The Brief Resilience Scale: Accuracy and Construct Validity in Measuring Resilience to Depression and Anxiety in Multiple Sclerosis

Background & Objective
Resilience, the ability to ‘bounce back’ from challenges like neuropsychological symptoms, including depression and anxiety, is a key focus in positive clinical psychology. However, no gold standard exists for resilience, particularly in individuals with MS. Valid instruments are needed to better understand protective factors and support healthcare professionals. This study aimed to (1) assess the accuracy of the Dutch translation of the Brief Resilience Scale, BRSnl, in identifying individuals with MS with high resilience to depression and anxiety, and (2) evaluate its construct validity against depression, anxiety, fatigue, and disability.

Methods
A total of 293 MS patients (Mage = 45.3 years, SD = 10.3; 17% male) participated in this online cross-sectional study. Resilience to depression and anxiety was defined as a Hospital Anxiety Depression Scale (HADS) score < 8. Additionally, the Expanded Disability Status Scale (EDSS) and a visual analogue scale for fatigue were administered. Statistical analyses included Area Under the Curve (AUC) for accuracy, Bayesian Factors (BF), and effect sizes (ES). BFs were interpreted using standard thresholds (BF > 10 for strong evidence and BF < 1 supporting the null hypothesis).

Results
The BRSnl demonstrated acceptable accuracy for resilience (HADS < 8; AUC = .76, 95% CI [.70, .83]) and for identifying individuals with possible depression or anxiety (HADS > 10; AUC = .79 [.73, .84]). A cut-off score of > 21 optimized sensitivity (73%) and specificity (72%). Scores < 14 showed maximum sensitivity (1.00) and negative predictive value (1.00), while scores > 25 demonstrated high specificity (> .95) and positive predictive values (.75 to .80). Construct validity was supported by the lack of association between BRS and disability (BF = 0.18) or age (BF = .20), alongside strong evidence for associations with fatigue (ES = -.33, BF = 7.7E+6) and HADS (-.61, BF = 1.2E+29). No effect of gender on BRS scores was found (BF = 1.6).

Conclusions
The BRSnl is a valid tool for measuring resilience to depression and anxiety in individuals with MS. Scores < 14 suggest low resilience, while scores > 25 indicate high resilience, providing a useful screening approach for clinicians.