Research Article
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The relationship between public health system resilience and psychological resilience: multilevel regression study

Year 2025, Volume: 23 Issue: 1, 1 - 10, 25.04.2025

Abstract

Objective: This study aims to explore the effect of Public Health System Resilience (PHSR) on the psychological resilience of individuals. To demonstrate this interaction, the study investigated psychological resilience levels of individuals negatively affected by the recently experienced COVID-19 pandemic as a disaster period in the province of Çanakkale.
Method: This study was conducted in two stages in April and September 2022. In the first stage, the PHSR Scorecard prepared by the United Nations Office for Disaster Risk Reduction was used to obtain the scores from the Merkez province of Çanakkale and the Bayramiç and Ayvacık districts. In the second stage, a questionnaire for demographic data and the Psychological Resistance Scale was administered to 510 people, including those over 65 years, small business owners, and students (high-school grades 2 and 3). The results were analyzed at two levels and with three different models using the Multilevel Regression analysis.
Results: Based on the multilevel regression model formulated for the factors affecting Psychological Resilience, it was found that PHSR was an explanatory or predictor variable for psychological resilience, and a high public health system resilience was associated with a high psychological resilience (Model 1 ß:0,29, p<0,05), (Model 2 ß:0,26, p<0,01) (Model 3 ß:1,05, p<0,01). It was also found that in PHSR interactions, small business owner groups (β = -0,77, t=-2,35, p<0,05) and student groups (β = -1,56, t=4,72, p<0,01) were affected more negatively than the group aged over 65 years.
Conclusion: Our study has demonstrated that PHSR effectively enhances individuals’ psychological resilience.

Ethical Statement

Çanakkale Onsekiz Mart University Clinical Trials Ethics Committee, decision numbered 2022-05 , 22/03/2022

