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Graduate Student Journal of Psychology
Spring 2024 - Vol. 22

Copyright 2024 by the Department of Counseling and Clinical Psychology
Teachers College, Columbia University

Resilience and Psychological Distress in Genetic Testing 
for Alzheimer's Disease 

 The landscape of preventative genetic testing is 
continuously expanding, providing insights into the 
likelihood of developing or transmitting genetic disor-
ders. This form of testing holds apparent significance: 
offering the advantage of foreknowledge about genetic 
diseases prior to the manifestation of symptoms, facil-
itating the diagnosis of various conditions, and receiv-
ing information pertaining to the potential transmis-
sion of genetic disorders to offspring (Khoury et al., 
2006). Within Alzheimer's disease and related demen-
tias, a focal point of investigation lies in genetic testing. 
Advanced technology is now available to analyze ge-
netic makeup, facilitating the identification of specific 
genes associated with the onset of Alzheimer's disease. 
Consequently, some individuals are interested in pro-
curing their genetic results (Cutler & Hodgson, 2003). 
As genetic testing advances and refines, its accessibil-
ity is anticipated to expand, granting individuals the 
choice of accessing information about their suscepti-
bility to Alzheimer's disease and related dementias. 
Ethical considerations stemming from the acquisition 
of potential symptomatology knowledge encompass 
issues of hereditary transmission, lifestyle adjust-
ments, and future life planning (Roberts et al., 2003).
 Alongside the benefits of genetic testing, there are 
potential ramifications for those who opt to acquire 
genetic information, notably an increase in psycholog-
ical distress. Psychological distress is characterized by 
a spectrum of stress-related symptoms encompassing 

anxiety, tension, and depression, significantly impact-
ing overall well-being (Gooding et al., 2006). In the 
context of discovering that one is a carrier of an Alz-
heimer’s disease gene, individuals may commonly be 
confronted with uncertainties regarding the timing 
and potential outcomes of their condition, thus in-
tensifying psychological distress (Galluzzi et al., 2022). 
Given that Alzheimer's disease and related demen-
tias involve irreversible brain degeneration and lack 
definitive curative treatments, the absence of viable 
long-term remedies could lead to distress among in-
dividuals experiencing cognitive impairment or a de-
mentia diagnosis (Cutler & Hodgson, 2003). There-
fore, receiving genetic information about Alzheimer's 
disease has the potential to induce substantial psy-
chological distress (Bookherimer & Burggren, 2009).
 Moreover, chronic stress has been shown to ex-
ert a detrimental impact on Alzheimer's disease itself. 
Research suggests that sustained stress can accelerate 
the progression of Alzheimer’s disease, leading to in-
creased neurodegeneration and the worsening of cog-
nitive and behavioral symptoms in affected individ-
uals (Justice, 2018). This complex interplay between 
stress and Alzheimer’s disease underscores the need 
for comprehensive interventions aimed at addressing 
both the psychological well-being of patients and the 
biological factors contributing to disease progression.
 Though the psychological impact of receiving a 
diagnosis for an incurable disease is apparent, the do-

Alicia Burgei
Department of Psychology, Tiffin University

The relationship between resilience and psychological distress resulting from genetic testing for Alzheimer’s disease 
among non-cognitively impaired individuals is examined in this study. Preventative genetic testing determines the 
likelihood of developing or passing on genetic disorders. However, receiving genetic information, especially regarding 
incurable diseases like Alzheimer’s disease, can lead to significant psychological distress. Resilience, the ability to cope 
with adversity and recover quickly, is considered a protective factor against psychological distress. The purpose of this 
study is to investigate whether higher levels of resilience are associated with lower psychological distress from genetic 
testing for Alzheimer’s disease and to determine if having a familial history of Alzheimer’s disease influences this re-
lationship. An online cross-sectional survey was conducted among 181 non-cognitively impaired participants (43.6% 
Male; 54.1% Female; Mage=38.1 [13.9]) using the Impact of Genetic Testing for Alzheimer’s Disease (IGT-AD) scale 
and the Brief Resilience Scale (BRS), along with a question about family history of Alzheimer’s disease. The results 
indicated a significant negative correlation between resilience and psychological distress, suggesting that individuals 
with higher resilience experienced lower distress related to genetic testing. However, family history did not mediate the 
relationship, meaning the protective effect of resilience was consistent regardless of familial risk. These findings have 
implications for developing targeted support services and resilience-based interventions to help individuals cope with 
the emotional impact of genetic testing for Alzheimer’s disease. Further research could explore other potential pro-
tective factors and examine the long-term impact of genetic testing results on psychological well-being and behavior.
 Keywords: resilience, psychological distress, genetic testing, Alzheimer’s disease



