Self-esteem and perceived stress in young adolescents with chronic disease. Unexpected findings

Depressive Symptoms, Perceived Stress, and Cortisol in School-Age Children With Type 1 Diabetes: A Pilot Study

Despite adequate insulin regimens and concurrent treatments for Type 1 diabetes (T1D), many children have trouble achieving glycemic control, as evidenced by elevated HbA1c levels. Maternal and child depressive symptoms, as well as child perceived stress, are associated with less optimal glycemic control. Cortisol, a stress hormone, may mediate the relationships among depressive symptoms, perceived stress, and glycemic control. The purposes of this pilot study were to (1) examine the feasibility of collecting salivary samples to measure cortisol change in prepubertal school-age children diagnosed with T1D and (2) determine effect sizes for the relationships among maternal depressive symptoms and child depressive symptoms, perceived stress, cortisol levels, and glycemic control. Participants were recruited using convenience sampling from a pediatric endocrinology clinic in the southeastern United States. All data, including surveys, salivary samples, HbA1c, height, and weight, were collected the same day as a clinic visit. The study included 30 children, ages 6.9–12.2 years, and their mothers. Most children were female (70%) and Caucasian (76.7%), but the sample was socioeconomically diverse. HbA1c values ranged from 6.1% to 12.2%. Of the children, 18 showed normal declines in cortisol over 3 hr, while 12 had increases in cortisol. Results show recruitment, participation, and data collection are feasible in school-age children with T1D. Examination of relevancy thresholds for effect sizes between variables of interest supports the need for future research in a larger, more representative sample on research questions that include the role cortisol plays as a potential mediator among examined variables.

Multidimensional analysis of food-allergic children and adolescents' self-concept: A comparison with a healthy matched sample

The study investigated self-concept in food-allergic youths and matched healthy controls. Global and domain-specific self-concepts were assessed in 154 participants (9-19 years) using the Multidimensional Self-Concept Scale. Statistical analysis assessed differences between the two samples and effects of asthma, dermatitis, age, and gender among patients. Significant differences were found for Total Scale score and for Competence and Physical scores. Patients showed clinically problematic self-concepts in Global, Competence, and Family domains. Age was found to be associated with the Total score. Health professionals should consider food-allergic patients' personality development. Further studies could examine disease-specific consequences and interventions.

How do you feel? Self-esteem predicts affect, stress, social interaction, and symptom severity during daily life in patients with chronic illness

Self-esteem has been demonstrated to predict health and well-being in a number of samples and domains using retrospective reports, but little is known about the effect of self-esteem in daily life. A community sample with asthma (n = 97) or rheumatoid arthritis (n = 31) completed a self-esteem measure and collected Ecological Momentary Assessment (EMA) data 5x/day for one week using a palmtop computer. Low self-esteem predicted more negative affect, less positive affect, greater stress severity, and greater symptom severity in daily life. Naturalistic exploration of mechanisms relating self-esteem to physiological and/or psychological components in illness may clarify causal relationships and inform theoretical models of self-care, well-being, and disease management.

A systematic review of the self-concept of children with cerebral palsy compared with children without disability

Young people with cerebral palsy (CP) are often assumed to have low self-concept, in other words, they do not feel good about themselves. We systematically searched the literature to determine whether this assumption was supported by empirical research. Relevant trials were identified by searching electronic databases, and this was supplemented by citation tracking. Of 1355 papers initially identified, six met the criteria for review. Results showed that adolescent females with CP have a lower self-concept than females without disability in the domains of physical appearance (d = -1.16; 95% confidence interval [CI] -2.06 to -0.26); social acceptance (d = -1.24; 95% CI -2.15 to -0.33); athletic competence (d = -0.93; 95% CI -1.79 to -0.07); and scholastic competence (d = -0.86; 95% CI, -1.71 to -0.01). Adolescent females with CP may be an at-risk group owing to their vulnerable self-concept. Clinicians may need to monitor and implement appropriate intervention strategies with this group. There was insufficient evidence to conclude that children with CP, in general, have a lower global self-concept compared with those without disability.

Chronic illness and emotional distress in adolescence

OBJECTIVE

The purpose of this study was to investigate emotional distress and suicidal ideation among adolescents with and without chronic illness.

METHODS

Two groups were compared from the Barcelona Adolescent Health Survey (3,129 students aged 14-19 years) data base. The index group included 162 adolescents with chronic conditions (100 females and 62 males) including those with asthma, diabetes, seizures, or cancer. No differences in prevalence of emotional distress or suicidal ideation were found among the four categories of disease. The control group included 865 subjects (383 females and 482 males). No age differences were evident between the index and control groups. Chi-square and Student's t-test were used for intergroup comparisons, with the criterion value set at p < .01 to reduce the probability of type I error. Analyses were conducted separately by gender.

