Coping styles and locus of control as predictors for psychological adjustment of adolescents with a chronic illness

Love beyond gluten: self-esteem, illness identity, and social support in romantic rejection concerns among adolescents with celiac disease

Introduction

Fear of stigmatization, high perceived partner burden, or refraining from self-disclosure may manifest in romantic rejection concerns among adolescents with celiac disease (CD), potentially impacting their health-related quality of life (HRQOL). This study examined the prevalence, predictors, and consequences of romantic rejection concerns among adolescents and young adults with CD.

Methods

A cross-sectional online survey was conducted among 165 German adolescents and young adults (aged 14-22) with self-reported CD. Participants completed measures of romantic rejection concerns, illness identity, self-esteem, peer support, and CD-specific HRQOL.

Results

Participants reported moderate levels of concerns about the impact of CD on their romantic relationships, with no significant gender differences. Participants involved in romantic relationships expressed lower concerns of rejection, but similar preference for a "gluten-free partner." Hierarchical regression analysis revealed that higher illness acceptance and peer support predicted lower rejection concerns. Significant interactions emerged between self-esteem and illness acceptance, and between self-esteem and peer support. Higher illness acceptance predicted fewer rejection worries only among those with high self-esteem, while peer support played a mitigating role only for those with low self-esteem. Romantic rejection concerns significantly predicted lower CD-specific HRQOL across all domains.

Discussion

Anxieties about CD's impact on romantic relationships are prevalent among adolescents and may hinder their HRQOL. The findings highlight the complex interplay between self-esteem, illness identity, and social support in shaping romantic concerns. Targeted interventions focusing on peer support and fostering positive illness identity are recommended to alleviate rejection fears and improve HRQOL among youth with CD.

Coping in Pediatric Burn Survivors and Its Relation to Social Functioning and Self-Concept

Pediatric burn survivors experience increased risk for bullying, stigmatization, body image concerns, and problematic social functioning. Although coping behaviors are associated with engagement in social supports and positive self-concept in multiple pediatric illness populations, their relation has not been examined in pediatric burns. This study examined coping in relation to social functioning and self-concept in 51 pediatric burn survivors aged 7–17years (M=12.54; SD=2.65). Survivors and their caregivers completed the Child Coping Strategies Checklist (CCSC; youth report); the Burn Injury Social Questionnaire (BISQ; parent and youth report); and the Piers-Harris Children’s Self-Concept Scale-2 (PH-2; youth report). Associations between coping, social functioning, self-concept, demographic features, and burn injury characteristics were examined via bivariate correlations. Hierarchical linear regressions examined whether coping strategies predicted social functioning and youth self-concept beyond burn injury and demographic variables. Social functioning concerns were positively correlated with total body surface area (TBSA; r=0.63 and 0.40, respectively). TBSA was the only significant predictor of parent-reported social concerns (β=0.65, p<0.001). Greater distraction coping predicted fewer youth-reported social concerns (β=−0.39, p=0.01). Greater active coping (B=0.67, p=0.002) and lower avoidance coping (B=−0.36, p=0.03) predicted better youth-reported self-concept. This study advances our understanding of coping as potentially protective for psychosocial adjustment. Clinicians working with child burn survivors should incorporate active coping interventions into treatment. Further research including larger and more diverse samples is needed to understand the role of coping approaches on psychological adjustment during burn healing.

Coping, Anxiety, and Health Care Transition Readiness in Youth with Chronic Conditions

PURPOSE

To explore the relationship between coping and health care transition readiness, and to examine whether anxiety is a mediator between coping and health care transition readiness.

DESIGN AND METHODS

A sample of 174 youths with various chronic conditions (age 13.03 ± 2.02 years, 48.3% male) attending the 2018 Victory Junction Camp and their parents participated. Youths and parents completed measures to assess coping (Kidcope Checklist), anxiety symptoms (PROMIS Anxiety scale), and transition readiness (STARx Questionnaire) through Qualtrics online surveys.