6

BURGEI

main of potentially protective factors remains less ex-
plored. Resilience is a pivotal protective factor against 
psychological distress (Garmezy, 1991). Resilience, 
characterized by the ability to withstand or recover 
quickly from distress, has an established inverse cor-
relation with psychological distress (Yasien et al., 2016). 
Norman Garmezy introduced the resilience theory 
to understand how individuals who face adversities 
and risk exposure can develop normally and become 
healthy adults (Garmezy, 1991). This theory postu-
lates that resilience entails rebounding from emotion-
al distress and maintaining adaptive behavior despite 
threats and adversities to an individual's well-being.
 Resilience has been shown to impact the adjust-
ment to genetic testing results with hereditary diseas-
es, including cancers (Ho et al., 2010). Psychological 
distress from genetic testing is impacted by the se-
verity of the disease, perceived risk, ability to control 
the disease, and availability of treatments (Oliveri et 
al., 2018). Analogous to cancer, Alzheimer's disease 
significantly affects quality of life and psychosocial 
well-being and often necessitates long-term care or 
interventions (Oliveri et al., 2018). Hence, further 
exploration is required to unravel the interplay be-
tween resilience and psychological distress from ge-
netic testing, particularly in Alzheimer's disease. 
 Moreover, the influence of resilience on psycho-
logical distress may not be uniform across all indi-
viduals. Family history, which signifies whether an 
individual has a familial predisposition to Alzheimer's 
disease, has the potential to influence this relation-
ship. A family history of a disease, particularly one 
with a genetic component like Alzheimer's disease, 
can significantly heighten psychological distress (Liu 
& Cao, 2014). It leads to increased awareness of one's 
susceptibility, fostering stress and anxiety, as individu-
als become more concerned about their own risk and 
the possibility of transmitting the condition to their 
descendants (Roberts et al., 2003). Furthermore, fam-
ily history can impose a perceived genetic "inheritance 
burden" on individuals, leading to guilt and concern 
about implications for their loved ones or future gen-
erations (James et al., 2006). While family history can 
increase the risk of developing Alzheimer's disease 
(Liu & Cao, 2014), its role in the context of resilience 
and psychological distress remains underexplored. 
 An understanding of the psychological impact of 
genetic testing, particularly in the Alzheimer's context, 

is beneficial in identifying individuals at heightened 
risk of psychological distress and in devising additional 
coping strategies (Chung et al., 2009). Resilience-based 
interventions aimed at strengthening an individual's re-
silience, thereby mitigating distress, and at promoting 
emotional well-being hold the potential to significant-
ly enhance the quality of life for individuals afflicted by 
neurocognitive disorders. However, more information 
is needed to understand how to effectively introduce 
resilience interventions (Wang et al., 2021), specifical-
ly in the context of receiving genetic testing results.
Purpose
  The purpose of this study is to examine the rela-
tionship between resilience and psychological distress 
from genetic testing for Alzheimer’s disease among 
non-cognitively impaired individuals, hereafter re-
ferred to as ‘unimpaired.’ Drawing from resilience 
theory, which posits that protective factors mitigate 
the adverse consequences of risk exposure (Garmezy, 
1992), it is hypothesized that individuals with high-
er levels of resilience will experience lower levels of 
psychological distress when considering genetic test-
ing for Alzheimer's disease. This association rests 
on the premise that individuals exhibiting higher 
resilience levels will experience lower levels of emo-
tional and behavioral challenges, such as depression, 
anxiety, and stress (Yasien et al., 2016), compared 
to their counterparts with lower resilience levels.
 Furthermore, family history is hypothesized to 
mediate the interplay between resilience and psy-
chological distress. Instances of psychological dis-
tress, including anxiety, depression, and disease-spe-
cific distress, tend to intensify in the presence of 
a family history of particular diseases (Liu & Cao, 
2014). Family history is projected to influence the 
strength of the relationship of resilience as a posi-
tive adaptation to psychological distress, given that 
a familial history of Alzheimer's disease is likely to 
amplify the psychological distress experienced by par-
ticipants contemplating genetic testing for the disease.
The intent of the study is to answer two key research 
questions:  
 1. Do variations in the Impact of Genetic Testing  
 for Alzheimer's Disease (IGT-AD) scores relate   
 to levels of resilience among unimpaired partici  
 pants? 
 2. Does the presence of a family history of Alzhei 
 mer’s disease influence or mediate this relationship?



