflected as individual traits or qualities. (3) Environmental resources: external protective / risk factors reflected as social supports, services, resources, or social determinants of health. (4) Self-regulatory strategies / processes: the strategies and mechanisms through which young people self-manage their mood, emotions, thoughts, and/or behaviors. (5) Resilience-related outcomes: indices of positive development, adaptation, health, well-being etcContext Research conducted in any individual, community, or health-oriented setting that may reflect the context of transition-age youth’s personal mental health recoveryPage 4 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 protocol [41] and are shared in Table 1 to clearly define the scope of the review.Stage 2: identifying relevant literatureA multi-database search strategy was developed in con-sultation with a health sciences librarian at the University of Toronto (see online supplementary file 2). Six elec-tronic databases were searched to systematically iden-tify relevant empirical studies: MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, and Scopus. Specified search terms were explored using keywords and con-trolled vocabulary (subject / MeSH headings) and combined with appropriate Boolean logic. The search strategy was peer reviewed by two experienced mental health researchers external to the review team using the CADTH Peer Review Checklist for Search Strategies [48] before being conducted on December 6, 2021. Additional sources were identified by manually searching the refer-ence lists of relevant reviews and the included articles.Stage 3: study selectionSearch results were exported from each database to Endnote to remove duplicate files. All search results were then transferred to an online systematic review software (Covidence) for data management and screen-ing. Articles were screened in duplicate (AEN, MLdJ) using predetermined eligibility criteria defined for two stages of screening: i) title / abstract, and ii) full-text review. Specific inclusion and exclusion criteria were piloted at each screening stage using a subset of 10 ran-domly selected articles until 80% agreement was met. Disagreements were resolved by discussion or the deci-sion of a third reviewer. Challenges and uncertainties were also brought to the attention of the four content experts (CMS, SPB, NK, EJN). For inclusion in this scop-ing review, articles were required to meet the following criteria [41]: a) Population: Referred to transition-age youth diagnosed or living with SMI. b) Concept: Clearly defined or operationalized the concept of resilience from a process-oriented perspective. c) Type of source: Con-tained peer reviewed original research (quantitative, qualitative, mixed-method). d) Publication language / date: Written in English and published between 2000 and 2022. The publication date of included articles was limited to the year 2000 onwards (~ 22-year period) given two trends that emerged during this time: greater adoption of process-oriented perspectives of resilience within mental health research [7, 8], and increased focus on the developmental period of transition-age youth and the evaluation of mental health services for this popula-tion (e.g., early intervention programs) [1, 38].Stage 4: data extractionA standardized charting form was used to extract, organ-ize, and interpret data from the relevant articles. (1) Gen-eral document details and study characteristics included the APA citation, country, study context, and academic discipline. (2) Participant characteristics included age, SMI diagnosis, age at onset of SMI, stage of illness, demographic information, and sample size. (3) Informed by meta-narrative review [36], the following details were extracted to capture the interrelated dimensions that are shared within a research tradition (conceptual, theoreti-cal, methodological, instrumental): (a) study purpose and research questions / objectives, (b) theoretical frame-works / models applied, (c) conceptualizations and defi-nitions of resilience, (d) study design and methods (e.g., main methods used, intervention characteristics, inter-sectional approaches, type of youth engagement) [49], (e) resilience measures. (4) Informed by process-ori-ented models of resilience [20, 21], explanatory variables (e.g., predictors, mediators, moderators) and key con-structs (e.g., qualitative themes) that were emphasized and directly linked to resilience-related outcomes were extracted and sorted in accordance with the five core elements of resilience: (a) adversity, (b) personal charac-teristics, (c) environmental resources, (d) self-regulatory strategies, and (e) resilience-related outcomes. (5) Key messages and important results were also extracted to supplement the data above and support our interpreta-tion of the relevance of each paper for this review [36].One reviewer (AEN) completed extraction for all stud-ies. A second reviewer (MLdJ), who assisted in the ini-tial development of the charting form, verified a subset of articles (25%) to ensure consistency in data extraction. Challenges and uncertainties throughout this stage of the review were discussed with the rest of the review team (CMS, SPB, NK, EJN), who have research and clinical expertise in young adult mental health and resiliency.Stage 5: collating, summarizing, and reporting the resultsTo address the first research question, a meta-narrative approach was used to synthesize how resilience has been conceptualized and operationalized within the transi-tion-age youth mental health literature [36]. Findings were described by mapping conceptualizations of resil-ience over time and across different research traditions (or “paradigms”). The identification of research traditions involved grouping articles that reflected a similar con-ceptual focus (e.g., purpose, key variables), theoretical orientation (e.g., resilience frameworks, theorists, defini-tions), and methodological / instrumental approach (e.g., study design, measures), and by considering how resil-ience was portrayed as an overarching storyline or ‘lens’ Page 5 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 [36]. This information was coded using an inductive and iterative process until preliminary research traditions could be generated, each demonstrating a unique narra-tive. Research traditions were then further refined, with increased focus on analyzing temporal trends, re-visiting and cross-referencing information in the original articles, and continuously comparing each study and tradition [36, 45].To address the second research question, qualita-tive content analysis [50, 51] was used to identify types of resilience factors and outcomes that have been stud-ied among transition-age youth diagnosed with SMI. Descriptions of the explanatory / outcome variables and qualitative themes extracted in the charting form were inductively analyzed through a process of open-coding and then grouping variables into subcategories. The cod-ing and abstraction process was guided by two process-oriented models [20, 21], allowing for further grouping of subcategories that aligned with the five core elements of resilience (adversity, personal characteristics, environ-mental resources, self-regulatory strategies, resilience-related outcomes). This was an ongoing, interpretive process, whereby some of the variables extracted were re-categorized based on new interpretations, emerg-ing patterns, and the creation of higher order head-ings. Bronfenbrenner’s (1979) ecological systems theory informed the analysis and interpretation of internal and external protective factors identified [52]. Lastly, frequen-cies (%) and counts (n) were used to synthesize key study characteristics, and to supplement the narrative descrip-tions throughout. Meta-narrative and content analyses were conducted by one reviewer (AEN). Preliminary analyses to identify research traditions and categorize resilience factors and outcomes were reviewed by a sec-ond reviewer (MLdJ) who acted as a critical friend by dis-cussing, verifying and challenging interpretations from a critical perspective [53]. All members of the review team then refined the analyses and results through multiple discussions.Stage 6: community advisory group consultationGuided by recent recommendations [46], this scoping review engaged community advisory groups through-out the review process to enhance the relevance and applicability of the review findings. Following approval by the University of Toronto Health Sciences Research Ethics Board (REB #: 42495), transition-age youth with lived experience of SMI, clinicians, and mental health / resilience researchers were invited to participate in con-sultative meetings at two time points: topic consultation and input meetings (before completing study selection), and reaction meetings (after synthesizing included stud-ies). Participants provided informed consent before completing a brief demographic questionnaire and par-ticipating in a focus group.Topic consultation and input meetings focused on dis-cussing the scoping review protocol and participants were asked to share their perspectives of youth resilience, what they would most like to learn from the review, and feed-back on the review objectives and methods. During the reaction meetings, the results of the review were shared, and participants discussed their overall impression of the findings, recommendations for future research, and how this knowledge may be used or applied. Preferences for knowledge dissemination were collected at both time points. One focus group was conducted with transition-age youth at each time point (input meeting n = 6; reac-tion meeting n = 5), and one focus group was conducted with researchers and clinicians at each time point (input meeting n = 4; reaction meeting n = 7), resulting in a total of four consultative meetings (N = 20; one researcher and one transition-age youth participant attended both input and reaction meetings). Focus group discussions were 75–90 min in duration.Two members of the review team (AEN, MLdJ) co-facilitated the focus groups virtually using a videoconfer-encing platform (Zoom) and semi-structured interview guides. All focus groups were audio recorded, transcribed verbatim, and analyzed inductively using qualitative con-tent analysis [50, 51]. Analyses began with multiple read-ings of the transcripts to gain a holistic sense of the data and reviewing the field notes from each focus group discussion. Analyses were conducted using Nvivo soft-ware and followed a process of open-coding, the crea-tion of initial categories and higher order headings, and abstraction. Findings were reported to capture advisors’ perspectives and feedback with exemplary quotes. One reviewer (AEN) led the analyses, developed the prelimi-nary findings, and then sought feedback from a second reviewer, who reviewed and critiqued initial interpreta-tions in the role of a critical friend (MLdJ) [53]. Findings were then discussed in depth among the entire review team.Transparency and rigorSpecific methods were employed to enhance the trust-worthiness and rigor of the review process. Results were synthesized and reported in line with the PRISMA-ScR Checklist [44]. A detailed audit trail was used to track important decisions among the review team [54]. Ongo-ing reflexive practice was also used to acknowledge how our unique positions, backgrounds, and experiences may contribute to pre-existing assumptions about youth men-tal health and resilience, and thus impact methodological choices, analyses, and interpretations. Reflexivity encour-aged the review team to consider and confront potential Page 6 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 biases and power differentials during the research activi-ties [45, 53].ResultsThe initial search identified 6,872 unique articles fol-lowing the removal of duplicates. Following the 2-stage screening procedures, 397 full-texts were reviewed for eligibility. A total of 24 published articles met all inclu-sion criteria and were included in this review (see Fig. 1 for the PRISMA flow diagram).Study characteristicsThe 24 included studies were published between 2003 and 2021, and were from diverse geographic locations, including the U.S.A. (n = 7), Australia (n = 3), Brazil (n = 3), Canada (n = 2), Korea (n = 2), Italy (n = 1), The Netherlands (n = 1), New Zealand (n = 1), Norway (n = 1), South Africa (n = 1), Spain (n = 1), and Switzerland (n = 1). Based on the author affiliations and publication journal, the academic disciplines of the included articles were: psychiatry (n = 12), psychology (n = 7), nursing (n = 2), medicine (n = 2), and interdisciplinary (n = 1). Study and participant characteristics are summarized in Table 2.Included studies often involved transition-age youth with mixed or any SMI (41.6%), however many studies focused on specific diagnoses, including major depres-sive disorder (29.2%), schizophrenia spectrum disorders / psychosis (16.7%), personality disorders (8.3%), and eating disorders (4.2%). Due to the inclusion of studies using ret-rospective methods, research participants ranged in age from 13–37 years old. Mean age ranged from 14.9 years (middle adolescence) to 35.6 years (young adulthood). Ten studies reported the age at onset of SMI as occurring during adolescence, young adulthood, or both (onset was not clearly reported in 14 articles). Six studies focused on experiences of youth navigating a first episode [58, 61, 69, 72, 74, 76], four studies focused on chronic / recurring SMI [26, 62, 71, 75], and three studies described partici-pants as “recovered” or in recovery [56, 70, 73] (stage of Fig. 1 PRISMA flow diagram for scoping reviewsPage 7 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 Table 2 Details of included studies (N = 24) exploring resilience among transition-age youth with SMIAuthor Country Participant Characteristics: Diagnosis (Dx), Onset of SMI, Age (Range, Mean ± SD), Sex/Gender (%), Race/Ethnicity (%)Sample Size (N) Academic DisciplineSeok et al. (2012) [55] Korea Dx: Major Depressive Disorder (MDD). Onset: n/rAge: M = 31.9 ± 1.8 years. Sex/Gender: 73.1% Female. Race/Ethnicity: n/rN = 26 PsychiatryFischer et al. (2018) [56] U.S.A Dx: Major Depressive Disorder (MDD). Onset: n/rAge: M = 18.9 ± 2.5 years. Sex/Gender: 100% Female. Race/Ethnicity: 65% WhiteN = 20 PsychiatryKonradt et al. (2018) [57] Brazil Dx: Major Depressive Disorder (MDD). Onset: n/rAge: 18–29 years (M = 23.98 ± 3.38). Sex/Gender: 75.8% Women. Race/Ethnicity: n/rN = 61 PsychiatryDe Berardis et al. (2020) [58] Italy Dx: Major Depression. Onset: Young adulthoodAge: 18–37 years (M = 25.2 ± 3.8). Sex/Gender: n/r. Race/Ethnicity: n/rN = 103 PsychiatryVieira et al. (2020) [59] Brazil Dx: Major Depressive Disorder (MDD), Bipolar Disorder (BD). Onset: n/rAge: MDD: M = 26.02 ± 2.13 years; BD: M = 25.78 ± 2.11 yearsSex/Gender: 75.2% Female. Race/Ethnicity: 64.1% WhiteN = 407 PsychiatryPeters et al. (2021) [60] Brazil Dx: Major Depressive Disorder (MDD). Onset: n/rAge: 18–29 years. Sex/Gender: 78.3% female. Race/Ethnicity: n/rN = 106 PsychiatryFergusson et al. (2003) [61] New Zealand Dx: Major Depression. Onset: Young adulthoodAge: 14–21 years. Sex/Gender: 49.8% Female. Race/Ethnicity: n/rN = 403 PsychologyGralinski-Bakker et al. (2004) [26] U.S.A Dx: Any clinically diagnosed SMI, defined as serious psychiatric disorder requiring inpatient hospitalization for 2–12 months. Onset: Adolescence (M = 14.4 years)Age: T1: M = 25.8 years; T2: 26–35 years (30.35 ± 2.26)Sex/Gender: 53% Women. Race/Ethnicity: n/rN = 49 PsychologyHauser et al. (2007) [62] U.S.A Dx: Any clinically diagnosed SMI, defined as serious psychiatric disorder requiring inpatient hospitalization for 2–12 months. Onset: Adolescence (13–16 years old)Age: T1: 14–17 years; T2: young adulthood (18 +).aSex/Gender: 44% Female. Race/Ethnicity: Predomi-nantly CaucasianN = 67 PsychologyTan et al. (2015) [63] Australia Dx: Any axis 1 mental health disorder. Mixed mental disorders and clinically relevant decline in functioning. Onset: AdolescenceAge: 13–18 years (15.40 ± 1.55). Sex/Gender: 75% Female. Race/Ethnicity: n/rN = 80 PsychiatryMarvin et al. (2017) [64] U.S.A Dx: Any clinically diagnosed SMI requiring residential treatment. 