Network structure and mental health correlates of the Mount Sinai Resilience Scale

The Mount Sinai Resilience Scale (MSRS) assesses cognitive, behavioral, and emotional resilience processes, yet the interrelationships among these processes, including which are most central and most strongly associated with mental health outcomes, remain poorly characterized. This study used network analysis to characterize the structure of MSRS-assessed resilience processes and their associations with clinical outcomes in a population-based sample of U.S. adults (N = 1794) enriched for elevated perceived stress and trauma exposure. Participants completed the MSRS and validated measures of depressive, anxiety, and posttraumatic stress disorder (PTSD) symptoms and well-being. Regularized Gaussian graphical models were estimated to characterize network structure and centrality, with clinical outcomes incorporated as nodes to identify unique associations with individual MSRS items. The network demonstrated moderate density (157 of 276 possible edges), reflecting widespread conditional associations among resilience processes. Engagement in meaningful activities, perceived positive impact of spirituality, and active emotional recovery demonstrated the highest centrality, while emotional awareness and directly facing fears also showed high expected influence. Staying hopeful about the future, directly facing fears, and engaging in meaningful activities were consistently associated with lower depressive, anxiety, and PTSD symptoms and higher well-being. Forgiveness was positively associated with PTSD symptoms, suggesting a more complex role in trauma-related adaptation. Overall, MSRS resilience processes were organized around interconnected domains of meaning, spirituality, and emotional regulation. Hope, behavioral approach to feared experiences, and engagement in meaningful activities emerged as resilience processes with consistent associations across multiple mental health outcomes, highlighting their potential relevance for resilience-focused interventions.