7

RESILIENCE AND PSYCHOLOGICAL DISTRESS

 This study aims to recruit participants to com-
plete a survey consisting of the IGT-AD survey, Brief 
Resilience Scale, and a query regarding a family his-
tory of Alzheimer’s disease. The IGT-AD (Appendix 
1) was created to evaluate the nature of genetic infor-
mation and examine the impact of Alzheimer’s dis-
ease risk assessment (Chung et al., 2009). The survey 
will measure the adverse effects of participants receiv-
ing genetic information about Alzheimer’s disease. 
The Brief Resilience Scale (Appendix 2) will assess 
the perceived ability to bounce back or recover from 
stress (Smith et al., 2008). The variables, psychologi-
cal distress from Alzheimer's disease genetic testing 
and resilience, will be assessed for a relationship and 
will determine if family history impacts the relation-
ship. The findings hold significant implications for 
discerning susceptibility to psychological distress re-
lated to genetic testing and understanding the role of 
resilience in counteracting these psychological effects.

Method
Participant Recruitment and Selection
 To address the research question, a cross-section-
al survey was conducted online, leveraging the bene-
fits of prompt participant data collection without the 
need for in-person administration, which aligns with 
the study’s focus on obtaining a snapshot of charac-
teristics at a specific moment. This research project 
underwent rigorous ethical review and received In-
stitutional Review Board (IRB) approval from Tiffin 
University, ensuring the protection and well-being 
of all participants involved. Prior to involvement in 
the study, participants were required to complete an 
informed consent which provided comprehensive in-
formation about the research objectives, procedures, 
potential risks, benefits, and confidentiality measures. 
 Due to the convenience of online data collection, 
the internet survey platform, Prolific, was used for 
participant recruitment, with the study population 
of interest being cognitively unimpaired individuals. 
The survey obtained a study sample of participants 
who are not cognitively impaired or experiencing 
memory concerns through exclusion criteria. Par-
ticipants who answered “yes” to the initial question 
regarding memory concerns and cognitive impair-
ment: “Are you currently experiencing cognitive im-
pairment or concerns with your memory and think-
ing?”, were disqualified from the study. The survey 

was a convenience sample as the Prolific platform fills 
study places on a first-come, first-served basis and was 
distributed to all available participants. Participants 
were pre-screened for English as their primary lan-
guage, and an inclusion criterion was implemented 
to obtain participants only from the United States. 
Sample Size Determination
 A power analysis was conducted using G*Pow-
er to determine the appropriate sample size for the 
expected statistical analyses. For multiple regression 
(f2=.15, 80% power, α=.05) a minimum sample size 
of 82 and 68 participants, respectively, is required to 
yield meaningful results. The study aimed to recruit 
approximately 200 eligible participants to complete 
the survey, accounting for the number of partici-
pants deemed ineligible due to the initial question 
regarding memory concerns or cognitive impair-
ment and their incomplete survey completion. A to-
tal of 231 participants initiated involvement in the 
study, and 50 participants were disqualified from the 
study due to the inclusion criteria. The sample size 
consisted of 181 responses with an average survey 
completion time of three minutes. Participants who 
completed the entirety of the survey were reward-
ed $0.40 as an appreciation of their time and effort. 
Participant Demographics
 A total of 251 participants were presented with 
the survey, 181 met the inclusion criteria and com-
pleted the entirety of the survey. The sociodemo-
graphic characteristics are reported in Table 1. The 
sample consisted of 98 females (54.1%), 79 males 
(43.6%), and four non-binary participants (2.2%). 
Participants’ ages range from 19 to 73 years, with a 
mean age of 38.1 years (SD = 13.9). Regarding edu-
cational attainment, 1 participant (0.6%) had some 
high school education, 23 participants (12.7%) had 
completed high school or equivalent, 63 participants 
(34.8%) had some college education, 75 participants 
(41.4%) held a bachelor’s degree, and 19 partici-
pants (10.5%) held a graduate or professional degree. 
Survey Design
 The survey consisted of a one-group design with 
a two-variable comparison of psychological distress 
from Alzheimer’s disease genetic testing and resil-
ience. Google Forms was used to generate a survey 
consisting of the preliminary question regarding 
current cognitive impairment, two embedded scales, 
a question regarding family history of Alzheimer’s 