31% also had a learning disability. Onset: n/rAge: M = 14.85 ± 1.78 years. Sex/Gender: 100% Girls. Race/Ethnicity: 58% CaucasianN = 36 PsychologyHauber et al. (2019) [65] The Netherlands Dx: Personality Disorders. > 50% with co-occurring axis 1 disorder(s). Onset: n/rAge: 16–23 years (M = 18.9 ± 1.7). Sex/Gender: 88.6% Female. Race/Ethnicity: n/rN = 70 PsychiatryHadebe et al. (2020) [66] South Africa Dx: Any SMI (schizophrenia, depression, bipolar disor-der, anxiety).bOnset: n/rAge: 19–34 years. Sex/Gender: 30% Female. Race/Ethnicity: n/rYoung adults living in a low-resource areaN = 10 NursingGårdvik et al. (2021) [67] Norway Dx: Primary diagnosis of mood disorder or anxiety disor-der. Former outpatients with high degree of comorbid-ity and complex symptom patterns. Onset: n/rAge: T1: 13–18 years (M = 15.7 ± 1.7); T2: 16–21 years (M = 18.5 ± 1.6)Sex/Gender: 56.8% Girls. Race/Ethnicity: n/rN = 254 MedicinePage 8 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 Studies are listed in accordance with the research traditions identified in Table 3 (rather than alphabetically / chronologically). n/r, not reporteda Broader age range considered acceptable for inclusion in this review based on retrospective study design [62, 70] and relevance to the study of transition-age youth and early intervention [76]b Included one participant with primary diagnosis of epilepsy [66]c Multiple academic disciplines identified (rehabilitation, social work, psychiatry, occupational therapy, education). T1 and T2: used to indicate measures at multiple time points (e.g., baseline and follow up)Table 2 (continued)Author Country Participant Characteristics: Diagnosis (Dx), Onset of SMI, Age (Range, Mean ± SD), Sex/Gender (%), Race/Ethnicity (%)Sample Size (N) Academic DisciplineZimmermann et al. (2021) [68] Switzerland Dx: Borderline Personality Disorder (BPD). Onset: n/rAge: M = 16.6 ± 1.5 years. Sex/Gender: 100% Female. Race/Ethnicity: n/rN = 15 PsychologyHenderson et al. (2015) [69] Australia Dx: First Episode of Psychosis (FEP). Onset: Within the past 36 monthsAge: 19–28 years. Sex/Gender: 70% Male. Race/Eth‑nicity: n/rN = 10 PsychiatryLas Hayas et al. (2016) [70] Spain Dx: Eating Disorder (e.g., anorexia nervosa (AN), bulimia nervosa (BN), both AN & BN, eating disor-ders not otherwise specified). Onset: Adolescence (M = 16.6 ± 3.7 years)Age: M = 35.6 ± 6.7 years.aSex/Gender: 100% Women. Race/Ethnicity: n/rN = 20 PsychologyGrob et al. (2020) [71] U.S.A Dx: Depression. 47% had co-occurring mental health conditions. Onset: Adolescence (< 15 years) to emerg-ing adulthood (≥ 15 years)Age: 18–29 years. Sex / Gender: 50% Female. Race / Ethnicity: 63.9% WhiteParticipants recruited for maximum diversity (e.g., social identities, geographic locations)N = 38 MedicineLuther et al. (2020) [72] U.S.A Dx: Schizophrenia or Bipolar Disorder with Current PsychosisEarly psychosis group: individuals < 36 years old. Onset: M = 19.90 ± 4.49 yearsAge: M = 25.47 ± 4.47 years. Sex/Gender: 63% Male. Race/Ethnicity: 53% African AmericanN = 30 PsychiatryDelman et al. (2017) [73] U.S.A Dx: n/r. Onset: n/r. Young adults in recovery from “seri-ous mental health conditions”Age: 21–26 years (M = 24). Sex/Gender: 57% Female. Race/Ethnicity: 100% WhiteN = 7 PsychiatryLal et al. (2017) [74] Canada Dx: Schizophrenia Spectrum and Affective Psychoses. Onset: Within the past 3 yearsAge: 18–24 years (M = 22)Sex/Gender: 71% Male. Race/Ethnicity: 41% First Nations, Asian, and Latin AmericanParticipants from diverse sociocultural and economic backgroundsN = 17 InterdisciplinarycRayner et al. (2018) [75] Australia Dx: Any SMI, defined as a lifelong psychiatric condition that substantially disrupts daily functioning. All partici-pants reported one or more co-occurring disorders (e.g., anxiety, depression, schizophrenia, bipolar, borderline personality disorder). Onset: n/rAge: 18–23 years (M = 20). Sex/Gender: 66.7% Female. Race/Ethnicity: n/rN = 15 PsychologyShalanski et al. (2019) [14] Canada Dx: Any SMI (e.g., PTSD, depression, and addiction). History of complex mental health problems and trauma. Onset: n/rAge: 15–16 years. Sex/Gender: 100% girls. Race/Eth‑nicity: n/rN = 5 NursingKim et al. (2020) [76] Korea Dx: Psychosis and Schizophrenia Spectrum Disorders. Onset: n/rAge: Acute stage: M = 28.7 ± 8.7 years; Stabilization phase: M = 26.6 ± 7.0 years.bSex / Gender: 45% Women. Race / Ethnicity: n/rN = 340 PsychiatryPage 9 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 illness was not clearly identified in 11 sources). Based on the 23 studies that reported sex and/or gender, nearly half involved participants identifying as predominantly female (29.2%), or girls / women (16.6%). Race and/or ethnicity was not reported in sixteen articles. Based on the avail-able evidence, most samples were predominantly White/Caucasian; however, 20.8% of the studies involved more diverse samples with greater representation of youth from racialized or minority groups.RQ1: HOW has resilience been conceptualized and operationalized?Meta-narrative review was used to map how the concept of resilience has been conceptualized and operational-ized among transition-age youth with SMI. Four research traditions were identified, each contributing a unique storyline or ‘lens’ to the study of resilience: Stress Adap-tation (n = 6), Person-Environment Interactions (n = 9), Recovery-Focused (n = 4), and Critical and Cultural Per-spectives (n = 5). Key features of the articles included within each research tradition are presented in Table 3.In terms of study designs, fourteen studies (58.3%) were quantitative, nine studies (37.5%) were qualitative, and only one study (4.2%) used a mixed-method design. Two studies used specific recruitment strategies to improve diversity and inclusion among participants, five studies reported sex- and gender-based analyses, and two studies engaged transition-age youth with SMI in the research process. Resilience was operationalized and evaluated as one or more of the following: a set of resilience factors (e.g., risk / vulnerability and protective factors) (58.3%), a mechanism (e.g., mediator or moderator between risks and adaptive outcomes) (8.3%), an outcome (20.8%), or a process that unfolds over time (41.7%).Analyses did not elucidate a clear temporal trend based on the publication dates of the articles in each research tradition. However, results indicated that the study of resilience has evolved over time based on: (1) shifts in the main theorists and publication dates of conceptual papers cited (from interactive and developmental per-spectives first proposed in the 1990’s, to multidimen-sional and multi-system perspectives in the early 2000’s, to the most recent social-ecological frameworks that emerged from 2009/2011 onwards); (2) differences in the conceptual focus (from primarily individual-level factors, to the immediate environment and macro-level environ-ment); and (3) changes to the dominant methodological approaches (from variable-centred to person-centred approaches). The research traditions are ordered and described to illustrate these trends, including the theo-retical orientations, conceptual focus, and methodologi-cal/instrumental approaches. A visual summary is also shown in Fig. 2.Stress adaptation (2012 – 2020)The Stress Adaptation research tradition included six studies [55–60]. Rutter’s (2012) interactive model [81] and Masten et al.’s (1990) developmental perspective [82] of resilience, as well as integrative models of stress and coping [77–80], were used to emphasize the role of biological, psychological, social, and environmental pro-cesses that influence resilience throughout youth devel-opment. By integrating resilience theory with stress and coping models, resilience was framed as a process of positive adaptation following stressful or adverse life experiences, and as a protective factor contributing to stress and coping responses. In this tradition, resil-ience was conceptualized as transition-age youth’s posi-tive adaptation or resistance to stress, which enabled them to maintain their mental health despite exposure to risk. Accordingly, definitions of resilience referred to young people’s ability to adapt, cope and bounce back in response to stress or adversity.Studies within the Stress Adaptation tradition explored the protective role of resilience factors in the relation-ship between stressful life experiences and the develop-ment or severity of mental illness. Articles also focused on identifying psychological, genetic, and neural markers that may confer resiliency or vulnerability to mental ill-ness. The main outcome of interest was characterized as doing psychologically well (e.g., the absence or reduction of psychopathological symptoms). All six studies within this tradition employed quantitative study designs (e.g., cross-sectional, randomized clinical trial, longitudinal). Resilience was operationalized and evaluated as a set of resilience factors, as a mechanism, and as an outcome. Five studies used validated self-report measures of resil-ience that included items / subscales to capture personal characteristics reflective of youth’s resilience (e.g., self-efficacy, optimism) [83, 84].Person‑environment interactions (2003 – 2021)Nine studies make up the Person-Environment Interac-tions research tradition [26, 61–68], which placed more emphasis on how processes of resilience evolve over time and are facilitated through supportive environ-ments. These studies incorporated a wide range of psy-chosocial theories [85–89] to guide investigations among transition-age youth with SMI. In addition to the inter-active [81, 90, 91] and developmental perspectives [82, 92, 93] of resilience found in the Stress Adaptation tradi-tion, the study of resilience was framed through Luthar et al.’s (2000) multidimensional perspective [22], which emphasizes the contribution of both internal and exter-nal factors in shaping youth’s response to hardships and individual processes of resilience. Through these guid-ing frameworks, resilience was conceptualized as a set of Page 10 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 Table 3 Overview of each research tradition, detailing key shifts in the theoretical orientations, conceptual focus, and methodological approaches applied to the study of resilience among transition-age youth with SMIResearch TraditionsTheoretical OrientationConceptual FocusMethodological / Instrumental ApproachOverview & ApproachAuthorDefinitionPurposeStudy DesignOperationalization & MeasuresStress Adaptation(n = 6)Guiding Frameworks:Integrative frameworks of stress [77–80]Main resilience theorists:Rutter (interactive) [81], Masten (developmental) [82]Conceptualized resilience as:A process of positive adaptation determined through integrated biological, psychological, social, and environmental factorsFocus: Emphasized personal protective factors that promote adaptationApproach:Variable-centredSeok et al. (2012) [55]The personal characteristics that enable one to adapt to environmental challenges and to overcome adversities or stressorsTo investigate the relationships between early life stress and resil-ience factors with depressive symptom severityQuantitativeCross-sectional studyPersonal resilience factorsCD-RISC [83]5 Subscales: self-efficacy, self-confidence, optimism, self-control, spirituality / autonomyFischer et al. (2018) [56]The process of adapting well in the face of significant sources of stress and bouncing back from difficult life experiencesTo investigate neural markers of resilience to depression, and the modulatory role of posi-tive / negative life eventsQuantitativeLongitudinal studyPersonal (neurobiological) resil‑ience factorsKonradt et al. (2018) [57]The ability to adapt successfully in the face of stress and adversity, maintaining normal psychologi-cal and physical functioningTo assess the effects of resil-ience on severity of depressive and anxious symptoms after psy-chotherapyQuantitativeClinical follow-up study nested in a randomized clinical trialA mechanism and an outcomeRS [84]Global ScoreDe Berardis et al. (2020) [58]The adaptive ability to cope with adversity or traumaTo examine the relationships between alexithymia, somatic sensations, resilience, and sui-cidal ideationQuantitativeCross-sectional studyPersonal resilience factorsCD-RISC [83]Global ScoreVieira et al. (2020) [59]The ability to maintain relatively healthy and stable levels of physi-cal and psychological function-ing in the wake of traumatic experiencesTo examine the mediating effect of resilience on the relationship between childhood trauma and mood disorder / depressive symptom severityQuantitative Cross-sectional studyA mechanismRS [84]Global ScorePeters et al. (2021) [60]A person’s ability to adapt suc-cessfully to acute stress, trauma, or chronic forms of adversityTo explore clinical and biological correlates of resilience, and