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experience multiple adversities. Once children face three or four stresses or
risk factors, the rate of poor outcomes goes up three to five times compared
with controls, and under these circumstances the majority of children
suffer from psychiatric disorders. The main risk factors implicated are:
biological risks (physical illness, especially brain injury; low birth
weight);
parental mental health, personality and intelligence (any psychiatric
disorder, especially major psychoses, alcoholism and criminality; person-
ality disorders are particularly important: each of these factors operates
independently of upbringing style);
family dysfunction (interparental discord, hostility and criticism, stress-
ful life events);
risky neighbourhood (high crime, violence, and drug availability; poor
schooling, low social cohesion).Resilience and protective factors
Though cumulative risks and major stresses usually have adverse effects,
some children do considerably better than others, which has led to the
concept of resilience under stress. The factors associated with better out-
comes under stress are:
personal attributes (for example, calm as opposed to irritable temper-
ament, higher as opposed to lower IQ, stronger as opposed to weaker
belief in own ability);
family attributes (for example, warmth, closeness, cohesiveness);
the use of outside support by the family and child, who has at least
one strong positive, supportive relationship with an adult (who may be
outside the immediate family, for example, a grandfather or aunt).
Most of these factors are associated with better outcomes, whether or
not children are living in adverse circumstances. They therefore are not
only ‘protective’ against stress but are ‘promotive’ of good functioning
whatever conditions children are living under. This is what some re-
searchers and clinicians mean by ‘protective factors’, while others prefer
a narrower definition that excludes factors that are good for everyone.
Narrowly defined protective factors help cancel out the effects of risk
factors, but confer no added benefits to individuals who are not exposed
to stress. An analogy drawn from physical health may make this clearer.
Using a broad definition, a balanced diet is a protective factor since it
promotes everyone’s physical health, regardless of whether or not they
have been exposed to infectious diseases or some other risk. By contrast,
having a vaccination against rabies is a narrowly defined protective factor
since it reduces the risk of getting ill if bitten by a rabid dog, but does
not make people healthier if they are not exposed to rabies. In the field
of mental health, many more factors have been identified as protective in
the broad sense than in the narrow sense (but see Box 37.2 on p. 314 for
an example of protective factors operating in the narrow sense).