8

BURGEI

disease: “Do you have a history of Alzheimer’s dis-
ease in your family?” (Questionnaire 1), and demo-
graphic questions (Questionnaire 1). The study items 
were piloted among five participants to determine 
the appropriateness and consistency of the items.
Description of Scales
Impact of Genetic Testing for Alzheimer’s Dis-
ease Scale. The first scale, Impact of Genetic Testing 
for Alzheimer’s Disease (IGT-AD; Appendix 1), as-
sessed the dependent variable, psychological distress 
from receiving Alzheimer’s disease genetic testing 
(Chung et al., 2009). The IGT-AD scale was devel-
oped to accurately assess the psychological distress as-
sociated with genetic testing for Alzheimer's disease. 
While existing risk assessment scales predominantly 
focus on measuring depression and anxiety (Chung et 
al., 2009), the IGT-AD scale was formulated to gauge 
the psychological impact of genetic susceptibility to 
Alzheimer's disease, incorporating insights from oth-
er genetic testing impact assessment scales (Cella et 
al., 2002). This instrument is designed for clinical and 
research applications, providing a concise self-report 
measure of the psychological impact of genetic sus-
ceptibility to Alzheimer's disease (Chung et al., 2009). 
 This 16-item scale used a 4-point response scale 
where 0 was “strongly disagree,” and 5 was “strongly 
agree.” The total score ranges from 0-80, with higher 
scores reflecting greater psychological distress related 
to Alzheimer’s disease genetic testing (Chung et al., 
2009). In their study, Chung et al. (2009) reported a 
mean of 16.9 with a standard deviation of 9.9, serv-
ing as a reference point for interpretation, along with 
a Cronbach’s α of 0.82 for the scale. The IGT-AD was 
assessed for construct validity by comparing the final 
scale to other established psychometric scales, includ-
ing the Impact of Event Scale (IES), the Center for 
Epidemiologic Studies Depression Scale (CES-D), and 
the Beck Anxiety Inventory (BAI). Using Spearman’s 
correlations, the final scale was positively correlated 
with all the psychometric scales indicating convergent 
validity (Chung et al., 2009). The assessment results 
suggest that the IGT-AD is a valid and reliable scale 
that may be a more useful and sensitive tool in measur-
ing psychological distress specific to Alzheimer’s dis-
ease genetic testing than other generalized mood scales.
Brief Resilience Scale. The second scale, the 6-item 
Brief Resilience Scale (BRS; Appendix 2), was used 
to measure the independent variable, resilience, or 

the perceived ability to bounce back or recover from 
stress (Smith et al., 2008). This 6-item scale used a 
5-point response scale where 0 was “strongly dis-
agree,” and 5 was “strongly agree.” The total score 
ranges from 0-30, with higher scores reflecting great-
er resilience (M=21.18-23.88, SD=4.08-5.1; Smith et 
al., 2018). Smith et al. (2018) reported Cronbach’s 
α of 0.80-0.91 for the scale. The BRS was assessed 
for convergent validity and was positively correlat-
ed with resilience measures, including optimism, 
social support, and life purpose, and was negatively 
correlated with pessimism and negative interactions 
(Smith et al., 2008). The assessment results indicate 
that BRS is an adequate measure of resilience with 
good internal consistency and test-retest reliability.
Reliability and Validity in the Current Dataset
 To ensure the reliability and validity of the mea-
surement instruments in the current dataset, an 
analysis of internal consistency was conducted using 
Cronbach's alpha. The values for Cronbach's alpha 
in our dataset, demonstrating a high level of internal 
consistency (α= .82 for IGT-AD and α= .94 for BRS), 
were found to be consistent with previous research 
(Chung et al., 2009; Smith et al., 2018), affirming the 
instruments' sustained reliability. Additionally, the 
content validity of the scales, which assess the intend-
ed constructs, was confirmed as the items were adapt-
ed from previous studies with established validity.
Data Screening and Preliminary Assumptions
 Statistical analyses were performed using the 
SPSS 28.0 statistical software. The data met the as-
sumptions for multiple regression analysis: (a) one 
continuous independent variable (IGT-AD Total 
Scores), one continuous dependent variable (BRS To-
tal Scores), and one dichotomous mediator variable 
(family history) , (b) independent observations, (c) a 
linear relationship exists between the independent and 
dependent variables, (d) homoscedasticity is present, 
(e) no multicollinearity, (f) no outliers, and (g) the 
residuals are normally distributed. A Durbin-Wat-
son statistic was conducted to support the inde-
pendence of residuals (DW = 1.743). Standardized 
residuals indicated approximately normally distrib-
uted errors, as did the normal P-P plot of standard-
ized residuals. Tests for multicollinearity showed no 
concern (BRS total scores, Tolerance = .994, VIF = 
1.006; Family history, Tolerance = .994, VIF =1.006). 
 In order to explore the potential mediating effect 



