Chronic illness in adolescence

Adolescents experience numerous changes. Coping with a chronic illness adds yet another dimension to their lives. This paper reviews the literature on chronically ill adolescents, addressing social, biological, psychological, cognitive, and cultural issues.     

A developmental psychopathology perspective on adolescence.

Developmental psychopathology offers an integrative framework for conceptualizing the course of development during adolescence, with particular relevance for understanding continuity and the emergence of psychopathology during this and subsequent developmental periods. In this article, the utility of a developmental psychopathology perspective for informing the design of research, prevention, and intervention is highlighted. Interdisciplinary, organizational models of development, emphasizing the dynamic relations between the developing individual and internal and external contexts, are discussed. Examination of boundaries between abnormal and normal development during adolescence offers important vantage points for articulating diversity in the developmental course during this period. Conceptualizing divergence and convergence in developmental pathways, continuity and discontinuity in development, and the transactions of risk and protective processes leading to maladaptation, psychopathology, and resilience are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression and the social developmental context of adolescence.

Examines the interrelations of personal and social factors in fostering longitudinal patterns of depressive symptoms, using 3 waves of data from high school students in the Boston area. Previously depressed and nondepressed youths differed markedly in their emotional responsiveness to family and friend relations. Chronically depressed youths were unresponsive to family problems, but were highly reactive to peer relations. Among previously asymptomatic youths, family relations exerted greater effects on depressed mood than relations with peers. Further analyses suggest a process through which chronic family turmoil shapes long-term mental health while also intensifying the distancing from family and investment in peer relationships that typically occurs in adolescence. Findings illustrate the importance of modeling transactions between personal and environmental factors in research on adolescent mental health and development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Known and potential processes underlying developmental trajectories in childhood and adolescence.

Recent research on influences associated with variability in child and adolescent adjustment has highlighted the nature of the multiple processes underlying this variability. Variability in child and adolescent adjustment is viewed as a function of covarying influences from multiple domains, operating on specific developmental outcomes across a background of time and the availability of environmental niches for the individual. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic pain and depression: role of perceived impact and perceived control in different age cohorts

Chronic pain adversely affects individuals' physical as well as emotional well-being. A cognitive-behavioral model has been proposed to explain the role of cognitive appraisal variables in mediating the development of emotional distress following pain of long duration. There is little evidence linking the prevalence of depression in chronic pain patients to life stage, but there are suggestions in the literature that the link between medical illness and depression may be stronger in elderly patients. One purpose of this study was to replicate the efficacy of a previous study of the cognitive-behavioral mediation model in explaining the association between pain and depressed affect. A second purpose of this study was to extend the cognitive-behavioral model to evaluate relationships among pain, cognitive appraisal variables, and depressive affect in the elderly chronic pain population. One hundred chronic pain patients were divided into two age groups (< or = 69 years and > or = 70 years). A path analysis conducted for the total sample supported the cognitive-behavioral mediation model of depression in chronic pain, in which cognitive appraisal variables mediate the pain-depression relationship. Correlations among variables in each of the two age groups, however, revealed different patterns of association. Consistent with the cognitive-behavioral model, the younger patients demonstrated a low and non-significant correlation between pain severity and depression (r = 0.01). Conversely, a strong direct association was observed in the older patients between these variables (r = 0.51). These results suggest that the relationship between pain and depression varies substantially depending upon age cohort.     

Gender differences in the relationship between perceived social support and student adjustment during early adolescence.

The current study is an investigation of early adolescents' perceptions of social support from parents, teachers, classmates, and close friends, and how that support is related to measures of students' adjustment on a range of behavioral indices. Data were collected on a sample of 246 students in Grades 6 through 8 using the Child and Adolescent Social Support Scale (CASSS), and the Parent Rating Scale of the Behavior Assessment System for Children (BASC-PRS). Analyses using the social support subscale scores (Parent, Teacher, Classmate, and Close Friend) replicated past research in finding gender differences on mean levels of perceived social support, with girls perceiving higher levels of classmate and close friend support than boys. In addition, girls reported significantly more support from close friends than any other source, whereas boys reported significantly less support from classmates than any other source. Finally, results demonstrated gender differences in the relationship between social support and several indices of student adjustment, and provided evidence for the importance of considering gender differences in planning future research related to social support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender variation in developmental trajectories of educational and occupational expectations and attainment from adolescence to adulthood.

Adolescents' future expectations are a potentially important precursor of adult attainment and may illuminate how males and females vary in schooling and work. Thus, this longitudinal study examined gender variation in developmental trajectories of educational and occupational expectations from adolescence to adulthood and in connection to corresponding adult attainment. National data (NELS:88) including individuals aged 14 to 26 and hierarchical linear modeling analyses yielded several findings: Males and females had similar developmental trajectories of educational expectations from adolescence to adulthood with the sample average expecting to attend college. Probabilities of expecting a professional occupation were lower for males than females. Adolescent educational and occupational expectations predicted corresponding attainment in adulthood, although the relationship varied by gender. Males who reported high occupational expectations in adolescence had higher occupational attainment in adulthood compared to males with low occupational expectations, whereas females' adult occupational attainment did not vary by their adolescent occupational expectations. Gender variation in expectations and attainment is discussed in light of historical changes, and future directions of research are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal models of developmental dynamics between reading and cognition from childhood to adolescence.

