Medical
  • Research and White Papers
  • December 2024

Psychological Resilience: Health impacts and implications for insurers

By
  • Dr. Peter Farvolden
  • Dr. Adela Osman
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In Brief
This paper takes an in-depth look at psychological resilience research, highlights current challenges in risk stratification, and outlines a path forward for disability claims management and return to work.

Key takeaways

  • Research on psychological resilience holds significant promise for promoting both physical and mental health.
  • While disability claims and return to work offer immediate opportunities for applying psychological resilience research, challenges remain for implementing risk stratification applications.
  • Moving forward, psychological resilience is a field of research the industry should follow closely and support in anticipation of possibilities yet to be uncovered.

 

A proliferation of research on psychological resilience and its positive effect on coping with stress and health outcomes has brought new attention to this area of personal wellbeing. Despite all the excitement, potential, and promise, applying psychological resilience research to the risk-stratification process will require more analysis.

In contrast, the available research suggests a number of practical applications in the context of claims management. These opportunities are immediate and could provide further longitudinal data to better support insurance processes. This paper reviews psychological resilience research, highlights current challenges, and outlines a path forward for disability claims management and return to work.

The promise and potential

Psychological resilience is generally defined as the ability to adapt, recover, or bounce back from adversity, stress, or challenging life events. It refers to an individual’s capacity to maintain or regain mental wellbeing after facing difficulties such as trauma, illness, loss, or prolonged stress.1, 2, 3

Key elements of psychological resilience include:

  • Positive social support – the emotional, informational, and practical assistance provided by others that helps individuals cope with stress, adversity, and challenges
  • Adaptability – the ability to adjust to changing circumstances and cope with challenges
  • Self-efficacy – an individual’s belief in their ability to successfully execute specific actions or behaviors required to achieve a desired outcome
  • Emotional regulation – managing emotions effectively in the face of stress or adversity
  • Positive coping strategies – employing constructive methods to deal with hardship, such as problem-solving, seeking social support, or reframing negative experiences
  • Persistence – continuing to pursue goals despite setbacks or obstacles
  • Optimism and hope – maintaining a positive outlook and belief in the ability to overcome difficulties
  • Meaning – a sense of purpose, direction, and understanding, even in the face of adversity

Resilience is often viewed as a dynamic process, influenced by internal factors (e.g., personality traits, cognitive abilities) and external factors (e.g., social support, environmental context). It is not a fixed trait but can change over time and in response to different life situations.4, 5, 6, 7

Promoting physical and mental health

Research on psychological resilience holds significant promise for promoting both physical and mental health, as resilience is increasingly recognized as a key factor in helping individuals adapt to adversity, maintain wellbeing, and recover from stress and illness.

10 ways resilience can improve physical and mental health:

  1. Promoting psychological wellbeing
  2. Reducing levels of depression
  3. Alleviating anxiety
  4. Mitigating post-traumatic stress disorder (PTSD)
  5. Promoting mental health in children and adolescents
  6. Limiting the physical impacts of stress
  7. Improving recovery from illness
  8. Enhancing health-promoting behaviors
  9. Reducing the burden of chronic disease
  10. Fostering healthy aging

1. Promoting psychological wellbeing

Extensive research has focused on the relationship between psychological resilience and mental health, with resilience often viewed as a protective factor that buffers against the development of mental health disorders and enhances overall psychological wellbeing. Resilience helps individuals cope with emotional challenges, reducing the likelihood of developing common mental health disorders. Resilience promotes adaptive coping mechanisms, emotional regulation, and positive reframing of stressful situations, which mitigates the psychological impact of adversity.8-18

Studies demonstrate that resilience is associated with lower levels of mental health conditions such as depression and anxiety, even in individuals facing significant stressors such as trauma, illness, or life transitions. Resilience can buffer against the development of mental health disorders and their negative impact on psychological wellbeing, as well as physical health. For example, a study of older adults found that those with higher psychological resilience had lower mortality rates, even after accounting for depressive symptoms and physical health status.19, 20