RESULTS

Positive coping was positively related to transition readiness in both youth and parent-proxy reports, while negative coping was negatively related to transition readiness in youth reports. Anxiety mediated the relationship of positive coping and transition readiness in parent-proxy reports, and the relationship of negative coping and transition readiness in both youth self-reports and parent-reports.

CONCLUSIONS

Coping is an important factor in transition readiness. Furthermore, anxiety is an important mediator, and may be more influential in the relationship of negative coping and transition readiness.

PRACTICE IMPLICATIONS

Practitioners and health care providers can use these findings to promote the use of positive coping and reduce the use of negative coping, which in turn may improve outcomes for youth with chronic health conditions who are transitioning to adult health care services.

Psychological Interventions for People with Huntington's Disease: A Call to Arms

BACKGROUND

Although Huntington's disease (HD) can cause a wide range of psychological difficulties, no review has ever been carried out on the range of psychological interventions adopted with this population.

OBJECTIVE

To scope the literature on psychological interventions for psychological difficulties in people affected by HD.

METHODS

A systematic scoping review was performed across MEDLINE, PsycINFO, CINAHL, Academic Search Ultimate, and Cochrane Library up to 1 March 2020.

RESULTS

From an initial return of 1579 citations, a total of nine papers were considered eligible for review. These included a qualitative investigation, three case studies, two case series, two uncontrolled pretest-posttest designs, and only one randomised control trial (RCT). Despite the wide range of psychological difficulties which can be experienced by people affected by the HD gene expansion, the adopted interventions only accounted for five main psychological outcomes (anxiety, apathy, depression, irritability, and coping). Further discussion and suggestions for future research are provided for each outcome.

CONCLUSION

The current literature on psychological interventions in people affected by HD is extremely limited both in terms of methods and addressed clinical outcomes. Consequently, no conclusions can be offered yet as to which psychological therapy may help this population. As further more comprehensive research is urgently needed for this group, the ultimate aim of the present review is to act as a call to arms for HD researchers worldwide to help shed light on the most effective way to translate psychological theory into practice for the benefit of people affected by HD.

Coping styles in patients with hypospadias

OBJECTIVE

The objective of this study is to investigate the coping styles used by patients with hypospadias. Long-term hypospadias studies generally show satisfying outcomes, but some report a lower quality of life (QoL) or poorer psychosocial adjustment, particularly in patients with proximal hypospadias. A lower QoL or psychosocial adjustment was found to be associated with passive coping styles in other pediatric patient populations. Hypothetically, patients with hypospadias also develop different coping styles due to medical experiences in childhood, leading to the lower QoL outcomes on the long term. However, coping styles of patients with hypospadias have never been analyzed.

PATIENTS AND METHODS

Adult men with hypospadias repair in childhood were recruited (n = 55; aged 19.9 [IQR 19.2-22.1]). Coping styles were determined with the Utrecht Coping List (UCL) and results compared with a reference group of male students (n = 55, age 20-30 years, no medical history). Sub analysis of coping styles of the hypospadias groups was done based on three items: severity of hypospadias, time of last hypospadias surgery and occurrence of postoperative complications.

RESULTS

Compared to the reference groups, patients with hypospadias had higher scores on Avoidance (P < 0.05), particularly patients who had ≥1 postoperative complication or proximal hypospadias. Patients with proximal hypospadias also had lower scores on Seeking Social Support compared to the reference group (P < 0.05). Within the hypospadias group, coping style scores did not differ based on severity of hypospadias, timing of surgery or postoperative complications.

CONCLUSION

Patients with hypospadias, particularly those with proximal hypospadias or a postoperative complication, more often use an avoiding coping style compared to a reference population. Attention to coping styles during the follow-up of patients with hypospadias might help to improve the QoL in these patients.