dif-ferences in therapeutic effects based on genetic markersQuantitative Randomized clinical triala SGBAPersonal (genetic) resilience fac‑tors, and an outcomeRS [84]Global ScorePage 11 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 Table 3 (continued)Research TraditionsTheoretical OrientationConceptual FocusMethodological / Instrumental ApproachOverview & ApproachAuthorDefinitionPurposeStudy DesignOperationalization & MeasuresPerson‑Environment Interac‑tions (n = 9)Guiding Frameworks:Psychosocial theories (narrative medicine [85], social-emotional learning framework [86], tripartite model of depression and anxi-ety [87], Yalom’s 12 therapeutic factors [88], neurodevelopmental model of resilience [89])Main resilience theorists:Rutter (interactive) [81, 90, 91], Masten (developmental) [82, 92, 93], Luthar (multidimensional) [22]Conceptualized resilience as:A complex and transactional pro-cess dependent on both personal and environmental factorsFocus: Increased emphasis on external protective factors and transactional processes between each person and their immediate environmentApproach:Variable-centredPerson-centredLife-courseFergusson et al. (2003) [61]A set of protective factors that may mitigate risk of devel-oping suicidal behaviorsTo explore factors that may contribute to vulnerability or resiliency to suicidal behaviors among young peopleQuantitativeLongitudinal cohort studya SGBAPersonal / environmental (individ-ual, familial, school, peer-related) resilience factorsGralinski-Bakker et al. (2004) [26]Successful adaptation among individuals who faced challenging or threatening circumstancesTo examine early adult indicators of psychosocial adjustment as predictors of adult mark-ers of resilience (functioning and well-being) over timeQuantitativeLongitudinal studya SGBAA process over time, and personal / environmental resilience factorsHauser et al. (2007) [62]Unexpected adaptation in the face of serious adversityTo understand how resil-ient development unfolds among young people who have experienced SMI, and how pro-tective processes change over the life-courseQualitative Narrative follow-back studyA process over time, and “resilient functioning” as an outcomeTan et al. (2015) [63]The capacity of an individual to mobilise health-sustaining resources from a myriad sources – family, community and cultureTo examine the efficacy of a mindfulness-based group intervention for adolescents with mixed mental health disordersQuantitative Randomized con-trolled trialAn outcomeRSCA [94]Global ScoreMarvin et al. (2017) [64]A set of skills (e.g., social and emotional competen-cies) that can be taught and/or strengthenedTo evaluate the Strong Teens social-emotional learning cur-riculum among adolescent girls in a residential treatment centerQuantitativeNon-equivalent quasi-experi-mental wait-list controlAn outcomeSEARS [95]Global ScoreHauber et al. (2019) [65]The belief that one can cope with stressful life eventsTo identify therapeutic factors in adolescents’ written narratives, and relate these to changes in symptoms after treatmentMixed-methods studyA process over time, and personal / environmental (therapeutic) resilience factorsHadebe et al. (2020) [66]The ability of an individual to function completely in the face of adversity or stressTo explore young adults’ resilience and social support networksQualitativeExploratory studyEnvironmental (social support) resilience factorsGårdvik et al. (2021) [67]Positive adaptation to risk expo-sure, and a more positive psycho-logical outcome than would be expected in case of high levels of environmental adversitiesTo examine whether resilience factors and treatment proce-dures among adolescents first presenting at mental health clinics were related to psychiatric symptom load three years laterQuantitativeProspective longitudinal cohort studya SGBAPersonal / environmental resil‑ience factorsREAD [96]Global Scale & 5 Subscales: personal competence, social com-petence, structured style, family cohesion, social resourcesZimmermann et al. (2021) [68]A positive outcome despite adversityTo investigate movement syn-chrony in relation to therapeutic outcomes during psychotherapy treatmentQuantitativeObservational studyPersonal / environmental (move-ment synchrony) resilience factorsPage 12 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 Table 3 (continued)Research TraditionsTheoretical OrientationConceptual FocusMethodological / Instrumental ApproachOverview & ApproachAuthorDefinitionPurposeStudy DesignOperationalization & MeasuresRecovery‑Focused(n = 4)Guiding Frameworks:Recovery models of mental health [97–99], transdiagnostic treatment model [100]Main resilience theorists:Aranda (interpretivist) [101],Luthar (multidimensional) [22, 102], Bottrell (social theory) [103], Richardson (metatheory) [104], Bonanno (recovery vs. resilience distinction) [105, 106]Masten (developmental / multi-systems) [92, 93]Conceptualized resilience as:A dynamic and multidimensional process which promotes func-tioning and recoveryFocus: Adaptive strengths and processes in the context of youth’s recoveryApproach:Person-centredHenderson et al. (2015) [69]A dynamic process wherein individuals display positive adaptation despite experiences of significant adversity or traumaTo explore young people’s expe-rience of a first episode of psy-chosis over time and to develop a substantive theory of their responses and behaviorsQualitativeGrounded theory studyA process over timeLas Hayas et al. (2016) [70]A dynamic process in which psy-chological, social, environmental, and biological factors interact to enable an individual at any stage of life to develop, maintain, or regain his/her mental health despite exposure to adversity [107]To explore the role of resilience in recovery from eating disorders (EDs), and to develop a model of resilience in women with EDsQualitativeGrounded theory studyA process over time, and personal / environmental resilience factorsGrob et al. (2020) [71]A set of complex, subjective pro-cesses through which individuals negotiate their complicated journey toward clarified identity and life purposeTo explore how participants’ depression impacted their transi-tion from adolescence to emerg-ing adulthood, and built their capacity to form a coherent iden-tity and find a purpose in lifeQualitativeGrounded theory studyb EDIc Youth engagement (consulta-tion)A process over timeLuther et al. (2020) [72]The capacity of a dynamic system to withstand or recover from significant challenges that threaten its stability, viability, or developmentTo examine whether resil-ience differs among those with early vs. prolonged psychosis, and the associa-tions between resilience scores and specific symptom domainsQuantitativeCross-sectional studyPersonal resilience factorsRS [84]Global Score & 2 Subscales: personal competence, acceptance of self and lifePage 13 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 Table 3 (continued)Research TraditionsTheoretical OrientationConceptual FocusMethodological / Instrumental ApproachOverview & ApproachAuthorDefinitionPurposeStudy DesignOperationalization & MeasuresCritical and Cultural Perspec‑tives (n = 5)Guiding Frameworks:Social-ecological frameworks (capital theory [108], ecological systems theory [52]) and recovery models of mental health [109, 110]Main resilience theorists:Bottrell (social theory) [103], Ungar (social-ecological) [23], Luthar (multidimensional) [22], Masten (developmental) [92], Richardson (metatheory) [104]Rutter (interactive) [91]Conceptualized resilience as:A process that unfolds over time, dependent on one’s culture and the supportive capacity of the environmentFocus: Increased emphasis on service-related factors, systemic barriers, macro-level environment, and cultureApproach:Person-centredDelman et al. (2017) [73]The employee’s ability to rebound and manage their health in the face of challenges and adversity that affect their workTo examine facilitators of young adult peer provider success in community mental health treatment settingsQualitativeExploratory studyc Youth engagement (partner-ship)A process over time, personal / environmental resilience factorsLal et al. (2017) [74]A process of an individual’s efforts to navigate and negotiate towards resources considered meaningful for well-being in the presence of adver-sity, and the environment’s concurrent capacity to support individual effortsTo understand how mental health and related services support and hinder resilience in young people diagnosed with first episode psychosisQualitativeGrounded theory and narrative inquiryb EDIA process over timeRayner et al. (2018) [75]A unique youth recovery process that enabled young people to take on the various challenges in life despite systemic (i.e., lack of employment opportunities or social exclusion) and mental health adversityTo develop a thematic model of youth recovery utilising the experiences of young people with severe mental illnessQualitativeNarrative studyA process over timeShalanski et al. (2019) [14]A dynamic process in which positive adaptation is achieved despite significant adversityTo explore resilience from the perspective of teenage girls recovering from mental illness, and to provide an alterna-tive view de- pathologizing psychiatric diagnosesQualitativeInterpretive phenomenological studyA process over timeKim et al. (2020) [76]The dynamic process of adapta-tion to challenging life condi-tions that could be protective against mental problemsTo investigate the clinical charac-teristics and psychosocial factors associated with depression in patients with early psychosis according to stage of illnessQuantitativeCross-sectional studya SGBAPersonal resilience factorsBRS [111]Global ScoreCD-RISC Connor-Davidson Resilience Scale [83], RS The Resilience Scale [84], RSCA Resiliency Scales for Children and Adolescents [94], SEARS The Social Emotional Assets and Resilience Scale [95], READ Resilience Scale for Adolescents [96], BRS Brief Resilience Scale [111]a SGBA, sex- and gender-based analysesb EDI, used recruitment strategies to maximize diversity and inclusion among participantsc Engaged youth as research advisors or partnersPage 14 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 transactional processes (between youth and their envi-ronment), triggered in response to experiences of adver-sity. Successful adaptation was still a defining component of resilience, however, environmental factors and person-environment interactions were increasingly recognized.In this tradition, investigations were centered on understanding reciprocal relationships between the per-son and the environment, as well as the protective effects of resilience for youth mental health. As such, a broader range of key concepts and outcomes were explored related to the individual (e.g., psychosocial adjustment, symptoms, role functioning) and the immediate environ-ment (e.g., social support networks, relational / therapeu-tic processes). The use of longitudinal, mixed-method, intervention, and narrative study designs supported the exploration of resilience over the life-course and/or mul-tiple time points. Resilience was operationalized and evaluated as a set of resilience factors, an outcome, and a process. Three studies directly measured resilience using validated scales [94, 95], one of which was designed to evaluate multidimensional components (both personal and environmental) [96].Recovery‑focused (2015 – 2020)The Recovery-Focused research tradition comprised four studies [69–72], which shared many features and theo-retical underpinnings with the first two traditions. How-ever, this research tradition explicitly situated the study of resilience within the context of transition-age youth’s mental health recovery. Recovery models [97–99] and transdiagnostic frameworks [100] of mental health were combined with interpretivist [101], multidimensional [22], and social theories [103] of resilience. As such, there was a shift in conceptual papers and theorists that informed the Recovery-Focused tradition, includ-ing Luthar et al.’s (2000) and Masten et al.’s (2011) more recent work (e.g., multi-systems perspective) [22, 93, 102], as well as Bonanno [105, 106], Richardson [104], and Bottrell [103]. These frameworks and theorists posi-tion resilience as a complex, multidimensional, and sub-jective process, involving youth’s adaptation and growth following significant adversity. Resilience was conceptu-alized as both a protective factor and dynamic process that enables youth to develop or regain their mental health, and is thus a critical component of the recovery journey.Studies within the Recovery-Focused tradition had a unique focus on how resilience unfolds in conjunc-tion with, and in comparison to, processes of recovery. Additionally, researchers aimed to clearly distinguish the concept of resilience from the concept of recovery. From a recovery-oriented lens, studies of resilience included a wider range of key concepts and adaptive outcomes, including experiences of meaning making, re-constructing identity, life purpose, and acceptance. There was also greater recognition of the self-regulatory strategies that young people adopted to bolster their resilience and recovery (e.g., coping skills, help-seek-ing). Three studies used qualitative grounded theory designs to explore interactions among protective factors and adaptive outcomes, which operationalized resil-ience as a process. In the one quantitative study, per-sonal resilience factors were evaluated using a validated resilience scale [84].Fig. 2 Research traditions. Note: Visual representation of the four research traditions, illustrating main theoretical, conceptual, and methodological trends. A Bubble chart. Larger bubbles indicate a greater proportion (%) of resilience factors identified across micro-, meso-, and macrosystems (y-axis) within the respective research tradition (x-axis). B Diagram. The solid line (left) represents changes in the theoretical and conceptual focus and the dashed line (diagonal) represents shifts in the predominant methodological approaches employedPage 15 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 Critical and cultural perspectives (2017 – 2020)Five studies were included in the final research tradi-tion, Critical and Cultural Perspectives [14, 73–76]. This research tradition emphasized the role of broader societal systems and contexts in shaping resilience and/or critically analyzed the implications of resilience research among transition-age youth with SMI. Similar to the Person-Environment Interactions and Recovery-Focused