Modifiable Protective Factors Associated With Resilience in Trauma-Exposed Adults: A Systematic Review

This systematic review aims to synthesize what protective factors have been identified to promote resilience in adults who have experienced potentially traumatic events (PTEs). APA PsychInfo and PubMed were searched to identify literature published between 2014 and 2024 that studied resilience in trauma-exposed adults. Studies were included if: the PTEs experienced by participants met Criterion A for events preceding posttraumatic stress disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-V TR); the study measured modifiable protective factors; and the study included a measure of resilience. Two independent reviewers used standardized data extraction forms and assessed risk of bias with the Mixed Methods Appraisal Tool. Of 991 unique references, 13 articles met inclusion after full-text review. A social-ecological framework guided the synthesis and categorization of factors bolstering resilience. At the interpersonal level, protective factors identified included social support and religious attendance. At the institutional or organizational level, employment, length of employment, and workplace belongingness were identified as promoting resilience. At the community level, access to social resources to help meet basic needs was found to strengthen resilience. Finally, at the public policy level, employee assistance supported resilience. This review identified critical gaps in current resilience literature. Future research should define the type, timing, and duration of PTEs exposure, as well as specify the time lapsed between data collection and the PTEs exposure. Resilience conceptualizations and interventions should focus on tracing resilience across time and on multisystemic resilience-oriented interventions that include the individual, interpersonal, institutional/organizational, community, and public policy levels.