An Integrative Review of the Prevalence of Depression among Pediatric Patients with Sickle Cell Disease

Sickle cell disease (SCD), a common hematological disorder, has received increased interest from researchers who set to discover whether individuals with SCD are at risk for depression. However, the prevalence of depression varies substantially between published studies. Therefore, two aims were identified in this critical review: (1) to summarize the prevalence of depression among children and adolescents diagnosed with SCD and (2) identify if disease severity predicts rates of depression within this population. Results from the 13 studies included in this review show the prevalence of depression was between 4%-46%. Pain predicted a higher occurrence of depression within this population.

Happiness When the Body Hurts: Achieving Well-Being in Chronic Health Conditions

This article provides a framework for understanding the application of positive psychology, in particular, Seligman's PERMA, in the context of chronic childhood illness. In particular, inflammatory bowel disease is a chronic illness that is often associated with social and emotional challenges for youth diagnosed with this lifelong condition. Specific disease factors that seemingly work against happiness are explained, and traditional notions of happiness are discussed and redefined. With PERMA as a guide, adult caregivers (eg, psychiatrists, psychologists, parents, gastroenterologists) can help youth living with chronic illness practice acceptance, adjust expectations, and find meaning, fulfillment, and psychological well-being.

The Mediating Role of Perceived Social Support in the Relationships Between General Causality Orientations and Locus of Control With Psychopathological Symptoms

The main aim of this study is to investigate the mediator role of perceived social support in the relationship between general causality orientations and locus of control with psychopathological symptoms. Total 751 participants were consisted of 558 female ages between 17 and 36 (Female M = 19.03, SD = 0.09) (74.3%), 192 male ages between 17 and 37 (Male M = 20.71, SD = 0.17) (25.6%) and a participant who did not provide any gender information. We used the General Causality Orientations Scale (GCOS) and Locus of Control Scale (LOCS) in order to understand the basic motivation for the emergence of behavior. Beck depression Inventory (BDI) used to evaluate the psychological symptoms for depression, Maudsley Obsessive Compulsive Inventory (MOCI) for obsessive-compulsive symptomology and Brief Symptom Inventory (BSI) for overall psychological distress and finally to evaluate mediating role of social support used the Perceived Social Support Scale (PSSS). According to the results, having internal locus of control and autonomy orientation have shown positive effect to statistically significant predictors for psychological symptomology, having external locus of control and impersonal orientation have shown negative effect. Perceived social support was found to be suited for the role of partial mediator, and social support from friends was found to have more positive roles than social support from family. In conclusion, exceedingly considerable to conduct further research in order to contribute to the understanding of the mediating role of general causality orientations and locus of control with psychopathology symptomology.

The impact of coping patterns and chronic health conditions on health-related quality of life among children and adolescents

This study examined the relationship among chronic disease, coping strategy patterns, and health-related quality of life (HRQOL) among children and adolescents. The cohort included 273 Israeli children and adolescents aged 8-18 years diagnosed with asthma, diabetes mellitus, or celiac disease. All completed the Coping with a Disease Questionnaire (CODI) and the DISABKIDS Chronic Generic Measure (DCGM-37). The outcome measures were as follows: association of the use of effective and non-effective coping strategies with type of disease; predictive value of coping patterns for health-related quality of life; a European sample was used for comparison. On k means cluster analysis, three strategy patterns (two "effective" and one "non-effective") were associated with health-related quality of life and disease specifics. Disease predicted coping patterns, but it had a weak direct relationship to health-related quality of life. Coping patterns were the strongest predictor of health-related quality of life. These results are similar to the European DISABKIDS study, indicating cross-cultural parallels.

CONCLUSIONS

The findings highlight the power of the concept of coping patterns as opposed to coping strategies to explain HRQOL of children and adolescents with chronic disease. Both types of disease (categorical approach) and coping patterns (non-categorical approach) are relevant to predicting HRQOL. What is Known: • The literature on coping has widely documented the existence of individual (unique) coping strategies. • Coping strategies are considered "useful" or "non-useful," based on whether they increase or decrease negative outcomes caused by certain stressors, such as chronic illness. What is New: • Our findings suggest that youngsters can use "non-useful" strategies to reduce stress caused by chronic illness, while still maintaining higher quality of life, as long as they also apply certain "useful" strategies. • The use of certain combinations of coping strategies, rather than single strategies, is more important to our understanding of how coping affects HRQOL of children with chronic disease.