2. Reducing levels of depression

Psychological resilience is linked to lower vulnerability to developing major depressive disorder (MDD). Resilience is inversely related to the severity and onset of depressive symptoms. Individuals with high resilience are better equipped to manage stress and negative emotions, which reduces the likelihood of experiencing chronic or severe depression. Studies also suggest that resilient individuals are more likely to engage in adaptive coping mechanisms (e.g., problem-solving, seeking social support), rather than maladaptive ones (e.g., avoidance, rumination), leading to better mental health outcomes. For example, one study found that resilience was significantly associated with lower levels of emotional distress and depressive symptoms among cancer patients, emphasizing its protective role in mental health.21, 22

Resilience appears to influence how well individuals respond to treatments for depression, such as psychotherapy or pharmacotherapy. Patients with higher resilience tend to have better treatment adherence, are more engaged in therapeutic processes, and may experience more rapid or sustained recovery. This is particularly relevant in cognitive behavioral therapy (CBT), where resilience can facilitate the cognitive restructuring required to combat depressive thinking patterns.22-26

Resilience is believed to play a key role in reducing the likelihood of depression relapse or recurrence, which is a common issue in MDD. Resilient individuals may have stronger coping strategies and social supports that protect against the cyclical nature of depression. This capacity to “bounce back” after an initial depressive episode could reduce long-term recurrence rates.27-28

Resilience may also help buffer against the impact of comorbid conditions that often accompany MDD, such as anxiety disorders, substance abuse, or chronic physical health problems. Research indicates that higher resilience levels may reduce the negative impact of these comorbidities, potentially leading to better overall mental health outcomes.25, 29, 30

3. Alleviating anxiety

Resilience has also been shown to reduce the impact of anxiety. Resilient individuals tend to have better emotional regulation and are more likely to appraise stressful situations as manageable, which reduces the likelihood of developing anxiety disorders. Additionally, resilience enhances one’s ability to face uncertainty and challenges without becoming overwhelmed. For example, a study found that resilience is linked to a more adaptive response to threat, reducing the likelihood of anxiety-related symptoms.8, 31-33

4. Mitigating post-traumatic stress disorder

Resilience is a critical factor in preventing or mitigating the development of PTSD after traumatic experiences. Research suggests that resilient individuals are better able to process trauma, manage intrusive thoughts, and engage in positive coping strategies. For those who do develop PTSD, resilience is associated with quicker recovery and fewer long-term psychological consequences. For example, investigations into trauma and resilience have found that the majority of individuals exposed to trauma do not develop PTSD, and resilience factors such as optimism, emotional regulation, and social support play a crucial role in this outcome.3, 34

5. Promoting mental health in children and adolescents

Resilience is especially important for young people, as childhood and adolescence are critical periods for mental health development. Research shows that resilient children and adolescents are less likely to develop mental health disorders, even when exposed to stressors such as family conflict, poverty, or bullying. Interventions that promote resilience in youth – such as fostering self-esteem, emotional regulation, and problem-solving skills – are associated with better mental health outcomes later in life. For example, a landmark study showed that resilient adolescents from high-risk environments were more likely to achieve positive mental health outcomes than their peers with lower resilience.13, 35, 36

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6. Limiting the physical impacts of stress

Chronic stress is a well-established risk factor for numerous physical health issues, including cardiovascular disease, immune dysfunction, and metabolic disorders. Resilient individuals are better able to manage stress, which reduces the physiological toll on their bodies. By promoting resilience, individuals can protect against the harmful effects of stress, such as high blood pressure, inflammation, and compromised immune function, ultimately improving overall physical health. Resilient individuals tend to have better cardiovascular health and lower rates of chronic disease, both of which are major contributors to all-cause mortality. For example, research shows that resilience reduces cortisol levels (a stress hormone) and promotes healthier heart rate variability, both of which are linked to lower risks of chronic disease, such as heart disease and diabetes.37-43

7. Improving recovery from illness

Resilience appears to play a critical role in recovery from physical illnesses, injuries, and surgical procedures. Resilient individuals are more likely to engage in positive health behaviors, adhere to medical treatments, and maintain a hopeful outlook, which accelerates recovery, improves quality of life during recovery, and may improve long-term health outcomes and lower mortality risk.39, 40, 44, 45

Resilience also promotes recovery from mental health challenges. Resilient individuals are more likely to recover quickly from episodes of transient depression, anxiety, or trauma. Studies on PTSD have shown that individuals with higher resilience recover more quickly from traumatic events and are less likely to develop long-term psychological issues compared to those with lower resilience.46-49

