The Association of Resilience with Cardiovascular Disease Among Members of the Cowlitz Indian Tribe

AN ABSTRACT OF THE DISSERTATION OF Lisa Nelson-Majewski, for the Doctor of Philosophy degree in Education, presented on October 30, 2015, at Southern Illinois University Carbondale. TITLE: THE ASSOCIATION OF RESILIENCE WITH CARDIOVASCULAR DISEASE AMONG MEMBERS OF THE COWLITZ INDIAN TRIBE MAJOR PROFESSOR: Dr. Dhitinut Ratnapradipa Cardiovascular disease is the leading cause of death in the United States, and among the American Indian population (AHA, 2012; IHS, 2013). The concept of resilience is receiving increasing attention in chronic conditions. Resilience has been shown to play a protective role in patients with chronic disease conditions including osteoarthritis (Wright, Zautra, & Going, 2008), breast and ovarian cancer (Brix et.al., 2008; Costanzo et. Al., 2009) and diabetes (DeNisco, 2010; Yi, Vataliano, Smith, Yi, & Weinger, 2008; Yi-Frazier et al., 2010). This study follows the paradigm shift from research focusing on risk factors of cardiovascular disease, to explore if resilience is significantly different among study participants of the Cowlitz Indian Tribe without a diagnosis of cardiovascular disease versus tribal participants with heart disease. The purpose of this study was to explore the relationships between resilience and cardiovascular health status, as well the relationship between resilience and the top six modifiable risk factors for cardiovascular disease, within the members of the Cowlitz Indian Tribe. Method. Following IRB approval, enrolled tribal members of the Cowlitz Indian Tribe, over the age of 18 years completed two survey tools. The tool utilized measure resilience this study is the 10-item Connor-Davidson Resilience Scale (CD-RISC). The second survey tool, including demographics and questions to assess cardiovascular risk factors, is the Behavioral Risk Factor Surveillance System (BRFSS). The cardiovascular risk factor questions include the same BFRSS questions utilized from the 2009-2010 BRFSS tribal questionnaires. Results. Resilience and six selected cardiovascular disease risk factors were surveyed from a total of 201 enrolled members of the Cowlitz Indian Tribe after informed consent obtained. Statistical analysis, with an alpha level of .05, revealed statistical difference between resilience and members with CVD versus resilience of members without CVD, (F (1,199) = 16.563, p = .000, ) (Table 5). All constructs of resilience impact overall resilience, while the second construct of resilience (trust in one’s instincts, tolerance of negative affect and strengthening effects of stress, emotional/cognitive control under pressure), had the most impact on overall resilience for those without CVD (r =0.909) (Table 6). HTN and resilience versus no HTN and resilience and resilience scores between those with normal cholesterol versus resilience scores of those with hyperlipidemia were the only two risk factors for CVD significantly impacted by resilience p = .049 and p = .020 respectively (Table 11; Table 13). While there was not a statistically significant difference (t (657) = -0.985) between Cowlitz Indian (N=201) resilience scores and the general population (N=458) (Davidson, 2003) (Table 22). The Cowlitz Indians (N=201) overall resilience score was statistically lower (t(359) = -3.12) than another federally recognized tribe (N = 160) Goins, Gregg, and Fiske (2012) (Table 21). Conclusion. Resilience is significantly different in members of the Cowlitz Indian Tribe who have not been diagnosed with CVD versus resilience scores of those self-identified as having CVD. Trust in one’s instincts, tolerance of negative affect and strengthening effects of stress, and emotional/cognitive control under pressure, was the construct of resilience that has the most impact on overall Cowlitz Indian resilience scores. Cowlitz participants with hypertension and hyperlipidemia, two of the six risk CVD factors evaluated, had statistical significance between the resilience scores versus the participants without the presence of these CVD risk factors