9

RESILIENCE AND PSYCHOLOGICAL DISTRESS

of family history on the relationship between psy-
chological distress and resilience, a mediator analysis 
using regression was applied. In the mediator anal-
ysis, psychological distress and resilience are defined 
as the dependent and independent variables, respec-
tively, while family history is defined as the media-
tor to determine if family history impacts the rela-
tionship. The PROCESS Macro Model 4 for SPSS 
was utilized to apply a bias-correct non-parametric 
bootstrapping technique with 5000 resamples to esti-
mate family history’s direct, indirect, and total effects 
(Preacher & Hayes, 2008). All assumptions for the 
mediator analysis using regression analysis were met.

Results
Descriptive Statistics
 The survey's descriptive statistics are reported in 
Table 2. The sample contained 52 participants with 
a family history of Alzheimer's disease (28.7%) and 
129 participants without (71.3%). No family history 
was coded as 0, and family history was reported as 1 
with a reported mean of .287 (SD = .454). The total 
scores of the IGT-AD scale ranged from 1 to 72, with 
a mean score of 34.3 (SD = 11.8), indicating moderate 
psychological distress related to Alzheimer's disease ge-
netic testing for the sample. The total score of the BRS 
scale ranged from 6 to 30, with a mean score of 19.8 
(SD = 5.4), indicating a moderately resilient sample.
Statistical Analyses
Multiple Regression Analysis 
 A multiple regression analysis was performed to 
investigate the relationship between psychological 
distress from Alzheimer’s disease-related genetic test-
ing (IGT-AD scores) and resilience (BRS scores). The 
model, incorporating BRS scores as the independent 
variable and IGT-AD scores as the dependent variable, 
yielded a significant negative association (Figure 1). The 
multiple correlation coefficient (R) was 0.415, indicat-
ing a moderate correlation between the predicted and 
observed values of IGT-AD scores and the predictor 
variable. The regression model, involving BRS scores, 
accounted for 17.22% of the variance in IGT-AD 
scores (R² = .172, F(2,175) = 16.057, p < 0.001). The 
unstandardized coefficient for BRS scores was -0.829 
(p < 0.001), indicating that, for each unit increase in 
BRS scores, IGT-AD scores decreased by 0.829 units.
Covariate Analysis
 To assess the potential influence of covariates on 

the relationship between BRS and IGT-AD scores an 
analysis of the covariates, including age, gender, and 
education was conducted. Education level emerged as a 
significant predictor (B = 1.963, SE = 0.892, β = 0.151, 
t = 2.202, p = .029), suggesting that individuals with 
higher education levels experienced higher psycholog-
ical distress. The results of this analysis revealed that 
after controlling for these covariates, the relationship 
between BRS and IGT-AD scores remained statistical-
ly significant (F(22,153) = 1.877, p = .015, η² = .212)). 
Mediator Analysis
  The mediator analysis results are reported in Ta-
ble 3. The analysis of family history revealed a non-sig-
nificant effect on IGT-AD scores (p = .163), suggest-
ing family history did not significantly influence the 
scores. The interaction term between BRS scores and 
family history did not significantly contribute to the 
variance in IGT-AD scores (R² = 0.011, F(1, 175) = 
2.326, p = 0.129), suggesting that the relationship 
between BRS scores and IGT-AD scores were not 
influenced by the presence of family history. Boot-
strap analysis further supported the regression results.

