Jessica Rassart

Sense of coherence is a predictor of perceived health in adolescents with congenital heart disease: A cross-lagged prospective study

BACKGROUND The life expectancy of patients with congenital heart disease (CHD) has increased substantially. Health care should meet their needs through enhancing psychological functioning, quality of life, and perceived health. A possible determinant of these variables is sense of coherence (SOC). The interplay between SOC and outcome variables is not thoroughly scrutinized yet. OBJECTIVE To examine the direction of relationships between SOC and domains of perceived health in adolescents with CHD. DESIGN A longitudinal, observational study with two measurement points and a time lag of nine months. SETTING The pediatric and congenital cardiology department of a university hospital in Belgium. PARTICIPANTS Adolescents with CHD (n=429 at time 1) were recruited from the hospitals database. At time 1, mean age was 15.8 years, 53.4% were boys, and most adolescents had a moderately complex heart defect (47.6%). METHODS Participants filled out the 13-item SOC questionnaire and the PedsQL scale at both time points. Cross-lagged path analysis using structural equation modeling was conducted, controlling for age, sex, educational level, disease complexity, and prior heart surgery for CHD. RESULTS SOC at time 1 positively predicted all domains of generic perceived health (physical, emotional, social, and school functioning) and three out of five domains of disease-specific perceived health (symptoms, physical appearance, and cognitive problems) at time 2. Conversely, better school functioning and less cognitive problems at time 1 positively predicted SOC at time 2. CONCLUSIONS Evidence was obtained for reciprocal pathways between SOC and the domains of perceived health, although the predominant direction of effects was found to be from SOC to perceived health. Hence, improving SOC has the potential to enhance future perceived health of adolescents with CHD.

Identity processes and personality traits and types in adolescence : Directionality of effects and developmental trajectories

Personality traits are hypothesized to be among the most important factors contributing to individual differences in identity development. However, longitudinal studies linking Big Five personality traits to contemporary identity models (in which multiple exploration and commitment processes are distinguished) are largely lacking. To gain more insight in the directionality of effect and the developmental interdependence of the Big Five and identity processes as forwarded in multilayered personality models, the present study assessed personality and identity in 1,037 adolescents 4 times over a period of 3 years. First, using cross-lagged path analysis, Big Five traits emerged as consistent predictors of identity exploration processes, whereas only one significant path from identity exploration to the Big Five was found. Second, using latent class growth analysis, 3 Big Five trajectory classes were identified, resembling the distinctions typically made between resilients, overcontrollers, and undercontrollers. These classes were characterized by different initial levels and (to a lesser extent) rates of change in commitment and exploration processes. In sum, important developmental associations linking personality traits to identity processes were uncovered, emphasizing the potential role of personality traits in identity development. Developmental implications and suggestions for future research are discussed.

Personality traits, quality of life and perceived health in adolescents with congenital heart disease

This study investigated how the Big Five personality traits were related to quality of life and perceived health in adolescents with congenital heart disease (CHD). Adolescents with CHD were selected from the database of paediatric and congenital cardiology of the University Hospitals Leuven. A total of 366 adolescents (15–20 years) participated; 364 were matched on sex and age with community controls. Adolescents’ personality was assessed using the Quick Big Five, quality of life was measured using a Linear Analogue Scale and several domains of perceived health were assessed using the Paediatric Quality of Life Inventory. Adolescents with CHD displayed similar Big Five levels as controls, except for a lower score on Extraversion. Whereas disease-specific domains of perceived health were mainly related to Emotional Stability, several traits contributed to patients’ quality of life and generic perceived health. Hence, the present findings demonstrate that the Big Five is a valuable framework for examining linkages between personality and disease adaptation in chronic disease populations. Moreover, these findings underscore the importance of examining patients’ personality to shed light on their daily functioning. Future research should explore potential mechanisms detailing how personality influences disease adaptation over time in these patients.

Identity dynamics and peer relationship quality in adolescents with a chronic disease: the sample case of congenital heart disease.