RESULTS

Compared with controls, a significantly greater proportion of females with chronic illness reported emotional problems, feeling in a bad mood, feeling sad, believing nothing amused them, having suicidal thoughts, expressing depressive symptomatology, and having personal problems needing professional help. In contrast, no significant group differences were found for males. No gender differences were found regarding recent contact with a mental health specialist.

CONCLUSIONS

Chronic illnesses were associated with substantive emotional distress and suicide ideation in females but not in males. Females with chronic conditions did not, however, seek mental health services more often than their non-chronically ill counterparts. This suggests serious shortcomings in identification of "at-risk" youth and effective outreach to this population.

Factors influencing self-esteem and self-consciousness in adolescents with spina bifida

PURPOSE

To identify the demographic, personal, familial, attitudinal, and social factors that influence the self-esteem of adolescents with spina bifida.

METHODS

A structured face-to-face interview, that included the Rosenberg Self-Esteem Inventory, was conducted with 107 adolescents with spina bifida. Discriminant analyses were performed to identify the factors that discriminate between adolescents with spina bifida who have low vs. high self-esteem and low vs. high self-consciousness. The discriminant functions included variables from the following domains: sociodemographics, personal biography, family interaction, peer relationships and activities, school and work experiences, attitudes toward spina bifida, sexuality and sexual education, and future aspirations.

RESULTS

The factors contributing most positively to adolescents' self-esteem were age-appropriate treatments by parents and parental permissiveness in social participation, as perceived by the adolescents. Factors negatively associated with self-esteem included school problems, a perception of disability by others, and living in a medium-sized town (i.e., population 10,000-49,999). The discriminant models correctly identified 57.8% of adolescents who had low self-esteem and 50.4% of those with high self-consciousness, and accurately classified 92.6% and 88.4% of those who had high self-esteem and low self-consciousness, respectively.

CONCLUSION

Parents' relationships with their adolescents have important associations with the self-image of the youth.

Body image in chronic illness--a reconceptualization

OBJECTIVE

Was to construct a classification system of the body image specifically relevant to patient experience of chronic physical disorder.

METHOD

To review both previous writings on body image and also data on psychosocial factors relevant to a variety of chronic illnesses. From this were derived four component parts of body image: comfort, competence, appearance and predictability. These are discussed in general and disease-specific terms.

RESULTS

Using this format, a classification system is offered. This is intended to be simple enough for routine clinical use and yet to offer some insight into body experience. An example is given.

CONCLUSION

Separating out the aspects of body image relevant to physical illness provides a clinically useful classification system. Further work is needed to determine its applicability as a research tool.

What, me worry? A survey of adolescents' concerns

Adolescence is generally regarded as a time of transition demanding considerable adaptation. Failing to successfully negotiate the developmental hurdles associated with this period can have serious physical and psychosocial consequences (e.g., teenage pregnancy, suicide, disruption of social relationships, poor school performance). Efforts to identify problems that adolescents typically experience have been useful in facilitating a better understanding of this developmental phase. However, the perceived concerns or worries of adolescents themselves have been neglected as an additional source of useful information. This study assessed the worries of 622 adolescents between the ages of 12 and 20 years on an 80-item self-report measure, the "Things That Worry Me" scale. Findings indicated consistent concerns related to terrorism, adolescents' self-esteem, parents' physical and mental health, and adolescents' dating and sexual relationships. Gender- and race-specific differences are discussed and implications for future research and clinical applications are offered.

Depression, self-esteem, and life events in adolescents with chronic diseases

This study assesses whether nonhospitalized adolescents with chronic diseases differ from their healthy peers on standardized measurements of depression, self-esteem, and life events. The study group consisted of 80 patients (20 with sickle cell disease, 40 with asthma, and 20 with diabetes). All patients had been admitted at least twice in the preceding year, had their disease for at least 2 years, and were between the ages of 12 and 18. The control group consisted of 100 adolescents, matched for age and socioeconomic status, from local schools. All subjects completed a questionnaire compiled from the Beck Depression Inventory (BDI), the Rosenberg Scale of Self-Esteem, and the McCutcheon Life Events Checklist. Adolescents with chronic disease had higher depression scores (p less than 0.001) and lower self-esteem (p less than 0.001) than their healthy age-matched controls. There was no statistically significant difference in life events between the chronic disease and control groups. Depression, self-esteem, and life events did not differ significantly among the three disease groups. These findings suggest a need for intervention strategies to address depression and low self-esteem in adolescents with chronic disease.