research traditions, recovery models of mental health [109, 110] were integrated with multidimensional, interactive, and developmental perspectives of resilience [22, 91, 92, 104]. However, Ungar’s (2011) social-eco-logical resilience framework [23] and Bottrell’s (2009) social resilience theory [103] were at the forefront of this research, which have recently brought greater atten-tion to the cultural context of resilience. Guided by these social-ecological frameworks, resilience was concep-tualized as a process that changes over time, facilitates youth’s positive adaptation and recovery, and is depend-ent on the supportive capacity of one’s environment.The studies within this research tradition focused on macro-level ecological systems that drive resilience pro-cesses, particularly one’s social, cultural, and institu-tional environment and the quality of resources / services within these contexts. This extended the conceptual focus beyond factors within the individual, family, or immedi-ate environment, and highlighted a wider range of social determinants of health (e.g., stigma, housing, work condi-tions). Additionally, resilience was studied through a more critical perspective, whereby studies recognized systemic facilitators / barriers to building resilience among transi-tion-age youth living with SMI, and offered a critique and new insights with implications for mental health poli-cies and services (e.g., patient-centred, trauma-informed, gender-responsive, culture-specific services). Four stud-ies within the Critical and Cultural Perspectives tradi-tion used qualitative methods, which operationalized and evaluated resilience as a process. One study employed a quantitative design, evaluating resilience factors using a validated self-report measure [111].RQ 2: What factors influence resilience among transition‑age youth with SMI, and what outcomes have been studied?Five core elements of resilience were explored across the 24 included articles. Results are summarized in Table 4. Four types of adversity were characterized as significant sources of challenge or hardship specific to youth with SMI. Analyses revealed that a large breadth of influen-tial resilience factors (personal characteristics, environ-mental resources, self-regulatory strategies) have been studied. Most research attention has been placed on transition-age youth’s personal characteristics, with a total of 31 unique internal protective / risk factors identi-fied. In contrast, 12 external protective / risk factors were identified as part of youth’s environmental resources, with most belonging within the immediate environment (e.g., family, peers, community) rather than the macro-level environment (e.g., broader societal, cultural, insti-tutional systems) [52]. Ten self-regulatory strategies were identified, explaining the mechanisms and processes that transition-age youth adopted to manage their men-tal health and build resilience. Twelve resilience-related outcomes were measured or described, spanning indices of mental illness and functioning, to how youth adapted, overcame challenges, and found purpose in life.Consultation with community advisory groupsFour virtual focus groups were conducted to gain the perspectives and feedback of potential knowledge users. Table 5 provides a summary of findings from the consul-tative meetings with illustrative quotes. Ten transition-age youth aged 20–28 years old who were diagnosed, treated, or living with SMI participated in the topic consultation and reaction meetings (Mage = 23.9; 40% White; 70% Women). Most reported a history of multiple co-occurring mental health conditions (50%; e.g., anxi-ety, mood, personality disorders, PTSD, or schizophre-nia spectrum disorders), anxiety (10%), mood disorder (20%), or comorbid anxiety and mood disorders (20%). Ten clinicians involved in the delivery of health services for youth with SMI and researchers in mental health also participated in separate discussions (Mage = 32.6 years; 50% White; 80% Women). Clinicians and researchers were from a variety disciplines, primarily occupational therapy (70%), psychology / psychiatry (20%) and rehabil-itation sciences (10%), and had diverse experiences work-ing in hospital (50%), community (20%), private practice (20%), and university / academic settings (20%). Most participants joined online from the province of Ontario (n = 15), as well as Alberta (n = 2), Manitoba (n = 1), New Brunswick (n = 1), and Quebec (n = 1).Perceptions of resilienceResilience was described by participants as multidimen-sional, involving both personal strengths and support-ive environments that enable people to bounce back after adversities. Particularly, resilience was viewed as both a trait (e.g., internal strength or characteristic) and a process, in that it changes throughout the life-course in response to personal circumstances. Relatedly, par-ticipants highlighted that resilience is difficult to define in real-world contexts, as experiences and meanings of resilience for youth are highly personal. In this way, participants underscored the plurality and subjectivity Page 16 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 Table 4 Five core elements of resilience studied among transition-age youth with SMISMI Serious mental illness, HRQOL Health-related quality of life, BMI Body mass index, SES Socio-economic statusMain Category SubcategoriesAdversityOnset / experience of SMI [14, 26, 62, 64–67, 69–71, 73–75]Trauma / abuse [14, 26, 55, 59, 61, 62, 76]Difficulty navigating life transitions [62, 69–71]Disconnection from friends, family, or community [26, 62, 64]Personal Characteristics (internal protective / risk factors) Psychosocial Global (trait) resilience [57–59, 65, 67, 70, 72, 73, 75, 76],Functional competence / psychosocial adjustment [26, 62, 65, 67, 72, 75, 76],Perseverance and desire for change [14, 62, 69, 70, 73],Meaning making [62, 71, 74], Attachment style [26, 61, 62]Personality characteristics [26, 61], Turning points [65, 70], Trust [14, 65] Self & Identity (Cognitive) Self-beliefs / self-perceptions [14, 55, 62, 71, 73, 75],Self-esteem / self-worth [14, 26, 61, 62, 65, 71],Self-awareness / self-knowledge [14, 62, 65, 70, 71, 75],Sex / gender identity [26, 60, 61, 67, 76], Age [60, 76], Identity formation [71, 75] Affective Acceptance [69–72, 75], Hope / optimism [14, 55, 65, 70, 75],Emotional expression [62, 65, 70], Spirituality / autonomy [55, 75] Behavioral Responsibility / accountability [14, 65, 70, 75], Substance use [26, 62, 75, 76], Criminality [26, 62], Structured style [67] Clinical Mental health disorder / symptoms [26, 56, 58, 62, 67, 71, 76], Stage of illness [72, 76], Duration of untreated mental illness [76] Physical health Psychosomatic symptoms [58], Sexual health [76], HRQOL [76], BMI [76] Biological Neural factors [56], Genetic factors [60]Environmental Resources (external protective / risk factors) Immediate Environment Social support networks and connectedness, including:Family support / environment [14, 26, 61, 62, 66, 67, 69–71, 73, 75, 76],Peer / interpersonal relationships [14, 26, 61, 62, 65, 66, 69, 73, 75],Professional support [69, 70, 73, 74], Community resources [14, 67]Childhood development and life experiences [14, 56, 61, 75],Informational support [65, 70, 73, 74],Family history of mental illness / suicidal behaviors [14, 56, 61],Relational processes [65, 68] Macro-Level Education / employment [26, 61, 73, 75, 76],Stigma / social expectations [14, 71, 73, 75], Family SES / income [61, 75, 76],Accessibility and nature of health services [74, 75], Isolation / alienation [14, 66],Housing [74, 75], Working conditions [73]Self‑Regulatory Strategies (to self‑manage mood, emotions, thoughts, behaviors)Engagement in services / treatment [57, 60, 63–65, 67–69, 74, 75],Agency & working towards goals [14, 62, 69–71, 75],Coping skills & efforts to increase well-being [14, 69–71],Social / occupational (re)engagement [70, 71, 75], Medication [67, 69, 75],Help-seeking [14, 62, 69], Helping others [65, 71, 73], Communication style [73],Mindfulness [63], Living in the here and now [70]Resilience‑Related OutcomesSymptoms of mental illness [55, 57, 59, 60, 63–65, 67, 68, 70, 72]Functioning in valued activities / roles [14, 26, 62, 66, 68, 69, 72, 73]Mental health / well-being [26, 63, 64, 70, 74]Positive adaptation / development [14, 62, 66, 69, 70]Overcoming challenges [14, 62, 66, 69]Global (trait) resilience [57, 60, 63, 64]Presence / absence of mental disorder [55, 56, 59, 76]Personal recovery processes [14, 70, 75]Finding and pursuing purpose in life [69–71]Suicidal ideation / behaviors [58, 61]Therapeutic process [64, 68]Re-constructing identity [71]Page 17 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 Table 5 Main categories and subcategories reflecting community advisors’ perspectives and feedback during the review processSubcategories Exemplary Quotes (pseudonyms)Topic consultation: Perceptions of resilience 1. Resilience is a multidimensional construct, without a single “universal” definition Involves personal strengths and supportive environments “In terms of resilience in this context, I think of it as like an individual’s ability to kind of bounce back from something that um has impacted their mental health in a negative way…the individual’s ability to learn from it and then, kind of, become stronger.” – Marlot (youth)“I just feel like resilience is something that is always going to be chang-ing. Like it’s going to be affected by the clients’ experiences, their cultural backgrounds, their support, their families.” – Eva (clinician) Difficult to define in real-world contexts “It’s not something that, yeah, like I hear the youth really talk about explic-itly… so that might be another part of it… when you’re going through the weeds, it can be difficult to kind of name.” – Derrick (clinician) 2. How resilience is framed matters Buzzword—personal responsibility vs. external systems “Where um people are constantly in a situation where they need to be ‘resil-ient’… how is our use of resiliency impacting how we frame these people in different situations?” – Jasmine (youth)“It feels a little bit like a backhanded compliment, like ‘oh, but you’re so resil-ient,’ when it is more like, more about larger socioeconomic um systems at play.” – Isabelle (clinician)Topic consultation: Main interests and what community advisors most wanted to learn from the review 1. Environmental factors and strategies that influence resilience Role of social determinants of health “Special consideration should be taken to account about, like race, ethnic-ity and socioeconomic status, and like other demographics…. that really impacts, I think, resilience… there’s multiplied effects of being in multiple minority groups.” – Helen (youth)“Highlighting the importance of cultural groups… any of the social deter-minants of health.” – Isabelle (clinician) How to improve resilience “It’s kind of about establishing a toolkit. Like what practices are key to resilience? What kind of coping strategies maybe help with resilience and which of them are crucial?” – Zoe (youth)“What about the people that continue to struggle?… what can we learn from this that would help prevent that?” – Derrick (clinician) 2. How resilience is conceptualized Definitions “The narrative around resilience… also what you’re trying to be resilient from, what you’re going through. And I wonder if there is a definition or cat-egories of how that will be defined or framed?” – Jasmine (youth)“I’m curious about how, like, the concept of resiliency has changed in the literature.” – Isabelle (clinician) Measures and outcomes “If we learn more about how resilience is defined, or maybe learn about more outcome measures, maybe that will help us, like, clients achieve their goals. Maybe it can help us change our practice.” – Eva (clini-cian)Reaction meeting: Overall impression of the review findings 1. Research traditions and resilience factors that resonated the most with advisors’ personal experiences Person-environment interactions and sociocultural determinants “I think for me the social determinants of health, they’re such a big factor in everything in your life, but especially you know mental health services… factoring in home situations and homelessness.” – Tina (youth)“It [culture] is going to impact seeking help, accessing resources, knowl-edge about resources… the impact that it would have with your family so, I think that’s a huge consideration.” – Phoebe (clinician) Youth recovery and self-regulatory strategies “I thought the recovery focused tradition resonated the most with me… the kind of things that I consume that makes the most difference to my mental health is actually hearing about… how they were able to overcome or get over their mental health issues.” – Yvonne (youth)“Whether the youth accessed mental health resources before and what coping strategies they have like under their belt currently that helps them build resilience… that’s kind of what I think about when we talk about the recovery focused tradition.” – Julia (clinician)Page 18 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 Table 5 (continued)Subcategories Exemplary Quotes (pseudonyms) Service-related factors “Sometimes people forget how much of an influence culture has… what works for a certain population of people may not work for somebody else because it’s not culturally appropriate… I think that also plays into the ser-vice-related factors.” – Katie (youth)“Family is so key… it’s often the parents that are calling to ask for resources and supports of how to navigate the system… also not so much access [but] is it readily available in their environment?" – Kirsten (clinician) 2. How resilience was portrayed in the results Research traditions “I was wondering if like the… the traditions changed, overtime?” – Yvonne (youth)“How you had the different traditions… kind of, how they build their story… I think that’s great” – Phoebe (clinician) Process model of resilience “One of my favorite things about this is just ‘changing symptoms’. It doesn’t necessarily mean positive or negative… it’s okay to kind of like… just re-go through the process.” – Zoe (youth)“I love this, and I think it’s very complex, like I think you have a lot, you’ve captured a lot here.” – Phoebe (clinician)Reaction meeting: Gaps and future research priorities 1. Macro‑level environment and patient‑oriented research practices Culture and spirituality “One thing that uh I think a lot of people don’t look into, at least from my experience, is religion.” – Katie (youth)“Perspectives from