Good and Bad Sides of Self-Compassion: A Face Validity Check of the Self-Compassion Scale and an Investigation of its Relations to Coping and Emotional Symptoms in Non-Clinical Adolescents

To demonstrate that the positive and negative subscales of Self-Compassion Scale (SCS) are very different in nature, we conducted a series of face validity checks on the items of this questionnaire among psychologists and psychology students (Study 1). Furthermore, a survey was administered to a convenience sample of non-clinical adolescents to examine the relations between various SCS subscales and symptoms of anxiety and depression as well as coping styles (Study 2). The results of the face validity checks revealed that the positive subscales seem to be well in line with the protective nature of self-compassion as they were mainly associated with cognitive coping and healthy functioning, whereas the negative subscales were chiefly associated with psychopathological symptoms and mental illness. The survey data demonstrated that the positive SCS subscales were positively correlated with adaptive coping (r's between .22 and .50) and negatively correlated with symptoms of anxiety and depression (r's between -.19 and -.53), while the negative subscales were positively correlated with symptoms (r's between .49 and .61) and maladaptive coping strategies such as passive reacting (r's between .53 and .56). Additional analyses indicated the negative subscales of the SCS accounted for a significant proportion of the variance in symptoms, whereas the unique contribution of the positive SCS subscales was fairly marginal. We caution to employ the total SCS score that includes the reversed negative subscales as such a procedure clearly inflates the relation between self-compassion and psychopathology.

Quality of life, delinquency and psychosocial functioning of adolescents in secure residential care: testing two assumptions of the Good Lives Model

BACKGROUND

In this study, two assumptions derived from the Good Lives Model were examined: whether subjective Quality of Life is related to delinquent behaviour and psychosocial problems, and whether adolescents with adequate coping skills are less likely to commit delinquent behaviour or show psychosocial problems.

METHOD

To this end, data of 95 adolescents with severe psychiatric problems who participated in a four-wave longitudinal study were examined. Subjective Quality of Life was assessed with the ten domains of the Lancashire Quality of Life Profile and coping skills with the Utrecht Coping List for Adolescents.

RESULTS

Results showed that adolescents who reported a lower Quality of Life on the health domain had more psychosocial problems at follow-up. No relationship was found between Quality of Life and delinquent behaviour. In addition, active and passive coping were associated with delinquent behaviour and psychosocial functioning at follow-up.

CONCLUSIONS

Based on the results of this longitudinal study, the strongest support was found for the second assumption derived from the Good Lives Model. Adolescents with adequate coping skills are less likely to commit delinquent behaviour and have fewer psychosocial problems at follow-up. The current study provides support for the use of strength-based elements in the treatment programmes for adolescents in secure residential care.

Social Functioning and Coping Strategies in Romanian and Moldavian Adolescents with Chronic Diseases

The present study aimed to explore the cultural differences in social functioning and coping strategies in chronically ill adolescents. One hundred sixty-eight chronically ill adolescents (45.8 % girls), age 11 to 17 years from Romania (N = 78) and Republic of Moldova (N = 90) were recruited. Participants filled in self-assessment measures for social functioning problems and coping strategies. Results indicated cross-cultural differences in the studied factors: Moldavian adolescents reported more social functioning problems and higher use of maladaptive coping strategies, while using less adaptive strategies than Romanian counterparts. The associations between social functioning and maladaptive coping strategies were stronger for Romanian than Moldavian adolescents. Further, various coping strategies acted as important predictors for social functioning in the two country samples. Findings suggest that, while the direction of the relation between coping and social functioning in chronically ill adolescents is cultural invariant, the importance played by specific coping strategies in determining social functioning varies by cultural context. Therefore, clinical interventions aimed at improving the social functioning of chronically ill adolescents should take into account the reality of their cultural setting.

