Salud Mental

Psychometric properties of the resilience scale in Mexican patients with chronic hemodialysis


Abel Lerma
Gabriela Ordónez
Lubia Mendoza
Elihud Salazar-Robles
Jesús Rivero
Emmanuel Pérez-Granados
Héctor Pérez-Grovas
Patricia Ruiz-Palacios
Armando Ibarra
Claudia Lerma


Introduction. Resilience consists of a series personalized skills to cope with adverse situations and overcome them, and even emerge strengthened. Resilience in patients with chronic renal insufficiency (CRI) treated with hemodialysis (HD) has been evaluated with general questionnaires that are not specific for this population.

Objective. To evaluate the psychometric properties of a resilience questionnaire in patients treated with chronic HD.

Method. The study included 280 patients with CRI (aged 18 to 85, 44% women) treated with HD for at least two months in six hemodialysis units in Mexico, who completed Beck’s depression and anxiety inventories, an inventory of cognitive distortions, and the Mexican Resilience Measurement Scale (RESI-M).

Results. Owing to the duplication of more than one factor, two of the 43 items were eliminated in the exploratory factor analysis. We confirmed five factors that explained 63.4% of the total variance, with a Cronbach’s alpha of .96 (the alpha ranges in the five factors from .85 to .95). The confirmatory analysis showed a theoretical structural model that fits the empirical data in an acceptable, balanced, and parsimonious way. The five factors correlate positively with each other and negatively with anxiety and depression symptoms and distorted thoughts.

Discussion and conclusion. The RESI-M scale is valid and reliable for assessing resilience in patients treated with chronic HD. Resilience factors evaluated with RESI-M are a potential therapeutic target to reduce depression and anxiety symptoms in these patients.
Hemodialysis, chronic renal insufficiency, psychological resilience, depression, anxiety, reliability


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Arbuckle, J. (2012). IBM SPSS AMOS 21 User´s Guide. Armonk, NY, USA: IBM Corporation.

Beck, A. T. (2006). Inventario de Depresión de Beck (BDI-II1). USA: The Psychological Corporation, Eds.

Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893-897. doi: 10.1037/0022-006X.56.6.893

Byrne, B. (2010). Structural equation modeling with AMOS: Basic Concepts, Applications, and Programming. New York, USA: Routledge.

Cabanyes Truffino, J. (2010). Resiliencia: una aproximación al concepto. Revista de Psiquiatría y Salud Mental, 3(04), 145-151. doi: 10.1016/j.rpsm.2010.09.003

Cukor, D. (2007). Use of CBT to treat depression among patients on hemodialysis. Psychiatric Services, 58(5), 711-712. doi: 10.1176/

Cukor, D., Cohen, S. D., Peterson, R. A., & Kimmel, P. L. (2007). Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness. Journal of the American Society of Nephrology, 18(12), 3042-3055. doi: 10.1681/ASN.2007030345

Cukor, D., Coplan, J., Brown, C., Friedman, S., Newville, H., Safier, M., … & Kimmel, P. L. (2008). Anxiety disorders in adults treated by hemodialysis: a single-center study. American Journal of Kidney Diseases, 52(1), 128-136. doi: 10.1053/j.ajkd.2008.02.300

Cukor, D., Rosenthal, D. S., Jindal, R. M., Brown, C. D., & Kimmel, P. L. (2009). Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney International, 75(11), 1223-1229. doi: 10.1038/ki.2009.51

Dobrof, J., Dolinko, A., Lichtiger, E., Uribarri, J., & Epstein, I. (2002). Dialysis patient characteristics and outcomes: the complexity of social work practice with the end stage renal disease population. Soc Work Health Care, 33(3-4), 105-128. doi: 10.1300/J010v33n03_08

Elliott, B. A., Gessert, C. E., Larson, P. M., & Russ, T. E. (2014). Shifting responses in quality of life: People living with dialysis. Qual Life Res, 23(5), 1497-1504. doi: 10.1007/s11136-013-0600-9

George, D. & Mailery, P. (Ed.) (2010). Using SPSS for Windows step by step: a simple guide and reference. Boston, MA: Aliyn & Bacon.

Hu, L. t., & Bentler, P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3(4), 424-453. doi: 10.1037//1082-989X.3.4.424

Kline, R. (2005). Principies and practice of structural equation modeling. New York, USA: The Guilford Press.