References

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  • Berkes E, Ross H. Community Resilience: Toward an Integrated Approach, Society & Natural Reso-urces. 2021; 26:1, 5-20, DOI:10.1080/08941920.2012.736605
  • United Nations Office for Disaster Risk Reduction (UNDRR). Resilience. Available online: https://www.preventionweb.net/terminology/view/501
  • T.C. Sağlık Bakanlığı. Covid-19 Bilgilendirme Platformu. (https://covid19.saglik.gov.tr/) Erişim Tari-hi: 03.10.2023. (In Turk-ish)
  • T.C. İçişleri Bakanlığı. 65 Yaş ve Üstü ile Kronik Rahatsızlığı Olanlara Sokağa Çıkma Yasağı Ek Genel-gesi. 2020. (https://www.icisleri.gov.tr/65-yas-ve-ustu-ile-kronik-rahatsizligi-olanlara-sokaga-cikma-yasagi-ek-genelgesi) Erişim Ta-rihi: 08.10.2023 (In Turkish)
  • Çiftçi, S. Covid-19 Pandemi Dönemi Milli Eğitim Bakanlığı’nın İlkokullara İlişkin Politika ve Uygula-malarının Değer-lendirilmesi, Yüksek Lisans Tezi, Alanya Alaaddin Keykubat Üniversitesi, 2022 (In Turkish)
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  • UNICEF. Preventing a lost decade. Urgent action to reverse the devastating impact of COVID-19 on children and young people. December 2021. https://www.unicef.org/reports/unicef-75-preventing-a-lost-decade
  • Yildirim H, Işik K, Aylaz R, The effect of anxiety levels of elderly people in quarantine on depression during covid-19 pan-demic, Social Work in Public Health 2021; 36:2, 194-204, DOI: 10.1080/19371918.2020.1868372
  • İnce, C. Küresel Afetin Yerel Yansımaları: Covıd-19’un Bitlis Esnafı Üzerindeki Etkileri. Avrasya Sos-yal ve Ekonomi Araştırmaları Dergisi 2020, 7 (8) , 130-145. (In Turkish)
  • Girdhar, R., Srivastava, V., & Sethi, S. (2020). Managing mental health issues among elderly during COVID-19 pandemic. Journal of geriatric care and research, 7(1), 32-35.
  • Wang X, Hegde S, Son C, Keller B, Smith A, Sasangohar F Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study J Med Internet Res 2020;22(9):e22817
  • Lischer, S. Safi, N. Dickson, C. Remote learning and students’ mental health during the Covid-19 pandemic: A mixed-method enquiry. Prospects 2022;51, 589–599 .
  • Güven H. Covid-19 pandemik krizi sürecinde e-ticarette meydana gelen değişimler. Avrasya Sosyal ve Ekonomi Araştırma-ları Dergisi. 2020 May 5;7(5):251-68. (In Turkish)
  • Dısaster Resılıence Scorecard For Cıtıes. Publıc Health System Resılıence Addendum. 2020. (https://mcr2030.undrr.org/sites/default/files/2021-06/UNDRR_Public%20Health%20Scorecard%20Addendum%20v2.0_English-Jan2021.pdf). Erişim Tarihi: 07.10.2023
  • Connor, KM. Davidson, JR. Development of a new resilience scale: the Connor–Davidson resilience scale (CD-RISC). De-press Anxiety. 2003;18(2):76–82.
  • Karaırmak, Ö. (2010). Establishing the psychometric qualities of the Connor–Davidson Resilience Scale (CD-RISC) using exploratory and confirmatory factor analysis in a trauma survivor sample. Psychiatry research, 179(3), 350-356. doi:10.1016/j.psychres.2009.09.012
  • Maas C. J. M. Hox J. J. Sufficient Sample Sizes for Multilevel Modeling. Methodology: European Jo-urnal of Research Methods for the Behavioral and Social Sciences 2005; 1(3), 86–92
  • Courtney CA, Ahmed AK, Jackson R, McKinnie D, Rubinoff P, Stein A, et al. Coastal community resi-lience in the indian ocean region: a unifying framework, assessment, and lessons learned.2008.
  • Bisri, M. Pangandaran Village Resiliency Level Due to Earthquake and Tsunami Risk 2011;. 293 - 298. 10.1109/ISPAW.2011.64.
  • Lee JH, Nam SK, Kim AR, Kim B, Lee MY, Lee SM. Resilience: a meta-analytic approach. Journal of counseling & develop-ment. 2013 Jul;91(3):269-79.
  • Abramson DM, Grattan LM, Mayer B, Colten CE, Arosemena FA, Bedimo-Rung A, Lichtveld M. The resilience activation framework: a conceptual model of how access to social resources promotes adaptation and rapid recovery in post-disaster settings. J Behav Health Serv Res. 2015 Jan;42(1):42-57.
  • Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. Ame-ri-can Psychologist, 44, 513-524.
  • Norris FH, Stevens SP, Pfefferbaum B, Wyche KF, Pfefferbaum RL. Community resilience as a me-taphor, theory, set of ca-pacities, and strategy for disaster readiness. American Journal of Commu-nity Psychology. 2008;41(1–2):127–150.
  • Gil-Rivas, V., & Kilmer, R. P. (2016). Building Community Capacity and Fostering Disaster Resilience. Journal of clinical psy-chology, 72(12), 1318–1332. https://doi.org/10.1002/jclp.22281
  • Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychologi-cal impact of quarantine and how to reduce it: rapid review of the evidence. The lancet. 2020 Mar 14;395(10227):912-20.
Year 2025, Volume: 23 Issue: 1, 1 - 10, 25.04.2025