different cultures and countries… that also should be considered here.” – Kirsten (clinician) Diversity and intersectionality “Including like an EDI lens would be very important… different religions, races and whatnot… this is something that I am kind of realizing now… as someone who um, kind of faced these barriers.” – Ariel (youth)“Youth resilience research that looks at different marginalized groups…. for example, um, youth living with disabilities… youth who are from the LGBTQ + community… different underserved groups. That’s kind of front and center in my mind.” – Kirsten (clinician) Youth and community engagement “Going into the community and actually asking what they want, rather than assuming… see what they need… have the community involved in that process. Making sure that it’s aligning um with their values.” – Ariel (youth) 2. Transdiagnostic resilience factors over the life‑course Co-occurring diagnoses or mental health issues “We should think more about how different mental health issues occur together and interact with one-another, since it’s not uncommon for peo-ple to have more than one issue at the same time.” – Yvonne (youth) Physical health “I do think sometimes um, like, psychosomatic symptoms are overlooked, um and even just the way your physical health can degrade as a result of your mental illness or… side effects of medications.” – Zoe (youth) Developmental stages and life transitions “During the different life transitions… people have different resources and support, and resilience looks different if you’re 13 versus if you’re, you know, 24.” – Lena (clinician)Knowledge dissemination preferences and applicability 1. Combining visual and written summaries Figures / models “I think a combination of a diagram for visual learners, and also written sum-mary.” – Eva (clinician)“Infographics are more accessible for lay audiences.” – Helen (youth) 2. Application Knowledge translation tool “I feel like this is so useful and meaningful to so many people, and especially if it’s in a really digestible form… like ‘Oh check out this thing… it shows a really comprehensive um kind of overview’… that would be really great… it makes it really accessible.” – Zoe (youth)“Presenting families and um clients with something like similar to this model… I’m really interested in like the wave at the bottom… do you think showing them… and explaining how it comes from research might help them in their resiliency journey?” – Cara (researcher)Page 19 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 of resilience, expressing that there are multiple ways to define and understand this complex concept (as opposed to a single, universal definition). Concerns were also raised regarding the “weaponization” of resilience. Partic-ipants elaborated on the use of the term “resilience” as a buzzword, which from their perspective emphasizes the individual’s role or responsibility in overcoming trauma and adversity, over and beyond the health and social sys-tems that shape resilience processes through the provi-sion of external resources and opportunities. As such, how resilience is framed in research and practice was noted as an important consideration.Main areas of interest in the study of resilienceIdentifying environmental factors and strategies that con-tribute to youth resilience was expressed as a key inter-est. Participants suggested that understanding the role of social determinants of health in shaping resilience pro-cesses would be valuable information, including the popu-lation characteristics and demographics of youth who have been involved in resilience research (e.g., race, culture, socioeconomic status). Specific coping skills and health care practices that have been shown to enhance resilience were also highlighted as important areas of focus that may inform future targets for intervention. Additionally, partic-ipants expressed interest in understanding how resilience has been conceptualized, including definitions, measure-ment, and resilience-related outcomes. Taken together, perceptions of resilience and main interests gathered in the topic consultation meetings aligned with the focus and scope of the review. Participant feedback was applied to refine the charting form and analyses.Overall impression and results that resonated the mostIn the reaction meetings, person-environment interac-tions were discussed in relation to how clinicians iden-tify protective factors in practice and the influence of youth’s social support network. Relatedly, participants highlighted the importance of cultural and social deter-minants of health in how young people subjectively expe-rience resilience and navigate the mental health care system. The recovery-focused tradition and self-regu-latory strategies resonated as well. Participants empha-sized resilience-related outcomes centered on adaptation and overcoming challenges as particularly meaningful, as this better acknowledged the ebb and flow of clinical symptoms, recovery-oriented practices and resources, and non-linear pathways of resilience. Self-regulatory strategies stood out among participants, as these results demonstrated the practical and tangible ways that young people build resilience and cope with the challenges of SMI. Interestingly, the most salient review findings were continuously linked to participants’ perspectives of youth mental health services. This underscored the critical role of service-related factors that contribute to processes of resilience. Clinicians and researchers highlighted the role of family-centred services and timely access to support, and youth participants emphasized the importance of culturally appropriate services. Lastly, the use of research traditions to share evolving storylines and trends, as well as a resilience model (figure) visually summarizing the core elements of resilience, were expressed as favorable ways to communicate the results. Collectively, discus-sions revealed that the review findings resonated with participants’ personal experiences and practices.Gaps and future research prioritiesFocus group discussions led to two key areas recom-mended for future research. First, increased focus on the macro-level environment and patient-oriented research was suggested. Specifically, participants identified a need for more research that considers transition-age youth’s culture and spirituality, as well as the importance of diversity and intersectionality (e.g., understanding resil-ience among marginalized and diverse populations with intersecting social identities). Youth participants also recommended engaging youth and community members within research activities as a priority to advance resil-ience research among transition-age youth with SMI. Second, the identification of developmental and trans-diagnostic resilience factors among youth with SMI was proposed as a future research direction (e.g., resilience factors, mechanisms and processes that are shared across multiple diagnoses and developmental periods). Youth participants emphasized the importance of understand-ing resilience factors that are relevant across diagnoses of SMI given the high prevalence of co-occurring mental health conditions. This included greater recognition of Table 5 (continued)Subcategories Exemplary Quotes (pseudonyms) Tangible resources or programming “Resiliency training has been popping up and could help in different format options.” – Tina (youth)“Programs that could be offered, partnerships that could be pursued with different community organizations… Like who’s operating in the eco-system and who can we connect with to bridge gaps… to just be stronger together in different communities.” – Kirsten (clinician)Page 20 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 biological and physical health indicators, which transi-tion-age youth described as an often overlooked area that is relevant to their resilience and mental health recovery (e.g., psychosomatic symptoms, medication side effects). In contrast, clinicians and researchers highlighted the importance of further exploring similarities and differ-ences in how resilience unfolds according to different life stages and transitions.Knowledge dissemination preferences and applicabilityParticipants had a preference for both written and vis-ual summaries to synthesize information. Participants expressed that a figure or model that captures resilience processes among transition-age youth with SMI would support knowledge translation among peers, colleagues, and clients. Additionally, participants suggested that the results of the review may be applied to inform the devel-opment of tangible resources and programming aimed at promoting resilience among transition-age youth experi-encing SMI. In sum, consultative meetings suggested that the results of the present review have practical value for informing future research and practices in youth men-tal health care. Participant feedback informed the final reporting of the scoping review results.DiscussionThe present scoping review provides a comprehensive synthesis of resilience research among transition-age youth with SMI, while integrating community advisory group feedback. Four research traditions emerged, each portraying processes of resilience through a unique storyline: Stress Adaptation, Person-Environment Interactions, Recovery-Focused, Critical and Cultural Perspectives. Resilience factors and outcomes were most commonly evaluated at the individual level or within the immediate environment, with fewer studies explor-ing the interplay of cultural processes, contexts, and broader societal systems. Community advisors shared the extent to which these results reflected their personal views, knowledge, and practices. Based on the perspec-tives of transition-age youth, clinicians and researchers, the findings of this review may inform directions for future research and advance practices within resilience-informed care approaches.Current tensions within and across the research traditionsTensions arose across the included articles in how resil-ience was conceptualized and investigated as a process. For inclusion in this scoping review, articles had to adopt a process-oriented perspective, which acknowledges that resilience is a changing state influenced by both internal strengths and the environmental resources that are afforded to youth [20, 21]. Yet, many studies did not adopt methodological approaches that allowed for evalu-ations of resilience over time, and only one study used a validated resilience measure that included subscales capturing environmental resilience factors [67]. Simi-lar tensions and discrepancies have been highlighted in prior reviews of resilience research among youth and adult populations [17, 18, 30–34, 112]. As noted by these authors, variability in how resilience is framed and defined has contributed to significant challenges in the measurement of resilience, the interpretation of study comparisons, and current understandings of resilience-informed interventions in research and clinical practice. There is currently no gold standard for self-report meas-ures of resilience for those undertaking quantitative stud-ies [113], and the extent to which existing measures apply to youth living with SMI is not well understood [114].Also similar to prior reviews of resilience research [17, 18, 30–34, 112], inconsistencies were observed in the terminology used across studies (e.g., resilience vs. resiliency; protective factors vs. resilience factors; interactions vs. transactions), which can lead to confu-sion and ambiguity [31]. Researchers are encouraged to provide a clear and explicit definition of resilience, which logically flows to the study purpose and rationale for methodological choices, instruments or techniques [31, 32]. The key theorists and conceptual papers detailed across the four research traditions identified in this review may provide a starting point for the selec-tion and use of consistent language in future work.Importantly, the four research traditions described in the present review overlapped and showed similarities in definitions and measures of resilience. This is expected in meta-narrative reviews synthesizing a complex field of study, where scientific evidence continuously inte-grates and builds on past knowledge [36]. However, by mapping how resilience has been studied across differ-ent research traditions, additional tensions were brought to light. Conceptualizations and operationalizations of resilience among transition-age youth with SMI varied, particularly through shifts in the guiding theorists and frameworks, which coincided with changes in the con-ceptual focus and methodologies – from predominantly variable-centred to more person-centred approaches. Variable-centred approaches often use quantitative designs to investigate the link between risk and protec-tive factors to adaptive outcomes, as well as targetable mechanisms that may buffer the impact of risks / adver-sity on one’s health and development [18, 112, 115]. In contrast, person-centred approaches often use longitu-dinal or qualitative methods to delineate how resilience unfolds for specific individuals, enabling evaluations and comparisons of resilience over time, individual lived experiences, and contexts [18, 112, 115]. With the Page 21 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 uptake of more advanced statistical analyses (e.g., mul-tilevel modelling, network analysis) and mixed-method study designs, researchers can leverage the strengths of both variable-centred and person-centred approaches in studies of resilience among transition-age youth with SMI [18, 116, 117].Prior reviews spanning multiple areas of study and populations have highlighted trends in how resilience research has evolved over time, which parallel the ten-sions seen here [18, 30]. Particularly, these changes and shifts were similarly reflected as four “waves” of resilience research [118–120], which have progressed from a focus on personal protective factors, to explorations of socio-cultural influences and interventions, to the most recent multi-system perspective that aims to promote multiple levels of analysis and cross-disciplinary research. Khan-lou and Wray (2014) [30] have also synthesized these shifts in their review of resilience literature and outline three approaches: a focus on individual factors, a con-structionist approach, an ecological and ecosystemic approach.Consultative meetings with community advisory groups confirmed the potential value of organizing resil-ience research in a way that portrays unique research