OBJECTIVE Identity formation has been found to relate to psychosocial and disease-specific functioning in chronically ill adolescents. Therefore, examining antecedent factors of identity formation in this population is needed. The main goal of the present longitudinal study was to examine how peer relationship quality influenced identity formation in adolescents with congenital heart disease (CHD). METHOD Adolescents with CHD were selected from the database of pediatric and congenital cardiology of the University Hospitals Leuven. A total of 429 adolescents (14-18 years) with CHD participated at time 1; 401 were matched on gender and age with community controls recruited at secondary schools. Adolescents completed questionnaires on identity and peer relationship quality. Nine months later, at time 2, 382 patients again completed these questionnaires. RESULTS Adolescents with CHD were generally found to be as competent as controls in addressing the task of identity formation. Moreover, the importance of peer relationships for identity formation was demonstrated. Supportive peer relationships positively influenced the process of identifying with the identity commitments made. Furthermore, such relationships protected adolescents from getting stuck in the exploration process. Finally, reciprocal pathways were uncovered; a maladaptive exploration process was also found to negatively affect peer relationships. CONCLUSION The present study found peer relationship quality to be an important antecedent factor of identity formation in adolescents with CHD. Future research should investigate how changes in peer relationships and identity relate to well-being in these patients.

Parental and peer support in adolescents with a chronic condition: a typological approach and developmental implications

Research has consistently demonstrated that contextual support is crucial towards the psychological functioning of adolescents with chronic conditions. However, the literature has predominantly focused on parental support instead of adopting an integrated approach to parental and peer support. The present manuscript with two longitudinal studies in adolescents with Type 1 diabetes and congenital heart disease examined the extent to which different clusters of maternal, paternal, and peer support at baseline were related to well- and ill-being over time. In both studies, four clusters emerged: combined support, parental support, peer support, and lack of support. Follow-up longitudinal analyses indicated that especially combined support from parents and peers proved to be of crucial importance towards psychological functioning. The present studies demonstrated the value of a typological approach for assessing social support in adolescents with chronic conditions. In addition to focusing on parental support, future research should assess peer support as well in these adolescents.

Illness self-concept in Type 1 diabetes: A cross-sectional view on clinical, demographic, and psychosocial correlates

The present study assessed the centrality of one’s illness self-concept, or the degree to which chronic illness intrudes upon one’s self, in a sample of 478 18–35-year-old patients with Type 1 diabetes. Confirmatory factor analysis indicated that illness self-concept centrality was a one-dimensional construct, despite the fact that three constituting components (i.e. pervasiveness, directionality, and illness self-consciousness) have been forwarded. Further, important demographic and clinical correlates of illness self-concept were identified: women, unemployed individuals, individuals with a lower educational level, and patients with an insulin pump had a more central illness self-concept. Finally, a series of correlation and regression analyses indicated that, despite the fact that illness self-concept centrality was negatively related to emotional stability, self-esteem, and diabetes integration, and positively to perceived consequences of diabetes, illness self-concept had unique predictive value over and above these variables for problem areas in diabetes and depressive symptoms. Implications and suggestions for future research are outlined.

Loneliness in children and adolescents with chronic physical conditions: A meta-analysis

Objective This meta-analysis examines loneliness in children and adolescents with chronic physical conditions as compared with their peers. Multilevel meta-analyses were performed on 43 studies (69 samples), published between 1987 and 2015. A total of 2,518 individuals with chronic physical conditions and 1,463 control peers were included in the analyses. Children and adolescents with chronic conditions are, on average, somewhat lonelier than their peers without such conditions. Moreover, the link between chronic conditions and loneliness varied according to the recruitment procedure used for participant selection. Stronger links were found for studies that recruited from patient organizations as compared with clinical registers. Findings support the link between loneliness and chronic conditions. To take into account the heterogeneity within patient groups, we advocate an alternative approach that cuts across diagnostic boundaries and focuses on illness-related variables such as illness duration and visibility of the condition.

Illness Identity in Adolescents and Emerging Adults With Type 1 Diabetes: Introducing the Illness Identity Questionnaire.