Abstract

References

  • Herrman H, Stewart DE, Diaz-Granados N, Berger EL, Jackson B, Yuen T. What is Resilience? The Canadian Journal of Psy-chiatry. 2011;56(5):258-265. doi:10.1177/070674371105600504
  • Berkes E, Ross H. Community Resilience: Toward an Integrated Approach, Society & Natural Reso-urces. 2021; 26:1, 5-20, DOI:10.1080/08941920.2012.736605
  • United Nations Office for Disaster Risk Reduction (UNDRR). Resilience. Available online: https://www.preventionweb.net/terminology/view/501
  • T.C. Sağlık Bakanlığı. Covid-19 Bilgilendirme Platformu. (https://covid19.saglik.gov.tr/) Erişim Tari-hi: 03.10.2023. (In Turk-ish)
  • T.C. İçişleri Bakanlığı. 65 Yaş ve Üstü ile Kronik Rahatsızlığı Olanlara Sokağa Çıkma Yasağı Ek Genel-gesi. 2020. (https://www.icisleri.gov.tr/65-yas-ve-ustu-ile-kronik-rahatsizligi-olanlara-sokaga-cikma-yasagi-ek-genelgesi) Erişim Ta-rihi: 08.10.2023 (In Turkish)
  • Çiftçi, S. Covid-19 Pandemi Dönemi Milli Eğitim Bakanlığı’nın İlkokullara İlişkin Politika ve Uygula-malarının Değer-lendirilmesi, Yüksek Lisans Tezi, Alanya Alaaddin Keykubat Üniversitesi, 2022 (In Turkish)
  • T.C. İçişleri Bakanlığı. (2020). https://www.icisleri.gov.tr/81-il-valiligine-tam-kapanma-tedbirleri-genelgesi-gonderildi (Ac-cess date:24 September 2023). (In Turkish)
  • UNICEF. Preventing a lost decade. Urgent action to reverse the devastating impact of COVID-19 on children and young people. December 2021. https://www.unicef.org/reports/unicef-75-preventing-a-lost-decade
  • Yildirim H, Işik K, Aylaz R, The effect of anxiety levels of elderly people in quarantine on depression during covid-19 pan-demic, Social Work in Public Health 2021; 36:2, 194-204, DOI: 10.1080/19371918.2020.1868372
  • İnce, C. Küresel Afetin Yerel Yansımaları: Covıd-19’un Bitlis Esnafı Üzerindeki Etkileri. Avrasya Sos-yal ve Ekonomi Araştırmaları Dergisi 2020, 7 (8) , 130-145. (In Turkish)
  • Girdhar, R., Srivastava, V., & Sethi, S. (2020). Managing mental health issues among elderly during COVID-19 pandemic. Journal of geriatric care and research, 7(1), 32-35.
  • Wang X, Hegde S, Son C, Keller B, Smith A, Sasangohar F Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study J Med Internet Res 2020;22(9):e22817
  • Lischer, S. Safi, N. Dickson, C. Remote learning and students’ mental health during the Covid-19 pandemic: A mixed-method enquiry. Prospects 2022;51, 589–599 .
  • Güven H. Covid-19 pandemik krizi sürecinde e-ticarette meydana gelen değişimler. Avrasya Sosyal ve Ekonomi Araştırma-ları Dergisi. 2020 May 5;7(5):251-68. (In Turkish)
  • Dısaster Resılıence Scorecard For Cıtıes. Publıc Health System Resılıence Addendum. 2020. (https://mcr2030.undrr.org/sites/default/files/2021-06/UNDRR_Public%20Health%20Scorecard%20Addendum%20v2.0_English-Jan2021.pdf). Erişim Tarihi: 07.10.2023
  • Connor, KM. Davidson, JR. Development of a new resilience scale: the Connor–Davidson resilience scale (CD-RISC). De-press Anxiety. 2003;18(2):76–82.
  • Karaırmak, Ö. (2010). Establishing the psychometric qualities of the Connor–Davidson Resilience Scale (CD-RISC) using exploratory and confirmatory factor analysis in a trauma survivor sample. Psychiatry research, 179(3), 350-356. doi:10.1016/j.psychres.2009.09.012
  • Maas C. J. M. Hox J. J. Sufficient Sample Sizes for Multilevel Modeling. Methodology: European Jo-urnal of Research Methods for the Behavioral and Social Sciences 2005; 1(3), 86–92
  • Courtney CA, Ahmed AK, Jackson R, McKinnie D, Rubinoff P, Stein A, et al. Coastal community resi-lience in the indian ocean region: a unifying framework, assessment, and lessons learned.2008.
  • Bisri, M. Pangandaran Village Resiliency Level Due to Earthquake and Tsunami Risk 2011;. 293 - 298. 10.1109/ISPAW.2011.64.
  • Lee JH, Nam SK, Kim AR, Kim B, Lee MY, Lee SM. Resilience: a meta-analytic approach. Journal of counseling & develop-ment. 2013 Jul;91(3):269-79.
  • Abramson DM, Grattan LM, Mayer B, Colten CE, Arosemena FA, Bedimo-Rung A, Lichtveld M. The resilience activation framework: a conceptual model of how access to social resources promotes adaptation and rapid recovery in post-disaster settings. J Behav Health Serv Res. 2015 Jan;42(1):42-57.
  • Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. Ame-ri-can Psychologist, 44, 513-524.
  • Norris FH, Stevens SP, Pfefferbaum B, Wyche KF, Pfefferbaum RL. Community resilience as a me-taphor, theory, set of ca-pacities, and strategy for disaster readiness. American Journal of Commu-nity Psychology. 2008;41(1–2):127–150.
  • Gil-Rivas, V., & Kilmer, R. P. (2016). Building Community Capacity and Fostering Disaster Resilience. Journal of clinical psy-chology, 72(12), 1318–1332. https://doi.org/10.1002/jclp.22281
  • Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychologi-cal impact of quarantine and how to reduce it: rapid review of the evidence. The lancet. 2020 Mar 14;395(10227):912-20.
There are 26 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Gamze Çan 0000-0002-7065-649X