traditions or ‘storylines’. Particularly, the research tradi-tions described herein demonstrate evolutions in think-ing which may be used to guide future theory-driven research with strong epistemological congruence. Thus, results of the current review may contribute to enhancing conceptual clarity within the study of resilience among young people with SMI.Resilience factors and outcomesThe current review also uncovered how five core ele-ments of resilience have been characterized within the transition-age youth mental health literature. Find-ings revealed that a broad scope of resilience factors and outcomes have been studied. Overall, the results resonated with community advisors’ personal experi-ences and perspectives of resilience. However, the cen-tral role of supportive and accessible health services in fostering resilience among transition-age youth with SMI was uniquely highlighted in the review findings, and equally emphasized in the consultative meetings. Transition-age youth who have experienced SMI, clini-cians, and researchers called attention to the importance of contextualizing resilience processes and focusing on service-related factors and practices that may support youth’s resilience. These results were used to expand on the process-oriented models of resilience which informed the present study [20, 21], with the addition of “service-related factors” as a central component. A pro-cess model of resilience developed in collaboration with transition-age youth, clinicians, and researchers is shown in Fig. 3 to clearly depict the main findings and key messages.To date, the greatest amount of research attention has been placed on identifying resilience factors assessed at the individual level. The personal characteristics identi-fied largely overlapped with internal risk and protective factors that have been highlighted in the adult mental health and developmental psychopathology literature [17, 18, 30–32, 34]. Also consistent with prior resilience research, biological and physical health characteris-tics were rarely explored as influential resilience factors among transition-age youth with SMI. This is somewhat surprising considering the well-known physical health risks associated with SMI, and emerging therapeutic practices targeting healthy lifestyle behaviors and mind–body connection [121, 122]. The self-regulatory strategies identified also mirror prior research [18, 32, 114, 123], and highlighted the importance of engaging in supportive services, coping skills, youth’s agency in working towards goals and participating in meaningful occupations. Results demonstrate a variety of potential mechanisms of change that can be further explored and expanded on in efforts to support processes of resilience in young people with SMI.Importantly, the resilience factors listed above are inseparable from individuals’ environmental resources and opportunities [25]. Within the context of young peo-ple’s mental health recovery, researchers have increas-ingly emphasized the importance of understanding how resilience processes arise through person-in-environ-ment transactions, which are contextually and cultur-ally dependent [9, 30, 31, 123, 124]. As evidenced by the results of the current review, and consistent with prior research [17, 18, 30–32, 34], most studies have considered environmental resources and transactional processes that involve youth’s immediate environment (e.g., social support networks). The role of broader social, politi-cal, institutional, and cultural systems that makeup the macro-level environment can be much more difficult to investigate, and has therefore received less attention [30, 35]. Relatedly, findings demonstrated that there is cur-rently limited resilience research among transition-age youth with SMI belonging to racialized, marginalized, or other underserved groups. Increased focus on the macro-level environment and experiences of youth with diverse and intersecting social identities would reveal important social and contextual factors that impact health inequali-ties, and in turn influence meanings and processes of resilience [25, 30, 35].Experiences of adversity and positive adaptation are considered defining features of resilience that are closely linked [8, 9]. The present review revealed that Page 22 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 transition-age youth with SMI face unique challenges and adversities, which underscores the importance of trauma-informed care approaches among this popula-tion [14]. Future research is warranted that fully contex-tualizes various types of adversity during this transitional period of development [35]. Further, enhancing access and engagement in trauma-specific evidence-based treat-ment should be considered in future research and clinical practice, as this may be a central resource for supporting positive cascading effects in the resilience processes of transition-age youth living with SMI [14, 18, 114]. Simi-lar to prior reviews of resilience research [31, 34], clinical outcomes designed to assess pathology and impairment were still a common focus. However, findings illustrated a clear trend towards exploring positive outcomes that reflect youth’s adaptation, functioning, well-being and life purpose, which more closely align with strengths-based and recovery-oriented approaches [8, 9, 17, 123, 124]. There is ongoing debate in resilience research as to what exactly should be considered a positive resilience-related outcome [8, 112]. The perspectives of transition-age youth who have experienced SMI, members of their social sup-port network, and mental health professionals should be prioritized to identify outcomes that matter the most and build on the results of this review [32, 35, 114].Taken together, the present review synthesized a wide scope of resilience factors and outcomes that have been studied among transition-age youth with SMI. Results extended prior process-oriented models of resilience by identifying factors related to the provision of health ser-vices as a central component unique to this population. Further, by uncovering resilience factors and outcomes shown to be salient across and beyond specific diagno-ses of SMI, results can be used to inform the design and delivery of services catered to a broader range of youth mental health service users. As such, results hold practical implications and provide valuable insights into protective factors, mechanisms, and transdiagnostic intervention targets that may support youth’s positive development, functioning, and well-being.Future research directionsBased on the scoping review findings, including com-munity advisory group consultations, five key areas are recommended for future resilience research among tran-sition-age youth with SMI:Fig. 3 Process model of resilience among transition-age youth with SMI. Note: Processes of resilience are depicted through person-in-environment transactions. Core elements include: (A) experiences of adversity; multi-modal resilience factors: (B) personal characteristics, (C) environmental resources, (D) service-related factors, (E) self-regulatory strategies; and (F) resilience-related outcomes. Resilience processes are illustrated as unfolding over time, through non-linear pathways based on one’s subjective experiences, and bound within youth’s context. B & C: Results of the present scoping review suggest that personal (internal) and environmental (external) factors may exist along a continuum of risk and protective effects. This model was adapted from current process-oriented models of resilience in rehabilitation sciences [20, 21]Page 23 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 (1) Interdisciplinary and integrative studies are needed to build a knowledge base that is relevant to researchers and clinicians from various disciplines.(2) Intersectional approaches and collaborative research practices focused on fostering youth and community engagement are needed to gain the perspectives of more diverse populations and bring co-produced knowledge to the forefront of future work.(3) Mixed-method and longitudinal study designs, as well as advanced statistical analyses, should be applied in future research. These methods have the capacity to examine dynamic processes of resilience and interactions between multi-modal resilience factors.(4) Further investigations of developmental and trans-diagnostic resilience factors are needed to clarify how resilience unfolds during different life stages and resilience factors that are shared within and across multiple SMI diagnoses (including physical / biological markers).(5) Macro-level environmental factors which impact resilience processes among transition-age youth with SMI should be a focus of future resilience research to understand broader social and cul-tural determinants that may inform health policy changes. In addition to the research designs and methods stated above, future work may consider adopting specific strategies suggested for explor-ing the influence of broader contexts, systems, and health services on youth resilience processes, such as: participatory / co-design research approaches, prioritizing contextually and culturally relevant out-comes, greater consideration of social determinants of health within the main data analyses and report-ing [35, 114, 125, 126], and the use of resilience measures capable of evaluating social-ecological resources (e.g., community inclusion and opportu-nities, cultural identity, spirituality) [96, 127, 128].Strengths and limitationsThere are several limitations to the present review which should be noted. First, an assessment of the methodo-logical quality of evidence was not completed as this is beyond the scope of a scoping review design [42, 43, 47]. The lack of quality assessment limits the types of con-clusions and implications that can be drawn from the current results [43]. Second, variability in how the pop-ulation (transition-age youth) and concept (resilience) have been defined, as well as restrictions to the search strategy based on language, date, and publication type may have limited the breadth of the search and contrib-uted to English language bias. Relatedly, articles that did not clearly define or operationalize resilience were excluded. As such, there are sources not included in the present review that may still be quite informative to the study of resilience among transition-age youth with SMI (e.g., review papers, interventions that did not define resilience).The application of recent guidelines for high quality and transparent reporting is a notable strength to the current review which helped to mitigate the challenges and limi-tations mentioned above [44, 45, 48, 54]. Additionally, the scoping review protocol was developed and carried out by a multidisciplinary review team with backgrounds in occupational therapy / rehabilitation sciences (AEN, SPB, EJN), kinesiology (MLdJ, CMS), and psychiatry / early intervention (NK). The integration of multiple perspec-tives and academic disciplines supported the study selec-tion process and interpretation of the review findings. Lastly, the inclusion of community advisory group con-sultations was a key strength of the present review. This is a crucial step that has been recommended for advancing resilience research [35] and as part of the scoping review methodology [43, 46] to promote a more collaborative approach and emphasize the voices of young people and knowledge users. Incorporating the perspectives and feedback of transition-age youth who have experienced SMI, as well as mental health clinicians and researchers, was essential for maximizing the relevance and overall contribution of the research.ConclusionsThe distinct impact and burden of SMI among young people has been increasingly recognized among research-ers and clinicians. Results of the present scoping review demonstrate that investigations of resilience among tran-sition-age youth with SMI are growing in popularity, and hold strong potential for revealing novel strengths and resources that can inform the development of innova-tive youth mental health practices and policies. Further research is encouraged that adopts interdisciplinary and intersectional approaches, and prioritizes community and youth engagement in research practices, in order to deepen current understandings of resilience among tran-sition-age youth with SMI.AbbreviationsBMI Body mass indexBRS Brief Resilience ScaleCD-RISC Connor-Davidson Resilience ScaleDx DiagnosisEDI Strategies to maximize diversity and inclusion among participantsHRQOL Health-related quality of lifePCC Population, concept, contextPRISMA-ScR Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews ChecklistPage 24 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 READ Resilience Scale for AdolescentsRS The Resilience ScaleRSCA Resiliency Scales for Children and AdolescentsSEARS The Social Emotional Assets and Resilience ScaleSES Socio-economic statusSGBA Sex- and gender-based analysesSMI Serious mental illnessSupplementary InformationThe online version contains supplementary material available at https:// doi. org/ 10. 1186/ s12888- 023- 05158-0.Additional file 1: Supplementary File 1. PRISMA-ScR Checklist.Additional file 2: Supplementary File 2. Complete multi-database online search strategy conducted Dec 6, 2021.AcknowledgementsWe would like to thank all of the youth, clinician and researcher advisors who guided this research. We would also like to acknowledge Julia Martyniuk, health sciences librarian (University of Toronto), for their expertise and assis-tance in developing the search strategy for this scoping review.Authors’ contributionsAEN led the conceptualization of this review and drafted the protocol with support from CMS, MLdJ, SPB, NK and EJN. AEN and MLdJ conducted the literature search, screening, and data extraction procedures and co-facilitated focus groups. All authors contributed to the analyses and interpretation of results. AEN drafted the manuscript with support from CMS and EJN. All authors edited and provided feedback on the manuscript (AEN, CMS, MLdJ, SPB, NK and EJN). All authors read and approved the final manuscript.FundingThe first author (AEN) was funded by a Canada Graduate Scholarships Doc-toral Award (CGS-D) from the Canadian Institutes of Health Research (CIHR) during the preparation of this manuscript. CMS and EJN are funded by the Canada Research Chairs program.Availability of data and materialsThe dataset generated / analyzed as part of the review are included in this published article (and its supplementary information files). The qualitative focus group data that supports the review findings are potentially identifiable and thus not suitable for sharing via a public database. The data are available from the corresponding author upon reasonable request (subject to ethical permissions and participant consent).DeclarationsEthics approval and consent to participateInstitutional research ethics approval was received from the University of Toronto Health Sciences Research Ethics Board (REB #: 42495) to conduct the community advisory group input and reaction meetings. All study procedures involving human participants were in accordance with the ethical standards of the institutional and national research committees, and with the latest version of the Declaration of Helsinki. Transition-age youth, clinicians and researchers provided informed consent prior to participating.Consent for publicationNot applicable.Competing InterestsThe authors declare no competing interests.Author details1 Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada. 2 Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada. 3 Department of Occupational Sci-ence and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada. 4 Foundry, Vancouver, BC, Canada. 