The authors applied linear dynamic models to longitudinal data to examine the dynamics of reading and cognition from 1st to 12th grade. They used longitudinal data (N=445) from the Connecticut Longitudinal Study (S. E. Shaywitz, B. A. Shaywitz, J. M. Fletcher, & M. D. Escobar, 1990) to map the dynamic interrelations of various scales of the Wechsler Intelligence Scales for Children--Revised (i.e., Full, Performance, and Verbal) and specific markers of the Woodcock-Johnson Psycho-Educational Battery--Revised reading cluster (i.e., Letter-Word ID, Decoding, and Comprehension). The results of these analyses indicate that (a) there is a positive dynamic relation between reading and cognition across the selected age range; (b) this dynamic relation is symbiotic, with positive influences in both directions; (c) the influence from cognition to reading is stronger when considering the Wechsler Intelligence Scales for Children Performance--Revised Performance scale and weaker with the Verbal scale; (d) when examining the different Reading subtests, the influences from cognition are more apparent for Letter-Word ID and Comprehension and are less perceptible for Decoding; and (e) the dynamics of reading and cognition appear to be of stronger magnitude during 1st to 3rd grade, less strong during 4th to 8th grade, and weaker from 9th to 12th grade. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family roots of empathy-related characteristics: The role of perceived maternal and paternal need support in adolescence.

Theories on empathy development have stressed the role of socialization in general and the role of parental support in particular. This 3-wave longitudinal study of middle adolescents (N = 678) aimed to contribute to the extant research on the socialization of empathy (a) by examining the relative contribution of perceived maternal and paternal need supportive parenting on over-time changes in adolescents' emotional and cognitive aspects of empathy (i.e., empathic concern and perspective taking, respectively) and (b) by considering the possibility of reciprocal relations between perceived parenting and adolescent empathy. Whereas paternal need support consistently predicted over-time changes in perspective taking in both sons and daughters, perceived maternal need support predicted changes in empathic concern among daughters only. In addition, although less consistently so, empathy dimensions also predicted over-time changes in perceived parenting. Results are discussed in terms of the nature of empathy and in the light of domain-specific effects of each parent. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Posttraumatic growth and HIV disease progression.

The relationship between posttraumatic growth (PTG; perceiving positive changes since diagnosis) and disease status, determined by changes in viral load and CD4 count over time, was examined among 412 people living with HIV. In controlled multiple regression models, PTG was not associated with disease status over time for the entire sample. However, there were significant associations for certain subgroups. PTG was positively associated with CD4 counts for Hispanic participants (vs. non-Hispanic) and those with low (vs. high) levels of optimism. PTG was inversely associated with viral load among those low (vs. high) in pessimism. Although PTG was inversely associated with depressive symptoms, alcohol, and illicit drug use, these factors did not account for the findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV-1 disease progression and AIDS-defining disorders in rural Uganda

BACKGROUND: The majority of people infected with HIV-1 live in Africa, yet little is known about the natural history of the disease in that continent. We studied survival times, disease progression, and AIDS-defining disorders, according to the proposed WHO staging system, in a population-based, rural cohort in Uganda. METHODS: In 1990 we recruited a random sample of people already infected with HIV-1 (as prevalent cases) detected during the initial survey round of a general-population study to form a natural-history cohort. Individuals from the general-population cohort who seroconverted between 1990 and 1995 (incident cases) were also invited to enroll. Participants were seen routinely every 3 months and when they were III. FINDINGS: By the end of 1995, 93 prevalent cases and 86 incident cases had been enrolled. Four patients in the prevalent group were in stage 4 (AIDS) at the initial visit. During the next 5 years, 37 prevalent cases progressed to AIDS. Seven incident cases progressed to AIDS and the cumulative progression to AIDS at 1, 3, and 5 years after seroconversion was 2%, 6%, and 22%, respectively. The cumulative probability of AIDS at 4 years from entering stages 1, 2, and 3 was 11%, 33%, and 58%, respectively. There were 47 deaths among prevalent cases and seven among incident cases during follow-up. The cumulative mortality 4 years after patients entered stages 1, 2, 3, and 4 was 9%, 33%, 56%, and 86%, respectively. The median survival after the onset of AIDS was 9.3 months. INTERPRETATION: Our results are important for the setting of priorities and rationalisation of treatment availability in countries with poor resources. We found that progression rates to AIDS are similar to those in developed countries for homosexual cohorts and greater than for cohorts infected by other modes of transmission. However, we have found that the rates of all-cause mortality are much higher and the progression times to death are shorter than in developed countries.     

Stress and HIV disease progression: psychoneuroimmunological framework

BACKGROUND AND METHODS: A retrospective cohort study was conducted to estimate the effects of low-level exposure to external (penetrating) radiation on cancer mortality among 4,563 workers monitored for external radiation between 1950 and 1993 at a nuclear research and production facility in Southern California. RESULTS: Of the 875 deaths that occurred before 1995, 258 were due to cancer as the underlying cause. External comparisons of male subjects with the U.S. white male population indicated that the workers had lower rates of dying from all causes and all cancers, but a higher rate of dying from leukemia. Internal comparisons of workers exposed at different dose levels, using risk-set analyses with adjustment for confounders, demonstrated an increased mortality rate in workers exposed to 200 mSv for hemato- and lymphopoietic cancers and for lung cancer. Mortality rates for total cancers and "radiosensitive" solid cancers increased monotonically with cumulative radiation dose, but no trends were observed for "nonradiosensitive" cancers. CONCLUSIONS: Despite possible residual confounding and low precision for estimating effects on specific cancers, these findings indicate that chronic, low-level radiation exposure may have more generalized carcinogenic effects than have been observed in most previous investigations. Such effects may have become evident as a result of the relatively long follow-up period in the present study.