Lerma, A., Perez-Grovas, H., Bermudez, L., Peralta-Pedrero, M., Robles-García, R., & Lerma, C. (2017). Brief cognitive-behavioral intervention for depression and anxiety symptoms improve quality of life among chronic hemodialysis patients. Psychology and Psychotherapy: Theory, Research and Practice, 90(1), 105-123. doi: 10.1111/papt.12098

Lerma, A., Salazar, E., Perez-Grovas, H., Bermudez, L., Gutierrez, D., Reyes-Lagunes, I., … & Lerma, C. (2012). Desarrollo y validación de un instrumento para la evaluación de distorsiones cognitivas en pacientes con insuficiencia renal cronica terminal. Salud Mental, 35(3), 189-194. Retrieved from:

Ma, L. C., Chang, H. J., Liu, Y. M., Hsieh, H. L., Lo, L., … & Lu, K. C. (2013). The relationship between health-promoting behaviors and resilience in patients with chronic kidney disease. Scientific World Journal, 124973. doi: 10.1155/2013/124973

Miranda-Zapata, E., Riquelme-Mella, E., Cifuentes-Cid, H., & Riquelme-Bravo, P. (2014). Análisis factorial confirmatorio de la Escala de habilidades sociales en universitarios chilenos. Revista Latinoamericana de Psicología, 46(2), 73-82. doi: 10.1016/S0120-0534(14)70010-X

Nicholas, D. B., Picone, G., & Selkirk, E. K. (2011). The lived experiences of children and adolescents with end-stage renal disease. Qualitative Health Research, 21(2), 162-173. doi: 10.1177/1049732310382789

Palomar-Lever, J. & Gómez-Valdéz, N. E. (2010). Desarrollo de una escala de medición de resiliencia con mexicanos (RESI-M). Interdisciplinaria, 27(1). Retrieved from:

Quiceno, J., & Vinaccia, S. (2012). Resiliencia y características sociodemográficas en enfermos crónicos. Psicología desde el Caribe, 29(1), 87-104. Retrieved from:

Robles, R., Varela, R., Jurado, S., & Páez, F. (2001). Versión mexicana del Inventario de Ansiedad de Beck: propiedades psicométricas. Revista Mexicana de Psicología, 18(2), 211-218.

Rodriguez-Piaggio, A. (2009). Resiliencia. Revista Psicopedagogia, 26(80), 291-302. Retrieved from:

Schipper, K., Abma, T. A., Koops, C., Bakker, I., Sanderman, R., & Schroevers, M. J. (2014). Sweet and sour after renal transplantation: A qualitative study about the positive and negative consequences of renal transplantation. British Journal of Health Psychology, 19(3), 580-591. doi: 10.1111/bjhp.12057

Shidler, N. R., Peterson, R. A., & Kimmel, P. L. (1998). Quality of life and psychosocial relationships in patients with chronic renal insufficiency. American Journal of Kidney Diseases, 32(4), 557-566. doi: 10.1016/S0272-6386(98)70017-4

Tabachnick, B., & Fidell, L. (2001). Using multivariate statistics. New York, USA: Harper & Row.

Tong, A., Cheung, K. L., Nair, S. S., Kurella, T. M., Craig, J. C., & Winkelmayer, W. C. (2014). Thematic synthesis of qualitative studies on patient and caregiver perspectives on end-of-life care in CKD. American Journal of Kidney Diseases, 63(6), 913-927. doi: 10.1053/j.ajkd.2013.11.017

Tong, A., Lesmana, B., Johnson, D. W., Wong, G., Campbell, D., & Craig, J. C. (2013). The perspectives of adults living with peritoneal dialysis: thematic synthesis of qualitative studies. American Journal of Kidney Diseases, 61(6), 873-888. doi: 10.1053/j.ajkd.2012.08.045

Torres-Castillo, M., Hernández-Malpica, E., & Ortega-Soto, H. (2012). Validez y reproducibilidad del Inventario para Depresión de Beck en un hospital de cardiología. Salud Mental, 14(2), 1-6.

Ullman, J. B. (2006). Structural equation modeling: Reviewing the basics and moving forward. Journal of Personality Assessment, 87(1), 35-50. doi: 10.1207/s15327752jpa8701_03

Vinaccia, S. & Quiceno, J. (2011). Resiliencia y calidad de vida relacionada con la salud en pacientes con insuficiencia renal crónica. Revista Argentina de Clínica Psicológica, XX(3), 201-211. Retrieved from:

White, N., Bichter, J., Koeckeritz, J., Lee, Y. A., & Munch, K. L. (2002). A cross-cultural comparison of family resiliency in hemodialysis patients. Journal of Transcultural Nursing, 13(3), 218-227. doi: 10.1177/10459602013003011

Wick, K., Bauer, S., Malessa, C., Settmacher, U., & Strauss, B. (2015). Relationship between stress and resources in patients waiting for organ transplantation: Comparison of patients with renal and liver insufficiency. Psychother Psychosom Med Psychol, 65(8), 311-320. doi: 10.1055/s-0035-1549999