8. Enhancing health-promoting behaviors

Resilient individuals are more likely to engage in health-promoting behaviors, such as regular physical activity and healthy eating, and avoid risky behaviors, such as smoking and excessive drinking. Longitudinal studies have shown that resilient individuals are more proactive in managing their health, seeking medical advice, and adhering to treatments for chronic conditions, which can reduce mortality risk. By fostering resilience, individuals can better manage stress and avoid maladaptive behaviors like substance abuse or overeating. A resilient mindset has been shown to promote sustained exercise adherence, which contributes to lower risks of obesity, cardiovascular disease, and diabetes.50-52

Resilience encourages individuals to seek social support, maintain optimism, and employ coping strategies such as cognitive restructuring, all of which protect mental health. These behaviors enhance emotional wellbeing and reduce the likelihood of developing mood disorders or chronic stress. Resilient individuals are more likely to participate in therapy or mindfulness practices, which support mental health and reduce symptoms of anxiety and depression.53-55

9. Reducing the burden of chronic disease

For individuals with chronic disease, such as diabetes, arthritis, or heart disease, resilience can improve self-management by fostering a proactive attitude toward health. Resilience helps individuals adapt to the challenges of living with a chronic condition and maintain better adherence to treatment plans, diet, and exercise routines. For example, research on diabetes patients shows that resilience is associated with better glycemic control and adherence to prescribed treatment, reducing complications and improving long-term outcomes.56-60

Chronic illness often leads to emotional challenges, including depression, anxiety, and feelings of helplessness. Resilience helps mitigate the mental health burden of chronic disease by promoting a positive attitude and effective coping strategies. Studies have found that resilient patients with chronic illnesses are less likely to develop depressive symptoms and tend to report better overall quality of life, despite ongoing health challenges. Research on cancer patients suggests that those with higher resilience experience better recovery, reduced emotional distress, and higher survival rates, as they are more likely to adhere to treatments and maintain a positive outlook during the recovery process.61-65

10. Fostering healthy aging

Psychological resilience has been extensively studied in older populations, as it is thought to play a crucial role in successful aging. Resilience is critical in older adults when they face age-related health declines, loss of loved ones, and increased physical limitations. Resilient older adults are better able to adapt to these changes, maintain independence, and engage in healthy aging behaviors that prolong life and improve wellbeing. Research shows that resilience in older adults is linked to lower mortality rates, better physical functioning, and lower risks of cognitive decline. A study of elderly adults found that those with higher resilience had a lower risk of death over a 10-year period, even in the presence of chronic illnesses.66-68

Resilience has been linked to lower levels of chronic inflammation, which is a key contributor to age-related diseases and mortality. Resilient individuals also tend to have stronger immune function, which helps protect against infections and other conditions that can lead to premature death. Studies on biological markers, such as C-reactive protein (a marker of inflammation), show that resilient individuals typically exhibit lower inflammation levels, which may promote better health at older ages and reduce the risk of mortality from cardiovascular disease, cancer, and metabolic disorders.19, 21, 69-81

Resilience helps older adults cope with the emotional challenges of aging, such as grief, loneliness, and fear of dependency. Resilient individuals are more likely to maintain mental wellbeing, avoid depression, and remain socially engaged. A study on successful aging found that resilient older adults reported better mental and physical health and were less likely to experience loneliness or depression, even in the face of age-related challenges.82-84

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Resilience and socioeconomic factors

Low socioeconomic status (SES) is a known predictor of higher mortality and morbidity due to increased exposure to stressors, reduced access to healthcare, and unhealthy living conditions. Resilience is seen as a protective factor for individuals from low SES backgrounds, helping them navigate adversity and adopt healthier behaviors. Some studies have shown that resilience can mediate the relationship between low SES and mortality, potentially reducing the negative health outcomes associated with poverty. The exact mechanisms through which resilience interacts with socioeconomic factors to influence mortality are still under investigation, but the significant role of environmental and systemic factors should not be overlooked.85-87

Resilience interventions and health promotion

Programs designed to increase resilience (e.g., through cognitive restructuring, emotional regulation, and coping skills) have been shown to reduce stress, improve mental wellbeing, and lower risk factors for heart disease, such as hypertension and high cholesterol. Studies have also demonstrated improvements in health behaviors such as smoking cessation, diet, and physical activity.88-90

