Is the link between socioeconomic status and resilience mediated by reserve-building activities: Mediation analysis of web-based cross-sectional data from chronic medical illness patient panels

Carolyn Emily Schwartz, Jie Zhang, Brian Dale Stucky, Wesley Michael, Bruce David Rapkin

Research output: Contribution to journalArticle

1 Scopus citations


Objectives The purpose of this study is to test the hypothesis that the link between socioeconomic status (SES) and resilience is mediated by reserve-building activities. Design Cross-sectional observational study. Structural equation modelling (SEM) was used to test the mediation hypothesis. Setting Web-based survey. Participants Participants with a chronic medical condition were recruited from Rare Patient Voice. Primary and secondary outcome measures DeltaQuest Reserve-Building Measure; demographic variables to capture SES; Centers for Disease Control Healthy Days Core Module; Self-Administered Comorbidity Questionnaire. Resilience was operationalised using residual modelling. Results The study sample included 442 patients (mean age 49, 85% female). SES was modelled as a bifactor model composed of general SES and specific factors for personal finance and parent's education. A series of simple mediation models predicting resilience led to the selection of three reserve-building activities for subsequent SEM-based mediation models: Active in the World, Outdoor and Exercise. The full SEM model supported the hypothesis that the relationships from both general SES and personal finance to resilience were mediated by engaging in the three reserve-building activities. In addition, the number of comorbidities partially mediated the relationship between personal finance and reserve-building. Those with more comorbidities generally had lower levels of resilience. Conclusions This study provides suggestive evidence that reserve-building activities may be one pathway by which SES is associated with resilience: people of higher SES are more likely to engage in reserve-building activities that are intellectually stimulating, involve Outdoor pursuits and include physical Exercise. These reserve-building activities are not costly to pursue. These findings may empower patients to introduce more such reserve-building activities into their lives.

Original languageEnglish (US)
Article numbere025602
JournalBMJ open
Issue number5
StatePublished - May 1 2019



  • chronic illness
  • cognitive reserve
  • resilience
  • social determinants of health
  • socioeconomic status

ASJC Scopus subject areas

  • Medicine(all)

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