Hakan Kartal 0000-0002-3500-3514

Çetin Toraman 0000-0002-6280-5467

Coşkun Bakar 0000-0002-5497-2759

Early Pub Date April 20, 2025
Publication Date April 25, 2025
Submission Date May 2, 2024
Acceptance Date March 6, 2025
Published in Issue Year 2025 Volume: 23 Issue: 1

Cite

APA Çan, G., Kartal, H., Toraman, Ç., Bakar, C. (2025). The relationship between public health system resilience and psychological resilience: multilevel regression study. Turkish Journal of Public Health, 23(1), 1-10. https://doi.org/10.20518/tjph.1477110
AMA Çan G, Kartal H, Toraman Ç, Bakar C. The relationship between public health system resilience and psychological resilience: multilevel regression study. TJPH. April 2025;23(1):1-10. doi:10.20518/tjph.1477110
Chicago Çan, Gamze, Hakan Kartal, Çetin Toraman, and Coşkun Bakar. “The Relationship Between Public Health System Resilience and Psychological Resilience: Multilevel Regression Study”. Turkish Journal of Public Health 23, no. 1 (April 2025): 1-10. https://doi.org/10.20518/tjph.1477110.
EndNote Çan G, Kartal H, Toraman Ç, Bakar C (April 1, 2025) The relationship between public health system resilience and psychological resilience: multilevel regression study. Turkish Journal of Public Health 23 1 1–10.
IEEE G. Çan, H. Kartal, Ç. Toraman, and C. Bakar, “The relationship between public health system resilience and psychological resilience: multilevel regression study”, TJPH, vol. 23, no. 1, pp. 1–10, 2025, doi: 10.20518/tjph.1477110.
ISNAD Çan, Gamze et al. “The Relationship Between Public Health System Resilience and Psychological Resilience: Multilevel Regression Study”. Turkish Journal of Public Health 23/1 (April 2025), 1-10. https://doi.org/10.20518/tjph.1477110.
JAMA Çan G, Kartal H, Toraman Ç, Bakar C. The relationship between public health system resilience and psychological resilience: multilevel regression study. TJPH. 2025;23:1–10.
MLA Çan, Gamze et al. “The Relationship Between Public Health System Resilience and Psychological Resilience: Multilevel Regression Study”. Turkish Journal of Public Health, vol. 23, no. 1, 2025, pp. 1-10, doi:10.20518/tjph.1477110.
Vancouver Çan G, Kartal H, Toraman Ç, Bakar C. The relationship between public health system resilience and psychological resilience: multilevel regression study. TJPH. 2025;23(1):1-10.

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