5 Providence Research, Vancouver, BC, Canada. 6 Child, Youth and Emerging Adult Program, Centre for Addiction and Mental Health, Toronto, ON, Canada. 7 Department of Psychiatry, University of Toronto, Toronto, ON, Canada. 8 Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada. Received: 2 May 2023 Accepted: 31 August 2023References 1. McGorry P. Transition to adulthood: The critical period for pre-emptive, disease-modifying care for schizophrenia and related disorders. Schizo-phr Bull. 2011;37(3):524–30. https:// doi. org/ 10. 1093/ schbul/ sbr027. 2. Pearson C, Janz T, Ali J. Mental and substance use disorders in Canada. Health at a Glance. Statistics Canada. Catalogue no. 82–624-X. 2013. 3. Arnett JJ, Žukauskienė R, Sugimura K. The new life stage of emerging adulthood at ages 18–29 years: Implications for mental health. Lancet Psychiatry. 2014;1(7):569–76. 4. Stoep AV, Beresford SA, Weiss NS, McKnight B, Cauce AM, Cohen P. Community-based study of the transition to adulthood for adolescents with psychiatric disorder. Am J Epidemiol. 2000;152(4):352–62. https:// doi. org/ 10. 1093/ aje/ 152.4. 352. 5. Fusar-Poli P. Integrated mental health services for the developmental period (0 to 25 years): A critical review of the evidence. Front Psychiatry. 2019;10. https:// doi. org/ 10. 3389/ fpsyt. 2019. 00355. 6. Yung AR, Cotter J, McGorry PD. Youth mental health: Approaches to emerging mental ill-Health in young people. London: Routledge; 2020. 7. Fletcher D, Sarkar M. Psychological resilience: A review and critique of definitions, concepts, and theory. Eur Psychol. 2013;18(1):12–23. https:// doi. org/ 10. 1027/ 1016- 9040/ a0001 24. 8. Stainton A, Chisholm K, Kaiser N, Rosen M, Upthegrove R, Ruhrmann S, et al. Resilience as a multimodal dynamic process. Early Interv Psychia-try. 2019;13(4):725–32. https:// doi. org/ 10. 1111/ eip. 12726. 9. Echezarraga A, Las Hayas C, López de Arroyabe E, Jones SH. Resilience and recovery in the context of psychological disorders. J Humanist Psychol. 2019; https:// doi. org/ 10. 1177/ 00221 67819 851623 10. Mental Health Commission of Canada. Changing directions, changing lives: The mental health strategy for Canada. 2021. 11. Ministry of Health and Long-Term Care. Respect, recovery, resilience: Recommendations for Ontario’s mental health & addictions strategy. 2011. 12. World Health Organization. Mental health action plan 2013–2020. 2013. Available from: https:// apps. who. int/ iris/ handle/ 10665/ 89966 13. Friesen BJ. Recovery and resilience in children’s mental health: Views from the field. Psychiatr Rehabil J. 2007;31(1):38–48. https:// doi. org/ 10. 2975/ 31.1. 2007. 38. 48. 14. Shalanski L, Ewashen C. An interpretive phenomenological study of recovering from mental illness: Teenage girls’ portrayals of resilience. Int J Ment Health Nurs. 2019;28(2):492–500. https:// doi. org/ 10. 1111/ inm. 12552. 15. Fusar-Poli P, Solmi M, Brondino N, Davies C, Chae C, Politi P, et al. Transdiagnostic psychiatry: A systematic review. World Psychiatry. 2019;18(2):192–207. https:// doi. org/ 10. 1002/ wps. 20631. 16. Fritz J, de Graaff AM, Caisley H, van Harmelen A-L, Wilkinson PO. A systematic review of amenable resilience factors that moderate and/or mediate the relationship between childhood adversity and mental health in young people. Front Psychiatry. 2018;9. https:// doi. org/ 10. 3389/ fpsyt. 2018. 00230. 17. Davydov DM, Stewart R, Ritchie K, Chaudieu I. Resilience and mental health. Clin Psychol Rev. 2010;30(5):479–95. https:// doi. org/ 10. 1016/j. cpr. 2010. 03. 003. 18. Masten AS, Lucke CM, Nelson KM, Stallworthy IC. Resilience in develop-ment and psychopathology: Multisystem perspectives. Annu Rev Clin Psychol. 2021;17(1):521–49. https:// doi. org/ 10. 1146/ annur ev- clinp sy- 081219- 120307. 19. Fine SB. Resilience and human adaptability: Who rises above adver-sity? Am J Occup Ther. 1991;45(6):493–503. https:// doi. org/ 10. 5014/ ajot. 45.6. 493.Page 25 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 20. McLarnon MJW, Rothstein MG. Development and initial validation of the workplace resilience inventory. J Pers Psychol. 2013;12(2):63–73. https:// doi. org/ 10. 1027/ 1866- 5888/ a0000 84. 21. Nalder E, Hartman L, Hunt A, King G. Traumatic brain injury resiliency model: A conceptual model to guide rehabilitation research and practice. Disabil Rehabil. 2019;41(22):2708–17. https:// doi. org/ 10. 1080/ 09638 288. 2018. 22. Luthar SS, Cicchetti D, Becker B. The construct of resilience: A critical evaluation and guidelines for future work. Child Dev. 2000;71(3):543–62. https:// doi. org/ 10. 1111/ 1467- 8624. 00164. 23. Ungar M. The social ecology of resilience: Addressing contextual and cultural ambiguity of a nascent construct. Am J Orthopsychiatry. 2011;81(1):1–17. https:// doi. org/ 10. 1111/j. 1939- 0025. 2010. 01067.x. 24. Hutcheon E, Lashewicz B. Theorizing resilience: Critiquing and unbounding a marginalizing concept. Disabil Soc. 2014;29(9):1383–97. https:// doi. org/ 10. 1080/ 09687 599. 2014. 934954. 25. Ungar M, Theron L. Resilience and mental health: How multisys-temic processes contribute to positive outcomes. Lancet Psychiatry. 2020;7(5):441–8. https:// doi. org/ 10. 1016/ S2215- 0366(19) 30434-1. 26. Gralinski-bakker JH, Hauser ST, Stott C, Billings RL, Allen JP, Hauser ST, et al. Markers of resilience and risk: Adult lives in a vulnerable popula-tion. Res Hum Dev. 2004;1(4):291–326. https:// doi. org/ 10. 1207/ s1542 7617r hd0104_4. 27. Browne J, Estroff SE, Ludwig K, Merritt C, Meyer-Kalos P, Mueser KT, et al. Character strengths of individuals with first episode psychosis in Individual Resiliency Training. Schizophr Res. 2018;195:448–54. https:// doi. org/ 10. 1016/j. schres. 2017. 09. 036. 28. Browne J, Mueser KT, Meyer-Kalos P, Gottlieb JD, Estroff SE, Penn DL. The therapeutic alliance in individual resiliency training for first episode psy-chosis: Relationship with treatment outcomes and therapy participa-tion. J Consult Clin Psychol. 2019;87(8):734–44. https:// doi. org/ 10. 1037/ ccp00 00418. 29. Schwarz S. Resilience in psychology: A critical analysis of the concept. Theory Psychol. 2018;28(4):528–41. https:// doi. org/ 10. 1177/ 09593 54318 783584. 30. Khanlou N, Wray R. A whole community approach toward child and youth resilience promotion: A review of resilience literature. Int J Ment Health Addict. 2014;12(1):64–79. https:// doi. org/ 10. 1007/ s11469- 013- 9470-1. 31. Rudzinski K, McDonough P, Gartner R, Strike C. Is there room for resil-ience? A scoping review and critique of substance use literature and its utilization of the concept of resilience. Subst Abus Treat Prev Policy. 2017;12(1). https:// doi. org/ 10. 1186/ s13011- 017- 0125-2 32. Christmas CM, Khanlou N. Defining youth resilience: A scoping review. Int J Ment Health Addict. 2019;17(3):731–42. https:// doi. org/ 10. 1007/ s11469- 018- 0002-x. 33. Raanaas RK, Bjøntegaard H, Shaw L. A scoping review of participatory action research to promote mental health and resilience in youth and adolescents. Adolesc Res Rev. 2020;5(2):137–52. https:// doi. org/ 10. 1007/ s40894- 018- 0097-0. 34. Tankersley AP, Grafsky EL, Dike J, Jones RT. Risk and resilience factors for mental health among transgender and gender nonconforming (TGNC) youth: A systematic review. Clin Child Fam Psychol Rev. 2021;24(2):183–206. https:// doi. org/ 10. 1007/ s10567- 021- 00344-6. 35. Hart A, Gagnon E, Eryigit-Madzwamuse S, Cameron J, Aranda K, Rathbone A, et al. Uniting resilience research and practice with an inequalities approach. SAGE Open. 2016;6(4). https:// doi. org/ 10. 1177/ 21582 44016 682477 36. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O, Peacock R. Storylines of research in diffusion of innovation: A meta-narrative approach to systematic review. Soc Sci Med. 2005;61(2):417–30. https:// doi. org/ 10. 1016/j. socsc imed. 2004. 12. 001. 37. United Nations. Definition of youth. 2013. Available from: http:// www. un. org/ esa/socdev/documents/youth/fact-sheets/youth-defnition.pdf. 38. McGorry P, Bates T, Birchwood M. Designing youth mental health services for the 21st century: Examples from Australia, Ireland and the UK. Br J Psychiatry. 2013;202(s54):s30–5. https:// doi. org/ 10. 1192/ bjp. bp. 112. 119214. 39. National Institute of Mental Health. Mental illness 2021. Available from: https:// www. nimh. nih. gov/ health/ stati stics/ mental- illne ss. shtml#: ~: text= Serio us mental illness (SMI) is,or more major life activities 40. Substance Abuse and Mental Health Services Administration. Behind the term: Serious mental illness. Development Services Group, Inc. 2016. Available from: https:// www. hsdl. org/? abstr act& did= 801613 41. Nesbitt AE, Sabiston CM, deJonge ML, Barbic SP, Kozloff N, Nalder EJ. Understanding resilience among transition-age youth with serious mental illness: Protocol for a scoping review. BMJ Open. 2022;12(9):e059826. https:// doi. org/ 10. 1136/ bmjop en- 2021- 059826. 42. Arksey H, O’Malley L. Scoping studies: Towards a methodological frame-work. Int J Soc Res Methodol. 2005;8(1):19–32. https:// doi. org/ 10. 1080/ 13645 57032 00011 9616. 43. Levac D, Colquhoun H, O’Brien KK. Scoping studies: Advancing the methodology. Implement Sci. 2010;5(1):69. https:// doi. org/ 10. 1186/ 1748- 5908-5- 69. 44. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467–73. https:// doi. org/ 10. 7326/ M18- 0850. 45. Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. RAMESES publication standards: Meta-narrative reviews. J Adv Nurs. 2013;69(5):987–1004. https:// doi. org/ 10. 1186/ 1741- 7015- 11- 20. 46. Sabiston CM, Vani M, DeJonge M, Nesbitt A. Scoping reviews and rapid reviews. Int Rev Sport Exerc Psychol. 2022;15(1). https:// doi. org/ 10. 1080/ 17509 84X. 2021. 19640 95 47. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Sys-tematic review or scoping review? Guidance for authors when choos-ing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. https:// doi. org/ 10. 1186/ s12874- 018- 0611-x. 48. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline state-ment. J Clin Epidemiol. 2016;75:40–6. https:// doi. org/ 10. 1016/j. jclin epi. 2016. 01. 021. 49. Darnay K, Hawke LD, Chaim G, Henderson JL, INNOVATE Research Team. INNOVATE Research: Youth Engagement Guidebook for Researchers. Toronto: Centre for Addiction and Mental Health; 2019. 50. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15. https:// doi. org/ 10. 1111/j. 1365- 2648. 2007. 04569.x. 51. Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H. Qualitative content analysis: A focus on trustworthiness. SAGE Open. 2014;4(1). https:// doi. org/ 10. 1177/ 21582 44014 522633 52. Bronfenbrenner U. The Ecology of Human Development: Experiments by Nature and Design. Cambridge, Massachusetts: Harvard University Press; 1979. 53. Smith B, McGannon KR. Developing rigor in qualitative research: Prob-lems and opportunities within sport and exercise psychology. Int Rev Sport Exerc Psychol. 2018;11(1):101–21. https:// doi. org/ 10. 1080/ 17509 84X. 2017. 13173 57. 54. Anderson JK, Howarth E, Vainre M, Humphrey A, Jones PB, Ford TJ. Advancing methodology for scoping reviews: Recommendations aris-ing from a scoping literature review (SLR) to inform transformation of Children and Adolescent Mental Health Services. BMC Med Res Meth-odol. 2020;20(1):1–14. https:// doi. org/ 10. 1186/ s12874- 020- 01127-3. 55. Seok JH, Lee KU, Kim W, Lee SH, Kang EH, Ham BJ, et al. Impact of early-life stress and resilience on patients with major depressive disorder. Yonsei Med J. 2012;53(6):1093–8. https:// doi. org/ 10. 3349/ ymj. 2012. 53.6. 1093. 56. Fischer AS, Camacho MC, Ho TC, Whitfield-Gabrieli S, Gotlib IH. Neural markers of resilience in adolescent females at familial risk for major depressive disorder. JAMA Psychiat. 2018;75(5):493–502. https:// doi. org/ 10. 1001/ jamap sychi atry. 2017. 4516. 57. Konradt CE, de Cardoso T A, Mondin TC, de Souza LD M, Kapczinski F, da Silva RA, et al. Impact of resilience on the improvement of depres-sive symptoms after cognitive therapies for depression in a sample of young adults. Trends Psychiatry Psychother. 2018;40(3):226–31. https:// doi. org/ 10. 1590/ 2237- 6089- 2017- 0047. 58. De Berardis D, Fornaro M, Valchera A, Rapini G, Di Natale S, De Lauretis I, et al. Alexithymia, resilience, somatic sensations and their relationships with suicide ideation in drug naïve patients with first-episode major depression: An exploratory study in the “real world” everyday clinical practice. Early Interv Psychiatry. 2020;14(3):336–42. https:// doi. org/ 10. 1111/ eip. 12863.Page 26 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 59. Vieira IS, Pedrotti Moreira F, Mondin TC, de Cardoso T A, Branco JC, Kapczinski F, et al. Resilience as a mediator factor in the relationship between childhood trauma and mood disorder: A community sample of young adults. J Affect Disord. 2020;274:48–53. https:// doi. org/ 10. 1016/j. jad. 2020. 04. 011. 60. Peters RB, Xavier J, Mondin TC, de Cardoso T A, Ferreira FB, Teixeira L, et al. Bdnf val66met polymorphism and resilience in major depressive disorder: The impact of cognitive psychotherapy. Brazilian J Psychiatry. 2021;43(1):22–8. https:// doi. org/ 10. 1590/ 1516- 4446- 2019- 0726. 61. Fergusson DM, Beautrais AL, Horwood LJ. Vulnerability and resiliency to suicidal behaviours in young people. Psychol Med. 2003;33(1):61–73. https:// doi. org/ 10. 