Interventions aimed at enhancing psychological resilience to improve cardiovascular health have been tested in both healthy populations and those at risk for cardiovascular disease (CVD). One randomized, controlled trial found that a resilience training program significantly reduced blood pressure and improved quality of life in individuals with hypertension, a major risk factor for CVD. Additional studies suggest that resilience-training programs can improve mental and physical health, which may lower mortality risk. However, more research is needed to determine the long-term effects of these interventions on mortality.91,92

Interventions aimed at building resilience, such as mindfulness training, cognitive behavioral therapy (CBT), and social support programs, show promise in preventing mental health issues before they arise, particularly in high-risk populations such as trauma survivors, adolescents, and individuals with chronic illnesses. Studies have demonstrated that resilience training in schools and workplaces can reduce stress, prevent burnout, and lower the incidence of depression and anxiety in both youth and adults.94-98

Interventions that build resilience may not only enhance individual health but also reduce healthcare costs and improve population health outcomes, making resilience research a valuable area for continued exploration.

Challenges to applying resilience research in insurance risk stratification

Current research on psychological resilience has made significant advances, but applying current research on psychological resilience to insurance risk stratification presents several challenges. These issues affect the understanding, measurement, and application of resilience across different populations and contexts. Some of the key problems with resilience research for risk assessment include:

Lack of agreement on a definition Psychological resilience lacks a universally accepted definition. Resilience is a multifaceted concept that involves various factors, such as personality traits, coping mechanisms, social support, and environmental influences; therefore, researchers have not yet reached a consensus on its definition.5, 99, 100
Lack of consistent standardized scales Measurement tools like the Connor-Davidson Resilience Scale (CD-RISC) and the Resilience Scale for Adults (RSA) assess different dimensions of resilience, and no single scale is widely accepted. The variability in measurement tools makes it difficult for insurers to integrate resilience assessments into the underwriting process in a standardized way.
Limited longitudinal research Most resilience research is cross-sectional. Without long-term data, it’s difficult to assess how resilient behavior may evolve or predict long-term outcomes accurately. More longitudinal studies are needed to establish the long-term health benefits of resilience.
Cultural considerations Cultural factors influence how resilience is expressed and developed, and research is still evolving on how resilience operates across different cultural contexts. What constitutes resilient behavior in one culture may not in another, which complicates the application of resilience-building interventions globally.109-112
Subjectivity in self-reports Most tools for measuring resilience rely on self-reports, which are subject to biases such as social desirability, recall bias, and mood at the time of the assessment. In insurance underwriting, this subjectivity poses a risk for inaccuracies, as clients may not accurately assess their own resilience levels.113-116
Difficulty in verifying resilience Unlike physical health indicators (e.g., cholesterol levels, BMI), psychological resilience is difficult to verify objectively. This complicates its use in risk assessment, as insurers typically rely on quantifiable and verifiable data.117, 118
Biological pathways While some research investigates the biological underpinnings of resilience (e.g., genetics, neuroplasticity, stress hormone regulation), this area is still underdeveloped. The complex interaction among the environment, biological factors, and psychological resilience is not fully understood, limiting insights into how resilience can be fostered at a biological level.120-122

 

Opportunities to apply resilience research to disability claims management and return to work

By leveraging research on resilience and strategies for building resilience, insurers, employers, healthcare professionals, and rehabilitation professionals can enhance mental and physical recovery for workers/claimants, reduce time away from work, and improve overall outcomes for those navigating disability claims.