Discussion
 The present study investigated the relationship 
between resilience and psychological distress resulting 
from genetic testing for Alzheimer's disease among 
unimpaired individuals. The findings indicated a sig-
nificant negative correlation between resilience and 
psychological distress, indicating that higher levels of 
resilience were associated with lower levels of distress 
related to genetic testing for Alzheimer's disease, ir-
respective of age and gender. These results support 
previous research that resilience can act as a protective 
factor against psychological distress in the context of 
genetic testing for hereditary diseases (Ho et al., 2010).
 The negative correlation between resilience and 
psychological distress suggests that individuals with 
higher resilience may cope more effectively with the po-
tential implications of genetic testing for Alzheimer's 
disease. Resilience allows individuals to adapt positive-
ly to challenging situations and adversities (Garmezy, 
1991), which may translate into reduced distress when 
faced with the possibility of developing Alzheimer's 
disease. Higher levels of resilience may enable individ-
uals to maintain emotional well-being despite the per-
ceived threat of the disease and the uncertainty associ-
ated with genetic testing results (Yasien et al., 2016).



10

BURGEI

 The results also showed that family history did not 
significantly mediate the relationship between resil-
ience and psychological distress. This suggests that in-
dividuals with higher resilience may be better equipped 
to cope with the emotional impact of genetic testing, re-
gardless of their family history. While a family history of 
Alzheimer's disease can increase the risk of developing 
the condition (Liu & Cao, 2014), it did not significant-
ly impact how resilience influenced the psychological 
distress associated with genetic testing for the disease. 
 The development and use of the IGT-AD scale 
were essential in measuring the psychological im-
pact of genetic susceptibility to Alzheimer's disease 
(Chung et al., 2009). Previous scales primarily tar-
geted depression and anxiety, but the IGT-AD scale 
provides a more specific and sensitive measure for 
assessing distress specifically related to Alzheimer's 
disease genetic testing. Using validated and reli-
able measures, such as the IGT-AD and the BRS, 
strengthens the study's validity and supports the 
generalizability of the findings to other populations 
undergoing genetic testing for hereditary diseases.
 The present study contributes to the existing lit-
erature by focusing on unimpaired individuals' psy-
chological distress related to genetic testing for Alzhei-
mer's disease. Understanding the factors that influence 
individuals' responses to genetic testing is crucial, as it 
can help identify those at higher risk of experiencing 
distress and guide the development of tailored inter-
ventions. The results suggest that resilience-based 
interventions may be beneficial for individuals un-
dergoing genetic testing for Alzheimer's disease, as 
they may help mitigate the psychological distress asso-
ciated with receiving test results (Wang et al., 2021).
Limitations
 The present study had some limitations that 
should be acknowledged. The sample consisted of a 
convenience sample of unimpaired individuals recruit-
ed online, limiting the generalizability of the findings 
to the broader population. Future research could aim 
to recruit a more diverse and representative sample to 
increase external validity. The study's cross-section-
al design does not allow for causal inferences, and 
future longitudinal studies can better examine the 
relationship between resilience and psychological dis-
tress over time. It is crucial to acknowledge that the 
IGT-AD and BRS scales were not counterbalanced 
in this study, thereby introducing the possibility 

of order effects influencing participants' responses. 
Self-report measures are subject to response biases, 
and participants may have provided socially desirable 
responses, leading to potential measurement errors. 
 Another potential limitation arises from the re-
liance on participant-reported family history of Alz-
heimer's disease. This information could be subject to 
variations in accuracy, as it depends on participants' 
knowledge and the extent of their inquiries within 
their families. Some participants may have inquired 
about Alzheimer's disease in only a few generations, 
while others may have gone further back in their fam-
ily tree. For future research, adopting more standard-
ized and comprehensive methods for assessing family 
history may enhance the accuracy of this variable. 
Implications and Future Research
 The study's findings have several implications for 
clinical practice and future research. First, identifying 
individuals at higher risk of psychological distress re-
lated to genetic testing can inform the development 
of targeted support and counseling services to help 
individuals cope with the emotional impact of test 
results. Healthcare providers should consider incorpo-
rating resilience-based interventions as part of pre-and 
post-genetic counseling for Alzheimer's disease and 
other hereditary conditions. Such interventions may 
help individuals develop coping strategies and enhance 
their emotional well-being in the face of potential risk 
ultimately aiding in the reduction of stress that can 
contribute to the accelerated progression and neuro-
degeneration of Alzheimer's disease (Justice, 2018).
 While the present study did not explicitly assess 
the temporal aspect of psychological distress, it is es-
sential to acknowledge that distress may vary over 
time. Genetic testing results can trigger acute stress 
reactions, followed by an adjustment period. For some 
individuals, this psychological distress may be tempo-
rary, while for others, it may extend into a more pro-
longed and chronic experience. Future research could 
delve into the dynamics of psychological distress over 
time in relation to genetic testing results, examin-
ing the factors influencing its duration and intensity.
 Future research should explore other potentially 
protective factors, such as social support, coping strat-
egies, and personality traits, to gain a comprehensive 
understanding of the factors that influence psycholog-
ical distress related to genetic testing for Alzheimer's 
disease. Longitudinal studies can also provide insights 