1017/ s0033 29170 20067 48. 62. Hauser ST, Allen JP. Overcoming adversity in adolescence: Narratives of resilience. Psychoanal Inq. 2007;26(4):549–76. https:// doi. org/ 10. 1080/ 07351 69070 13106 23. 63. Tan L, Martin G. Taming the adolescent mind: A randomised controlled trial examining clinical efficacy of an adolescent mindfulness-based group programme. Child Adolesc Ment Health. 2015;20(1):49–55. https:// doi. org/ 10. 1111/ camh. 12057. 64. Marvin LA, Caldarella P, Young EL, Young KR. Implementing Strong Teens for adolescent girls in residential treatment: A quasi-experimental evaluation. Resid Treat Child Youth. 2017;34(3–4):183–202. https:// doi. org/ 10. 1080/ 08865 71X. 2017. 13942 47. 65. Hauber K, Boon AE, Vermeiren R. Therapeutic factors that promote recovery in high-risk adolescents intensive group psychotherapeutic MBT programme. Child Adolesc Psychiatry Ment Health. 2019;13(1):1–10. https:// doi. org/ 10. 1186/ s13034- 019- 0263-6. 66. Hadebe NF, Ramukumba TS. Resilience and social support of young adults living with mental illness in the city of Tshwane, Gauteng prov-ince. South Africa Curationis. 2020;43(1):1–7. https:// doi. org/ 10. 4102/ curat ionis. v43i1. 2084. 67. Gårdvik KS, Rygg M, Torgersen T, Wallander JL, Lydersen S, Indredavik MS. Association of treatment procedures and resilience to symptom load three-years later in a clinical sample of adolescent psychiatric patients. BMC Psychiatry. 2021;21(1):1–16. https:// doi. org/ 10. 1186/ s12888- 021- 03417-6. 68. Zimmermann R, Fürer L, Kleinbub JR, Ramseyer FT, Hütten R, Steppan M, et al. Movement synchrony in the psychotherapy of adolescents with borderline personality pathology – A dyadic trait marker for resil-ience? Front Psychol. 2021;12:1–9. https:// doi. org/ 10. 3389/ fpsyg. 2021. 660516. 69. Henderson AR, Cock A. The responses of young people to their experiences of first-episode psychosis: Harnessing resilience. Com-munity Ment Health J. 2015;51(3):322–8. https:// doi. org/ 10. 1007/ s10597- 014- 9769-9. 70. Las Hayas C, Padierna JA, Muñoz P, Aguirre M, del GómezBarrio A, Beato-Fernández L, et al. Resilience in eating disorders: A qualitative study. Women Heal. 2016;56(5):576–94. https:// doi. org/ 10. 1080/ 03630 242. 2015. 71. Grob R, Schlesinger M, Wise M, Pandhi N. Stumbling into adult-hood: Learning from depression while growing up. Qual Health Res. 2020;30(9):1392–408. https:// doi. org/ 10. 1177/ 10497 32320 914579. 72. Luther L, Rosen C, Cummins JS, Sharma RP. The multidimensional con-struct of resilience across the psychosis spectrum: Evidence of altera-tions in people with early and prolonged psychosis. Psychiatr Rehabil J. 2020;43(3):225–33. https:// doi. org/ 10. 1037/ prj00 00393. 73. Delman J, Klodnick VV. Factors Supporting the employment of young adult peer providers: Perspectives of peers and supervisors. Com-munity Ment Health J. 2017;53(7):811–22. https:// doi. org/ 10. 1007/ s10597- 016- 0059-6. 74. Lal S, Ungar M, Malla A, Leggo C, Suto M. Impact of mental health services on resilience in youth with first episode psychosis: A qualitative study. Adm Policy Ment Heal Ment Heal Serv Res. 2017;44(1):92–102. https:// doi. org/ 10. 1007/ s10488- 015- 0703-4. 75. Rayner S, Thielking M, Lough R. A new paradigm of youth recovery: Implications for youth mental health service provision. Aust J Psychol. 2018;70(4):330–40. https:// doi. org/ 10. 1111/ ajpy. 12206. 76. Kim SW, Kim JJ, Lee BJ, Yu JC, Lee KY, Won SH, et al. Clinical and psycho-social factors associated with depression in patients with psychosis according to stage of illness. Early Interv Psychiatry. 2020;14(1):44–52. https:// doi. org/ 10. 1111/ eip. 12806. 77. McEwen BS. The brain on stress: Toward an integrative approach to brain, body and behavior. Perspect Psychol Sci. 2013;8(6):673–5. https:// doi. org/ 10. 1177/ 17456 91613 506907. 78. Wu G, Feder A, Cohen H, Kim JJ, Calderon S, Charney DS, et al. Under-standing resilience. Front Behav Neurosci. 2013;7. https:// doi. org/ 10. 3389/ fnbeh. 2013. 00010. 79. Charney DS. Psychobiological mechanisms of resilience and vulner-ability: Implications for successful adaptation to extreme stress. Am J Psychiatry. 2004;161(2):195–216. 80. Feder A, Nestler EJ, Charney DS. Psychobiology and molecular genetics of resilience. Nat Rev Neurosci. 2009;10(6):446–57. https:// doi. org/ 10. 1038/ nrn26 49. 81. Rutter M. Resilience as a dynamic concept. Dev Psychopathol. 2012;24(2):335–44. https:// doi. org/ 10. 1017/ S0954 57941 20000 28. 82. Masten AS, Best KM, Garmezy N. Resilience and development: Con-tributions from the study of children who overcome adversity. Dev Psychopathol. 1990;2(4):425–44. https:// doi. org/ 10. 1017/ S0954 57940 00058 12. 83. Connor KM, Davidson JRT. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82. https:// doi. org/ 10. 1002/ da. 10113. 84. Wagnild GM, Young HM. Development and psychometric evaluation of the Resilience Scale. J Nurs Meas. 1993;1(2):165–78. 85. Charon R. Narrative medicine: A model for empathy, reflection, profes-sion, and trust. JAMA. 2001;286(15):1897–902. https:// doi. org/ 10. 1001/ jama. 286. 15. 1897. 86. Payton JW, Wardlaw DM, Graczyk PA, Bloodworth MR, Tompsett CJ, Weissberg RP. Social and emotional learning: A framework for promot-ing mental health and reducing risk behavior in children and youth. J Sch Health. 2000;70(5):179–85. https:// doi. org/ 10. 1111/j. 1746- 1561. 2000. tb064 68.x. 87. Joiner TE, Steer RA, Beck AT, Schmidt NB, Rudd MD, Catanzaro SJ. Physiological hyperarousal: Construct validity of a central aspect of the tripartite model of depression and anxiety. J Abnorm Psychol. 1999;108(2):290–8. https:// doi. org/ 10. 1037// 0021- 843x. 108.2. 290. 88. Yalom I, Leszcz M. The theory and practice of group psychotherapy. 5th ed. New York: Basic Books; 2005. 89. Feldman R. What is resilience: an affiliative neuroscience approach. World Psychiatry. 2020;19(2):132–50. https:// doi. org/ 10. 1002/ wps. 20729. 90. Rutter M. Psychosocial resilience and protective mechanisms. Am J Orthopsychiatry. 1987;57(3):316–31. https:// doi. org/ 10. 1111/j. 1939- 0025. 1987. tb035 41.x. 91. Rutter M. Implications of resilience concepts for scientific understand-ing. Ann N Y Acad Sci. 2006;1094(1):1–12. https:// doi. org/ 10. 1196/ annals. 1376. 002. 92. Masten AS. Ordinary magic: Resilience processes in development. Am Psychol. 2001;56(3):227–38. https:// doi. org/ 10. 1037// 0003- 066x. 56.3. 227. 93. Masten AS. Resilience in children threatened by extreme adversity: Frameworks for research, practice, and translational synergy. Dev Psychopathol. 2011;23(2):493–506. https:// doi. org/ 10. 1017/ S0954 57941 10001 98. 94. Prince-Embury S. Resiliency scales for children and adolescent: Profiles of personal strengths. San Antonio: NCS Pearson, Psych Corporation; 2006. 95. Merrell KW. SEARS: Social emotional assets and resilience scales. Lutz: Par Publishing Inc.; 2011. 96. Hjemdal O, Friborg O, Stiles TC, Martinussen M, Rosenvinge JH. A new scale for adolescent resilience: Grasping the central protec-tive resources behind healthy development. Meas Eval Couns Dev. 2006;39(2):84–96. https:// doi. org/ 10. 1080/ 07481 756. 2006. 11909 791. 97. Henderson AR. A substantive theory of recovery from the effects of severe persistent mental illness. Int J Soc Psychiatry. 2011;57(6):564–73. https:// doi. org/ 10. 1177/ 00207 64010 374417. 98. Frese FJ, Stanley J, Kress K, Vogel-Scibilia S. Integrating evidence-based practices and the recovery model. Psychiatr Serv. 2001;52(11):1462–8. https:// doi. org/ 10. 1176/ appi. ps. 52. 11. 99. Chiu MYL, Ho WWN, Lo WTL, Yiu MGC. Operationalization of the SAMHSA model of recovery: A quality of life perspective. Qual Life Res. 2010;19(1):1–13. https:// doi. org/ 10. 1007/ s11136- 009- 9555-2.Page 27 of 27Nesbitt et al. BMC Psychiatry (2023) 23:660 • fast, convenient online submission • thorough peer review by experienced researchers in your field• rapid publication on acceptance• support for research data, including large and complex data types• gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year • At BMC, research is always in progress.Learn more biomedcentral.com/submissionsReady to submit your research ? Choose BMC and benefit from: 100. Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eat-ing disorders: A “transdiagnostic” theory and treatment. Behav Res Ther. 2003;41(5):509–28. https:// doi. org/ 10. 1016/ s0005- 7967(02) 00088-8. 101. Aranda K, Zeeman L, Scholes J, Morales AS-M. The resilient subject: Exploring subjectivity, identity and the body in narratives of resilience. Heal An Interdiscip J Soc Study Heal Illn Med. 2012;16(5):548–63. https:// doi. org/ 10. 1177/ 13634 59312 438564. 102. Luthar SS, Cicchetti D. The construct of resilience: Implications for interventions and social policies. Dev Psychopathol. 2000;12(4):857–85. https:// doi. org/ 10. 1017/ s0954 57940 00041 56. 103. Bottrell D. Understanding ‘marginal’ perspectives: Towards a social theory of resilience. Qual Soc Work. 2009;8(3):321–39. https:// doi. org/ 10. 1177/ 14733 25009 337840. 104. Richardson GE. The metatheory of resilience and resiliency. J Clin Psychol. 2002;58(3):307–21. https:// doi. org/ 10. 1002/ jclp. 10020. 105. Bonanno GA. Loss, trauma, and human resilience: Have we underesti-mated the human capacity to thrive after extremely aversive events? Am Psychol. 2004;59(1):20–8. https:// doi. org/ 10. 1037/ 0003- 066X. 59.1. 20. 106. Bonanno GA. Resilience in the face of potential trauma. Curr Dir Psychol Sci. 2005;14(3):135–8. https:// doi. org/ 10. 1111/j. 0963- 7214. 2005. 00347.x. 107. Wathen CN, MacGregor JC, Hammerton J, Coben JH, Herrman H, Stewart DE, et al. Priorities for research in child maltreatment, intimate partner violence and resilience to violence exposures: Results of an international Delphi consensus development process. BMC Public Health. 2012;12(1):684. https:// doi. org/ 10. 1186/ 1471- 2458- 12- 684. 108. Bliss C, Cohen AJ, Harcourt GC. Capital Theory:, vol. I. Northampton: Edward Elgar Publishing; 2005. 109. Anthony WA. Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosoc Rehabil J. 1993;16(4):11–23. https:// doi. org/ 10. 1037/ h0095 655. 110. Leamy M, Bird V, Le BC, Williams J, Slade M. Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. Br J Psychiatry. 2011;199(6):445–52. https:// doi. org/ 10. 1192/ bjp. bp. 110. 083733. 111. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: Assessing the ability to bounce back. Int J Behav Med. 2008;15(3):194–200. https:// doi. org/ 10. 1080/ 10705 50080 22229 72. 112. Windle G. What is resilience? A review and concept analysis. Rev Clin Geron-tol. 2011;21(2):152–69. https:// doi. org/ 10. 1017/ S0959 25981 00004 20. 113. Windle G, Bennett KM, Noyes J. A methodological review of resilience measurement scales. Health Qual Life Outcomes. 2011;9(1):2–18. https:// doi. org/ 10. 1186/ 1477- 7525-9-8. 114. Thompson EG, Knowles SF, Greasley P. Understanding resilience in young people with complex mental health needs: A Delphi study. Clin Child Psychol Psychiatry. 2019;24(3):405–16. https:// doi. org/ 10. 1177/ 13591 04518 794789. 115. Luthar SS, Cushing G. Measurement issues in the empirical study of resilience: An overview. In: Glantz M, Johnson JL, editors. Resilience and Development: Positive Life Adaptations. New York: Kluwer Academic/Plenum Publishers; 1999. p. 129–60. 116. Kalisch R, Cramer AOJ, Binder H, Fritz J, Leertouwer IJ, Lunansky G, et al. Deconstructing and reconstructing resilience: A dynamic network approach. Perspect Psychol Sci. 2019;14(5):765–77. https:// doi. org/ 10. 1177/ 17456 91619 855637. 117. Fritz J, Fried EI, Goodyer IM, Wilkinson PO, van Harmelen AL. A network model of resilience factors for adolescents with and without exposure to childhood adversity. Sci Rep. 2018;8(1):1–13. https:// doi. org/ 10. 1038/ s41598- 018- 34130-2. 118. Masten AS. Resilience in developing systems: Progress and promise as the fourth wave arises. Dev Psychopathol. 2007;19:921–30. https:// doi. org/ 10. 1017/ S0954 57940 70004 42. 119. Ungar M, Brown M, Liebenberg L, Othman R, Kwong WM, Armstrong M, et al. Unique pathways to resilience across cultures. Youth Stud Aust. 2008;27(2):288–310. 120. Wright M, Masten A, Narayan A. Handbook of Resilience in Children. In: Goldstein S, Brooks R, editors. Handbook of Resilience in Children. 2nd ed. Boston, MA: Springer; 2013. p. 15–37. 121. Firth J, Solmi M, Wootton RE, Vancampfort D, Schuch FB, Hoare E, et al. A meta-review of “lifestyle psychiatry”: The role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry. 2020;19(3):360–80. https:// doi. org/ 10. 1002/ wps. 20773. 122. Vancampfort D, Stubbs B, Van Damme T, Smith L, Hallgren M, Schuch F, et al. The efficacy of meditation-based mind-body interventions for mental disorders: A meta-review of 17 meta-analyses of randomized controlled trials. J Psychiatr Res. 2021;134:181–91. https:// doi. org/ 10. 1016/j. jpsyc hires. 2020. 12. 048. 123. Zautra A, Hall J, Murray K, the Resilience Solutions Group. Resilience: A new integrative approach to health and mental health research. Health Psychol Rev. 2008;2(1):41–64. https:// doi. org/ 10. 1080/ 17437 19080 22985 68. 124. Liebenberg L. Reconsidering interactive resilience processes in mental health: Implications for child and youth services. J Community Psychol. 2020;48(5):1365–80. https:// doi. org/ 10. 1002/ jcop. 22331. 125. Ungar M. Practitioner review: Diagnosing childhood resilience – a systemic approach to the diagnosis of adaptation in adverse social and physical ecologies. J Child Psychol Psychiatry. 2015;56(1):4–17. https:// doi. org/ 10. 1111/ jcpp. 12306. 126. Ungar M, Theron L, Murphy K, Jefferies P. Researching multisystemic resilience: A sample methodology. Front Psychol. 2021;11:3808. https:// doi. org/ 10. 3389/ fpsyg. 2020. 607994. 127. Liebenberg L, Ungar M, Vijver FV. Validation of the child and youth resilience measure-28 (CYRM-28) among Canadian youth. Res Soc Work Pract. 2012;22(2):219–26. https:// doi. org/ 10. 1177/ 10497 31511 428619. 128. Liebenberg L, Moore JC. A social ecological measure of resilience for adults: The RRC-ARM. Soc Indic Res. 2018;136:1–9. https:// doi. org/ 10. 1007/ s11205- 016- 1523-y.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims in pub-lished maps and institutional affiliations.
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A scoping review of resilience among transition-age youth with serious mental illness : tensions, knowledge gaps, and future directions
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