It is well known that the cumulative effect of environmental stressors, such as economic hardship and family dysfunction, can lead to problems of violence, crime and substance abuse among individuals 1-5. However, a growing number of longitudinal and retrospective studies have also shown that most individuals are able to function successfully in society despite having grown-up in a negative environment 6-12.
Werner 12 has used the term resilience to refer to the capacity to avoid negative developmental outcomes despite exposure to high-risk conditions. Resilience may imply the existence of protective factors or mechanisms that have no effect in the absence of risk but may have a buffering effect in its presence 10.
Studies on resilience have identified three kinds of protective factors: (a) personal attributes such as intelligence, self-esteem, cognitive style, or interpersonal sensitivity, (b) a warm, responsive and responsible family, and (c) extra familial peer or adult support and positive identification models.
To our knowledge, there are no studies on determinants of resilience in Colombia. The purpose of the work presented in this paper was to take advantage of an existing database to examine a sub sample exposed to multiple adverse conditions in order to identify factors associated with resilience. By studying how these resilient individuals and their experiences differ from those with similar high risk status who developed problems, we may be able to identify new paths for prevention.
METHODS
The analyses are based on a case-control study carried out to identify risk factors for delinquency 13. In this study, cases were restricted to males between the ages of 18 and 30 who resided in Armenia, Bucaramanga, Tunja, Villavicencio or Florencia, all capital cities of departments with a population size ranging from 120 000 to 750 000 but located in a different cultural region of the country. One (Florencia) is located near the zone of conflict with the leftist guerrillas.
In the study on delinquency, cases were defined as men arrested for any motive in the previous two weeks and were recruited consecutively from police stations. A total of 223 cases were interviewed; 11 % had been arrested for homicide, 14 % for aggravated assault, 55 % for robbery, 5 % for drug trafficking, 4 % for "rebellion" (leftist guerrillas), 3 % for sexual assault, 3 % for vandalism, and the remainder for various other reasons including disorderly conduct, sedition, and fraud. For each case, a male who agreed to participate in the study and reported no history of arrests, interpersonal violence resulting in injury, or illicit activities was systematically identified in the neighborhood in which the case had lived during the longest period of time (n=223).
For the analyses presented in this paper, a subgroup of individuals (n=168) was selected based on exposure to three or more of the following life stressors: parental education less than the fifth grade, extreme poverty, parental antecedents of crime or alcohol abuse, permanent separations from parents, frequent (2 or more times a week) family conflict or frequent acute stressors which included number of temporary separations from parents (during at least 1 month but not more than 2 years), number of changes of residence, permanent separations from significant others different from parents, or having had stepparents. One point was added if the individual had been exposed to between four and eight of these stressors and two points were added if they had had nine or more.
Subjects were considered "resilient" if they had not been arrested, had not stolen something of value more than once in their life, reported not having problems (at home, with friends or at work) when drinking alcohol, drank less than five times a month, and had never consumed drugs (n=18). The resilient men were compared to those in the sample who had any of the previous problems (hereon referred to as "vulnerable") on the following variables: family composition and childhood exposure to psychological abuse (defined as having been frequently yelled at, insulted, or threatened with being hit or abandoned), physical abuse (defined as having been intentionally bruised or injured by parents or adult caregiver), or severe punishments (defined as having ever been hung, burned, enclosed for various hours, or submerged in water).
We also explored subjects' perceptions of their primary caregiver by giving them pairs of bipolar descriptors and asking them if their caregiver was a lot like or a little more like one or the other. Aspects explored were: (a) affect, operationally defined as receiving him with love and attention when he needed her/him versus rejecting him; (b) availability, defined as being available when needed versus could not be counted on; (c) arbitrary versus fair or reasonable in punishments; (d) level of supervision, defined as not knowing what he did versus monitoring his whereabouts, knowing where he was and who he was with; (e) consistency, defined as acting or reacting in predictable ways versus not knowing how he/she would react; and (f) problem solving ability, defined as being overwhelmed by problems versus ably handling problems on his/her own.