11

RESILIENCE AND PSYCHOLOGICAL DISTRESS

into how resilience evolves over time in response to 
receiving genetic testing results and the progression 
of Alzheimer's disease. Additionally, examining the 
long-term impact of genetic testing results on psy-
chological well-being and behavior, especially in those 
with a family history of Alzheimer's disease, can offer 
valuable information for personalized interventions.
Conclusion
 In conclusion, the present study adds to the grow-
ing body of literature on psychological distress related 
to genetic testing for Alzheimer's disease by examining 
the role of resilience as a protective factor. The findings 
highlight the importance of resilience in coping with 
the potential emotional impact of receiving genetic 
testing results and suggest that resilience-based inter-
ventions may be beneficial in supporting individuals 
undergoing genetic testing for Alzheimer's disease. 
Healthcare providers should consider incorporating 
resilience-based strategies in genetic counseling sessions 
to enhance individuals' ability to cope with the emo-
tional challenges of genetic testing. Further research is 
needed to explore other potentially protective factors 
and their role in influencing psychological distress relat-
ed to genetic testing for Alzheimer's disease, ultimate-
ly improving support and care for individuals at risk.

References
Bookheimer, S., & Burggren, A. (2009). APOE-4 

genotype and neurophysiological vulnerability to 
Alzheimer's and cognitive aging. Annual Review 
of Clinical Psychology, 5, 343-362. https://doi.
org/10.1146/annurev.clinpsy.032408.153625

Cella, D., Hughes, C., Peterman, A., Chang, C. H., Pe-
shkin, B. N., Schwartz, M. D., Wenzel, L., Lemke, 
A., Marcus, A. C., & Lerman, C. (2002). A brief 
assessment of concerns associated with genetic 
testing for cancer: The Multidimensional Impact 
of Cancer Risk Assessment (MICRA) question-
naire. Health Psychology, 21(6), 564-573. https://
doi.org/10.1037/0278-6133.21.6.564

Chung, W. W., Chen, C. A., Cupples, L. A., Roberts, 
J. S., Hiraki, S. C., Nair, A. K., Green, R. C., & 
Stern, R. A. (2009). A new scale measuring psy-
chological impact of genetic susceptibility testing 
for Alzheimer’s disease. Alzheimer Disease and 
Associated Disorders, 23(1), 50-56. https://doi.
org/10.1097/WAD.0b013e318188429e

Cutler, S. J., & Hodgson, L. G. (2003). To test or 

not to test: Interest in genetic testing for Alz-
heimer's disease among middle-aged adults. 
American Journal of Alzheimer's Disease & 
Other Dementias, 18(1), 9-20. https://doi.
org/10.1177/153331750301800106

Galluzzi, S., Mega, A., Di Fede, G., Muscio, C., Fas-
cendini, S., Benussi, L., Tagliavini, F., Frisoni, 
G. B., Di Maria, E., & Italian-DIAfN Working 
Group (2022). Psychological Impact of Predictive 
Genetic Testing for Inherited Alzheimer Disease 
and Frontotemporal Dementia: The IT-DIAfN 
Protocol. Alzheimer Disease and Associated Dis-
orders, 36(2), 118–124. https://doi.org/10.1097/
WAD.0000000000000494

Garmezy, N. (1991). Resilience in children's adapta-
tion to negative life events and stressed environ-
ments. Pediatric Annals, 20(9), 459-466. https://
doi.org/10.3928/0090-4481-19910901-05

Garmezy, N. (1992). Risk and protective factors in the 
development of psychopathology. Cambridge Uni-
versity Press.

