Adjusting to Chronic Health Conditions

Adjusting to Chronic Health Conditions

• Authors: Vicki S. Helgeson, Melissa Zajdel

• Affiliation: Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania

• Publication: Annual Review of Psychology, 2017

Abstract

• Research on chronic disease adjustment is crucial as more individuals live longer, often with chronic illnesses.

• Chronic illnesses can deteriorate, enter remission, or fluctuate but they overall persist.

• The review discusses:

  • Effects of chronic disease on identity.

  • Factors influencing adjustment:

    • Contextual (e.g., demographics, illness stigma)

    • Dispositional (e.g., personality resilience)

    • Social (e.g., support systems)

    • Dyadic coping

  • The review concludes with directions for future research.

Introduction

• Life expectancy has significantly increased (from 47 in 1900 to 79 in 2013).

• Major causes of mortality now include chronic diseases (e.g., heart disease, cancer).

• Adjustment to chronic illness is important as many live with their conditions for years or decades.

• Over 85.6 million people in the U.S. live with cardiovascular diseases; 14.5 million with cancer; 29.1 million with diabetes.

• Chronic diseases generally require active self-management rather than solely relying on physicians.

Effects of Chronic Disease on the Self

• Disease vs. Illness:

  • Disease: biological processes affecting individuals.

  • Illness: individual's experience of the disease.

• Chronic illness impacts one's identity, creating an illness identity that includes:

  • Physical impairments.

  • Emotional responses to symptoms.

  • Reevaluation of self-concept and future plans.

• Example: Men with prostate cancer faced diminished masculinity post-treatment; women with breast cancer faced distress over body image changes.

Adjustment Factors

Contextual Factors

• Factors influencing adjustment include:

  • Sex: Women often report poorer psychosocial adjustment than men in chronic conditions.

    • E.g. Women with type 2 diabetes show more depressive symptoms.

  • Social Class: Lower SES associated with poorer adjustment due to chronic stressors (e.g., fewer resources).

  • Race/Ethnicity: Health disparities exist; e.g. Black individuals experience greater distress and worse management of diabetes compared to Whites.

Resilience and Vulnerability Factors

• Resilience Factors:

  • Related to positive outcomes and include personality traits, cognitive adaptation, and benefits derived from adversity.

• Vulnerability Factors:

  • Include pessimistic attribution styles, avoidant coping, and gender-related traits.

Social Environmental Factors

• Social Support: Positive interactions are beneficial for adjustment; includes emotional, instrumental, and informational support.

• Unsupportive Interactions: Negative behaviors can undermine adjustment and contribute to distress (e.g., criticism, social constraints).

Dyadic Coping

• Involves managing stressors in relationships, particularly regarding chronic illness.

• Types of Dyadic Coping:

  • Positive dyadic coping: mutual support and collaboration.

  • Supportive dyadic coping: one partner assists the other managing the stressor.

  • Negative dyadic coping: ineffective attempts to help (e.g., criticism, superficial support).

Future Directions

• More research is needed on the interplay of factors affecting chronic illness adjustment, including:

  • Intersectionality in demographic factors.

  • The role of diverse social networks beyond spousal relationships.

  • Comprehensive longitudinal studies to understand time-related changes in adjustment.