Resilience and its associated factors in brain tumor patients in Karachi, Pakistan: An analytical cross-sectional study

Nida Zahid, Russell Seth Martins, Wajeeha Zahid, Wardah Khalid, Iqbal Azam, Shireen Shehzad Bhamani, Khabir Ahmad, Adnan Abdul Jabbar, Muhammad Shahzad Shamim, Rashid Jooma Khan, Gohar Javed, Ehsan Bari, Nargis Asad, Syed Ather Enam

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Objectives: This study assessed resilience in brain tumor patients at a tertiary care hospital in Pakistan (a lower middle-income country; LMIC) and explored its relationship with patients' sociodemographic factors, clinical characteristics, social support, and mental health. Methods: A cross-sectional survey was conducted amongst adult (≥18 years) patients with brain tumor at the Aga Khan University Hospital, Pakistan. Resilience was assessed by Wagnild and Young's Resilience Scale, and patients' psychosocial characteristics by the Hospital Anxiety and Depression Scale and the Enriched Social Support Instrument. Results: A total of 250 patients were included (mean age: 44 years; 68% males), with majority (97.6%) having high social support and only 4.4% and 2% having symptomatic depression and anxiety, respectively. On multivariable linear regression adjusted for covariates, lower resilience was associated with not being involved in household decision-making (Adjusted Beta Coefficient: 4.58 [95% Confidence Interval:−7.59, −1.56]), not currently working (−2.80 [−4.61, −0.99]), undergoing multiple neurosurgical interventions such as tumor biopsies or resections (−8.64 [−13.11, −4.16]), receiving chemotherapy (−5.17 [−9.51, −0.83]) or combination adjuvant therapy (−2.91 [−5.14, −0.67]), low social support (−7.77 [−13.73, 1.81]), mild depression (−13.00 [-17.00,-8.99]) or symptomatic depression (−19.79 [−24.69, −14.89]), and mild anxiety (−4.24 [−7.98, −0.50]). Conclusion: Our study highlights the function of familial/household role and working status in mediating resilience, and demonstrates the well-known protective effect of resilience for mental health in brain tumor patients in Pakistan, a South-Asian LMIC. These findings are of clinical relevance with regards to the development of culture-specific evidence-based resilience-building interventions that may help patients with brain tumors to cope with the psychological distress of cancer.

Original languageEnglish
Pages (from-to)882-891
Number of pages10
Issue number6
Publication statusPublished - Jun 2021


  • anxiety
  • brain tumor
  • cancer
  • depression
  • developing countries
  • mental health
  • oncology
  • psycho-oncology
  • resilience
  • social support


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