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Project

The biopsychosocial adjustment of emerging adults with a chronic illness: Trajectories, concomitants, and mechanisms of change

It has been estimated that over 20% of adults worldwide now have a chronic illness. The emergence of this new population poses various challenges to health care, as many of these patients struggle with the medical and psychosocial consequences of their illness. However, large inter-individual differences have been observed in how patients cope with their illness. To understand why some patients show poor functioning whereas others display signs of resilience, it is important that researchers identify modifiable determinants through which patients’ functioning can be improved. In the present doctoral project, we focused on the role of patients’ personality traits, illness perceptions, and coping strategies. Two common chronic illnesses were sampled to investigate whether findings could be generalized across illnesses. Type 1 diabetes is the most common chronic metabolic condition in youth, requiring a difficult management process including daily blood glucose testing, insulin injections, diet, and exercise. Congenital heart disease, comprising a wide spectrum of simple, moderate, and complex severity lesions, is the most common birth defect. When not managed properly, both illnesses are characterized by substantial morbidity and can impose a significant burden on individuals, families, and healthcare systems.

Our first objective was to explore differences in Big Five personality traits between individuals with and without a chronic illness, and to relate these traits to various generic and illness-specific outcomes. Small differences in Big Five personality traits were observed between patients and controls. These differences were somewhat more pronounced in emerging and young adults with Type 1 diabetes than in adolescents with congenital heart disease. Furthermore, in both patient samples, important associations were uncovered between the Big Five personality traits and various indicators of adjustment. In adolescents and emerging adults with Type 1 diabetes, these associations were found to be bidirectional in nature.

Our second objective was to examine the role of illness perceptions (i.e., how patients  think about their illness) and coping strategies (i.e., how patients deal with illness-specific challenges) in adjusting to chronic illness. Again, important associations were uncovered between illness perceptions and various indicators of adjustment in both illnesses. More specifically, illness perceptions were linked to quality of life, perceived health status, and symptoms of depression and anxiety in a large sample of adults with congenital heart disease from 15 different countries. Furthermore, in emerging and young adults with Type 1 diabetes, a two-wave longitudinal design was used to examine the directionality of effects. Evidence was found for a pathway from illness perceptions to patient adjustment, rather than vice versa. With regard to coping, we found evidence for a reverse pathway, with poorer glycemic control predicting a relative increase in avoidant coping and a relative decrease in illness integration five years later. Finally, illness perceptions and coping were identified as intervening mechanisms in the relationship between personality and adjustment in emerging and young adults with Type 1 diabetes, addressing our third research objective.

A fourth and final objective was to examine how different generic and illness-specific outcomes interacted with one another over time. In emerging and young adults with Type 1 diabetes, depressive symptoms were found to spill over in illness-specific distress over time. Furthermore, in adolescents with Type 1 diabetes, higher levels of benefit finding predicted better adherence to treatment guidelines six months later.

In sum, the present dissertation identified important associations among personality, illness perceptions, coping, and patient adjustment and, in this way, addressed important gaps in the chronic illness literature. We hope that our findings may help healthcare professionals in understanding the needs of individuals with a chronic illness and may inform prevention and intervention programs aimed at improving these patients’ adjustment.

 

Date:1 Oct 2011 →  30 Sep 2018
Keywords:Chronic illness, Personality, Illness perceptions, Coping
Disciplines:Biological and physiological psychology, General psychology, Other psychology and cognitive sciences
Project type:PhD project