OBJECTIVE The current study examined the utility of a new self-report questionnaire, the Illness Identity Questionnaire (IIQ), which assesses the concept of illness identity, or the degree to which type 1 diabetes is integrated into one’s identity. Four illness identity dimensions (engulfment, rejection, acceptance, and enrichment) were validated in adolescents and emerging adults with type 1 diabetes. Associations with psychological and diabetes-specific functioning were assessed. RESEARCH DESIGN AND METHODS A sample of 575 adolescents and emerging adults (14–25 years of age) with type 1 diabetes completed questionnaires on illness identity, psychological functioning, diabetes-related problems, and treatment adherence. Physicians were contacted to collect HbA1c values from patients’ medical records. Confirmatory factor analysis (CFA) was conducted to validate the IIQ. Path analysis with structural equation modeling was used to examine associations between illness identity and psychological and diabetes-specific functioning. RESULTS CFA indicated that the IIQ has a clear factor structure, meaningfully differentiating four illness identity dimensions. Rejection was related to worse treatment adherence and higher HbA1c values. Engulfment was related to less adaptive psychological functioning and more diabetes-related problems. Acceptance was related to more adaptive psychological functioning, fewer diabetes-related problems, and better treatment adherence. Enrichment was related to more adaptive psychological functioning. CONCLUSIONS The present findings underscore the importance of the concept of illness identity. A valid and reliable measure, the IIQ, is introduced to measure four illness identity dimensions in individuals with type 1 diabetes. These four illness identity dimensions were uniquely related to psychological and diabetes-specific functioning.

Development and persistence of depressive symptoms in adolescents with CHD.

Patients with CHD are vulnerable to psychiatric disorders. The present study compared baseline depressive symptoms between adolescents with CHD and community adolescents, and also assessed the development and persistence of depressive symptoms in patients. We examined the implications of persistent depressive symptoms towards quality of life and patient-reported health. In total, 296 adolescents with CHD participated in a four-wave longitudinal study, with 9-month intervals, and completed measures of depressive symptoms - Center for Epidemiologic Studies Depression Scale (CES-D) - at time points one to four and of quality of life - linear analogue scale (LAS) - and patient-reported health - LAS and Pediatric Quality of Life Inventory - at T (time) 4. Information about diagnosis, disease complexity, and previous heart surgery was collected from medical records. At T1, 278 patients were matched 1:1 with community adolescents, based on sex and age. The findings of this study indicate that patients scored significantly lower on depressive symptoms compared with community adolescents. Depressive symptoms in the total patient sample were stable over time and were unrelated to disease complexity. Based on conventional cut-off scores of the CES-D, substantial individual differences existed in the extent to which depressive symptoms persisted over time: 12.2% of the patients reported elevated depressive symptoms at minimally three out of the four time points. Especially physical functioning, cardiac symptoms, and patient-reported health at T4 were predicted by persistent depressive symptoms, even when controlling for the level of depressive symptoms at T4. Our findings indicate that those involved in the care of adolescents with CHD should remain vigilant to persistent depressive symptoms and arrange timely referral to mental healthcare services.

Parent–adolescent conflict, treatment adherence and glycemic control in Type 1 diabetes: The importance of adolescent externalising symptoms

Parent–adolescent conflict has been demonstrated to relate to treatment adherence and glycemic control in adolescents with Type 1 diabetes. The present longitudinal study investigated how these variables were interrelated over time, and examined whether externalising and internalising symptoms function as mediating variables. A total of 109 adolescents with diabetes participated at four annual time points and completed measures on conflict with parents, internalising and externalising symptoms. Information on treatment non-adherence and glycemic control was obtained from treating physicians. Cross-lagged analyses from a structural equation modelling approach indicated that father–adolescent but not mother–adolescent conflict positively influenced treatment non-adherence over time, which, in turn, was associated with higher glycosylated haemoglobin-values. Further, externalising but not internalising symptoms were found to mediate the pathway from father–adolescent conflict to treatment adherence over time. Finally, mother–adolescent conflict was found to relate indirectly to treatment non-adherence through its relationship with externalising symptoms. Hence, the present longitudinal study provides evidence that externalising symptoms represent an important mechanism through which earlier experiences of parent–adolescent conflict may influence later treatment non-adherence and poorer glycemic control. Implications and suggestions for future research are outlined.