Gooding, H. C., Linnenbringer, E. L., Burack, J., Rob-
erts, J. S., Green, R. C., & Biesecker, B. B. (2006). 
Genetic susceptibility testing for Alzheimer dis-
ease: Motivation to obtain information and con-
trol as precursors to coping with increased risk. 
Patient Education and Counseling, 64(1-3), 259-
267. https://doi.org/10.1016/j.pec.2006.03.002

Ho, S. M., Ho, J. W., Bonanno, G. A., Chu, A. T., & 
Chan, E. (2010). Hopefulness predicts resilience 
after hereditary colorectal cancer genetic testing: a 
prospective outcome trajectories study. BMC Can-
cer, 10(1), 1-10. https://doi.org/10.1186/1471-
2407-10-279

James, C. A., Hadley, D. W., Holtzman, N. A., & 
Winkelstein, J. A. (2006). How does the mode 
of inheritance of a genetic condition influence 
families? Genetics in Medicine: Official Jour-
nal of the American College of Medical Genet-
ics, 8(4), 234–242. https://doi.org/10.1097/01.
gim.0000215177.28010.6e

Justice N. J. (2018). The relationship between stress and 
Alzheimer's disease. Neurobiology of Stress, 8, 127–
133. https://doi.org/10.1016/j.ynstr.2018.04.002

Khoury, M. J., Jones, K., & Grosse, S. D. (2006). 
Quantifying the health benefits of genetic tests: 
the importance of a population perspective. Ge-
netics in Medicine, 8(3), 191-195. https://doi.



12

org/10.1097/01.gim.0000206278.37405.25
Liu, Y., & Cao, C. (2014). The relationship between 

family history of cancer, coping style and psycho-
logical distress. Pakistan Journal of Medical Sci-
ences, 30(3), 507-510. https://doi.org/10.12669/
pjms.303.4634

Oliveri, S., Ferrari, F., Manfrinati, A., & Pravettoni, 
G. (2018). A systematic review of the psycholog-
ical implications of genetic testing: a comparative 
analysis among cardiovascular, neurodegenerative 
and cancer diseases. Frontiers in Genetics, 9, 624. 
https://doi.org/10.3389/fgene.2018.00624

Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and 
resampling strategies for assessing and comparing 
indirect effects in multiple mediator models. Be-
havior Research Methods, 40(3), 879-891. https://
doi.org/10.3758/BRM.40.3.879

Roberts, S. J., LaRusse, S. A., Katzen, H., Whitehouse, 
P. J., Barber, M., Post, S. G., Relkin, N., Kimber-
ly, Q., Pietrzak, R. H., Cupples, A. L., Farrer, L. 
A., Brown, T., & Green, R. C. (2003). Reasons 
for seeking genetic susceptibility testing among 
first-degree relatives of people with Alzheimer dis-
ease. Alzheimer Disease & Associated Disorders, 
17(2), 86-93.

Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., 
Christopher, P., & Bernard, J. (2008). The 
brief resilience scale: assessing the ability to 
bounce back. International Journal of Behav-
ioral Medicine, 15(3), 194-200. https://doi.
org/10.1080/10705500802222972

Wang, Y., Chi, I., Zhan, Y., Chen, W., & Li, T. (2021). 
Effectiveness of resilience interventions on psy-
chosocial outcomes for persons with neurocogni-
tive disorders: a systematic review and meta-anal-
ysis. Frontiers in Psychiatry, 12, 709860. https://
doi.org/10.3389/fpsyt.2021.709860

Yasien, S., Nasir, J. A., & Shaheen, T. (2016). Rela-
tionship between psychological distress and re-
silience in rescue workers. Saudi Medical Jour-
nal, 37(7), 778-782. https://doi.org/10.15537/
smj.2016.7.15004

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Table 1

Sociodemographic Characteristics of the Participants



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Table 2

Survey Descriptive Statistics



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Table 3

Mediator Analysis



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Figure 1

Scatterplot of BRS and IGT-AD Total Scores



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Figure 2

Normality Distribution of IGT-AD and BRS Total Scores



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Appendix 1 

The Reveal Impact of Genetic Testing in Alzheimer’s Disease Scale (IGT-AD)

The questions below are about specific responses you may have about receiving your Alzhei-
mer’s disease genetic test results.  Please evaluate your response to receiving your results and 
answer every question in this section. Indicate whether you strongly disagree, disagree, agree, or 
strongly agree with each statement, by selecting the corresponding response.



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Note. Items 4, 5, 14, and 15 are reverse scored. To score, add the responses varying from 1-5 for 
all sixteen items, giving a range from 0-80.



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Appendix 2

Brief Resilience Scale (BRS)

Note. Items 2, 4, and 6 are reverse scored. To score, add the responses varying from 1-5 for all six 
items, giving a range from 6-30.



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Questionnaire 1 

Family History and Demographic Questions