  • Early identification of resilience factors to guide intervention: Assessing psychological resilience early in the disability claims process can help identify individuals who may be at greater risk for prolonged absences or poor recovery outcomes. By understanding resilience levels, insurers and claims managers can tailor interventions to build or strengthen resilience, improving claimants’ ability to cope with their condition and facilitating quicker recovery. Implementing resilience assessment tools, such as CD-RISC, during the initial stages of a disability claim can help gauge a worker’s capacity to manage stress, adapt to their condition, and successfully return to work. Those with lower resilience scores can be prioritized for targeted interventions, including cognitive behavioral therapy (CBT) or resilience training.122, 123
  • Resilience-based interventions to enhance recovery: Incorporating resilience-building programs into rehabilitation efforts can improve recovery outcomes for individuals receiving disability benefits. Resilience helps individuals better manage stress, regulate emotions, and engage in positive coping strategies, all of which contribute to more effective rehabilitation and a faster return to work (RTW). Resilience training programs, including CBT, mindfulness-based stress reduction (MBSR), and coping-skills workshops, can be integrated into rehabilitation plans. These interventions teach individuals how to reframe negative thoughts, build emotional regulation, and develop adaptive coping mechanisms, improving their readiness to return to work and reducing long-term disability.124, 125
  • Tailoring RTW plans based on resilience: By understanding the resilience levels of employees/claimants returning from disability leave, RTW plans can be personalized to better align with individual needs. Individuals with higher resilience may require less support, while those with lower resilience may benefit from a gradual return to work, along with ongoing mental health services. Developing individualized RTW plans that account for psychological resilience can optimize the process by providing the right level of support at the right time. For instance, a claimant with higher resilience may be ready for a more rapid transition to full duties, while someone with lower resilience may need a phased approach with flexibility to manage stress during the transition.126, 127
  • Prevention of long-term disability and relapse: Building resilience in individuals before and during their RTW process can prevent long-term disability or relapse. By enhancing coping skills and emotional strength, claimants are more likely to overcome setbacks and avoid the risk of returning to claim disability benefits due to poor mental health or stress-related issues. Offering workplace resilience training programs for claimants returning from disability, as well as for those at risk of stress-related absences, can significantly reduce the chances of prolonged or recurrent disability leave. Resilience interventions can be embedded into health and wellness programs, fostering an environment that supports mental wellbeing.128-130
  • Supporting mental health during disability claims: Psychological resilience plays a crucial role in managing mental health conditions such as depression and anxiety, which are often linked to disability claims. Applying resilience-based approaches can mitigate the psychological impact of illness or injury, improving mental health outcomes and reducing the duration of disability claims. Claim adjudicators can incorporate resilience-enhancing practices, such as motivational interviewing and positive psychology interventions. These strategies can foster a positive mindset, help individuals maintain hope and motivation, and reduce the emotional distress associated with the claims process.131-133
  • Enhancing work engagement and productivity post-RTW: Resilient individuals are more likely to be engaged and productive after returning to work, as they have stronger coping mechanisms and can better manage workplace stress. Supporting resilience during RTW can lead to better long-term job satisfaction, lower absenteeism, and higher productivity. Incorporating resilience training and mental health resources into employee assistance programs (EAPs) can help employees sustain their resilience over the long term, ensuring they remain productive and engaged after returning to work. Regular check-ins and resilience-boosting workshops can help maintain the benefits gained during the RTW process.134, 135
  • Promoting a resilience-focused organizational culture: Fostering a workplace culture that emphasizes psychological resilience can improve overall employee wellbeing and reduce the incidence of disability claims. Employees in resilience-focused environments are better equipped to manage work-related stress, avoid burnout, and recover from adversity, leading to fewer health-related absences. Employers can promote resilience through workplace wellness programs, resilience training, and mental health initiatives that emphasize stress management, emotional wellbeing, and social support.135, 136

By assessing resilience levels, tailoring interventions, and promoting resilience-building programs, organizations can support workers in navigating the challenges of returning to work and help prevent long-term disability from chronic conditions like arthritis, diabetes, or heart disease. Individuals with greater confidence in their ability to resume work responsibilities are more likely to return to work faster and maintain employment after returning. This is observed across various populations, including those recovering from physical injuries, mental health issues, and chronic illnesses.137-140

Conclusion

In the years ahead, how will insurers incorporate psychological resilience research into risk assessment, disability claims management, and other areas to better serve policyholders? The potential is clear, but challenges remain. While disability claims and RTW offer immediate opportunities, risk stratification applications can only be achieved over time and by continually seeking to overcome the obstacles currently preventing implementation. Regardless, psychological resilience is a field of research the industry should follow closely and support in anticipation of possibilities yet to be uncovered.

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Meet the Authors & Experts

Dr. Peter Farvolden
Author
Dr. Peter Farvolden
Mental Health Consultant
Dr Adela Osman
Expert
Dr. Adela Osman
Vice President, Head of Global Medical

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