Finally, self-esteem was measured with Rosenberg's 10 item scale 14 and Sense of Coherence was measured with Antonovsky's 13 item scale 15. The Sense of Coherence construct and corresponding scale refer to the degree with which an individual perceives the events encountered in the course of life to be predictable and explicable, that one has the resources needed to meet the demands posed by these events, and that these demands are challenging, worthy of investment, and engagement. Reliability for the scale is consistently high and there is also evidence for criterion, convergent, and discriminant validity based on samples from different cultures 16. The inclusion of this construct in the questionnaire was based on qualitative research suggesting strong feelings of unpredictability, lack of control, and a "no future" mentality among offenders in Colombia 17-18.
All information was obtained by a structured and standardized interview in the form of a life history carried out by trained interviewers. At the time of data collection and again at data entry, information was checked and corrected for inconsistencies. All variables were screened by simple frequency distributions to identify meaningful cutoff points for categorization. Odds ratios (or adjusted odds ratio when there were zeros in a cell) and a likelihood ratio Chi square statistic were calculated to identify trends in the data. Given the small number of resilient men in this sample, an odds ratio of three or more or a p value of less than 0,10 were considered as indicative of a trend and will be reported as such.
RESULTS
Among this sample of men who grew-up amidst various life stressors, 46 % had been exposed to three life stressors, 26,2 % had been exposed to four, 17,3 % had been exposed to five and 10,1 % had been exposed to six or more with no significant differences between resilient and vulnerable males as to number of exposures. Among those classified as "vulnerable" males, 91,3 % had either been arrested or reported stealing more than once in their life, 47,3 % reported drinking problems, and 43,6 % reported having ever consumed drugs (over 60 % reported doing so in the past month).
There were no significant differences among resilient and vulnerable males as to their age, the level of occupation of the head of the family household, mother's level of education, mother's age at time of birth, percentage identifying the mother as primary caregiver, percentage born into single parent households, number of siblings or birth order, parental antecedents of crime or alcohol abuse or parental separations (permanent or temporary). However, there were significant differences as to the frequency of conflict in the family: 38,7 % of vulnerable males reported fighting among family members two or more times a week compared to 11,1 % of the resilient men (p<0,05).
Table 1 presents the perceived characteristics of the caregiver and exposure to psychological or physical abuse among resilient and vulnerable males in this sample. Vulnerable males tended to perceive their mother as rejecting, overwhelmed by problems, unaware of their whereabouts and arbitrary in their punishments. They also more often reported having been physically abused. Finally, resilient men had significantly higher scores for self-esteem (p<0,001) and Sense of Coherence (p<0,01) and tended to have a higher average number of years of education (7,4 years vs. 6,0; p<0,10) and more stable work histories (41,1 months vs. 28 months; p<0,10).
DISCUSSION
In this sample, resilient and vulnerable males differed mainly in their family environment, especially, as to the characteristics of the care they received as children. Resilient males tended to report less arbitrary or physical punishment, more affection, acceptance, and supervision by caregiver. In addition they perceived their caregiver (mainly the mother) to be more capable at managing problems.
Before approaching the possible implications of these findings, various limitations of the data must be considered. First, the results are based on a sample of men between the ages of 18 and 30 selected for delinquency/non-delinquency and may not be representative of populations of substance abus-ers or high risk populations of males between those ages. Future studies on resilience and vulnerability should select samples that would better represent these groups. Secondly, the data is based on retrospective reports and may be biased due to selective or defective recall (although self-reports were externally validated by comparison with caregiver reports). Nevertheless, there is little reason to believe that these biases might be stronger for one group than the other. Thirdly, the data did not explore other possible differences between resilient and vulnerable men such as intelligence, temperament or the presence of other adults that may have provided support.
Despite these and other possible limitations, the findings corroborate the importance of nurturant and competent care identified in a previous study based on qualitative methods, which explore resiliency among men in Bogotá 17 in addition to numerous studies done elsewhere on resilience, as well as risk for crime or substance abuse 6-12. As found in other studies on resiliency 19, the presence of a competent adult caregiver probably buffered the negative impact of many events in the resilient men's lives and perhaps contributed to their developing greater self-esteem and Sense of Coherence.
A parent's available resources largely affect care-giving efficacy. Although political and social reforms are necessary to guarantee appropriate living conditions equally for all, until these occur, other prevention strategies should be considered. For example, promoting problem-solving skills and competent care giving among parents perhaps through empowerment strategies could be a productive strategy for prevention. The literature on resilience also suggests that other figures (parent surrogates, relatives, teachers, etc.) can also provide the needed stability and security for children in difficult circumstances so that mentoring programs should also be considered as potential strategies for prevention♦