Short term effectiveness and experiences of a peer guided web-based self-management intervention for young adults with juvenile idiopathic arthritis

BACKGROUND

A web-based self-management intervention guided by peer-trainers was developed to support young adults' self-management in coping with Juvenile Idiopathic Arthritis (JIA). To investigate its effectiveness, a randomized controlled trial (RCT) was conducted. In addition, the content of the chat and participants' goals were studied to identify underlying processes.

METHODS

An RCT with a six-month follow up period was conducted among 72 young adults with JIA, aged between 16 and 25 years old, randomly assigned to the intervention or to the usual care control group. After 24 weeks, in both groups 24 participants completed all measurements. Intentions to treat analyses were carried out by means of linear mixed models for longitudinal measurements. With self-efficacy as primary outcome, self-management, disease activity, quality of life, absenteeism of school/work, health care medication use and adherence to the intervention were studied. The participants' goals, personal achievements, interactions on the chat, and their appreciation of the intervention were analyzed using thematic analyses.

RESULTS

No significant differences were found on self-efficacy, quality of life, and self-management between the participants of the control group and the intervention group. In the intervention group, modeling and sharing experiences were the most recognized themes. Fifty-five goals were formulated and divided into the following categories: improvement and maintaining balance, setting and recognizing boundaries, communicating and coping with incomprehension. Adherence, appreciation of the own learning experience, and personal achievements were rated positively.

CONCLUSION

The web-based intervention did not lead to an improvement of self-efficacy. However, additional qualitative analyses showed that the intervention was appreciated and valuable for the participants. More research is needed on how to measure the added value of this intervention compared to the usual care.

TRIAL REGISTRATION

Trial registration number NTR4679 .

Predictive coding: A contemporary view on the burden of normality and forced normalization in individuals undergoing epilepsy surgery

Following epilepsy surgery, a good psychosocial outcome is not necessarily contingent on a good seizure outcome. Increasingly, it is believed that "successful" surgery is a combination of both an acceptable and expected seizure status as well as the individual's perception of improvements in quality of life (QOL). The factors that create this optimal outcome remain an ongoing area of research in the epilepsy community. That being said, there have been some major breakthroughs in observing and understanding poor outcomes seen in a subset of postoperative patients with epilepsy. Characteristics of burden of normality and forced normalization are two phenomena that have been evident in cases of poor postoperative outcomes. In this review, we provide a summary of research and concepts used to explain these poor QOL outcomes for a seemingly successful surgery and suggest a contemporary view in understanding the mechanism of forced normalization through understanding the brain as a predictive organ. Using such a predictive coding model together with recommendations of other studies, we suggest the crucial need for a preoperative intervention addressing patient predictions and expectations to optimize on the benefits achievable through epilepsy surgery.

Relationship of Distress and Perceived Control to Coping With Perceived Racial Discrimination Among Black Youth

This study examines the use of approach (e.g., seeking social support, problem solving) and avoidance (e.g., distancing, internalizing, externalizing) strategies for coping with perceived racial discrimination and their relationship to the subjective feelings of distress evoked by perceived experiences of discrimination and perceived control over discriminatory experiences among a small, relatively homogeneous sample of Black youth (N = 71). Results of hierarchical regression analyses support evidence from the general adolescent stress and coping literature that links avoidance coping to greater feelings of distress and approach coping to a greater sense of personal control. Greater self-reports of distress are related to greater use of internalizing and externalizing coping strategies. Greater self-reports of perceived control over discriminatory experiences are related to greater use of seeking social support and problem-solving coping strategies. Implications for promoting the successful coping of Black youth with perceived racial discrimination are discussed.

Impact of choice of coping strategies and family functioning on psychosocial function of young people with epilepsy

Both medical and psychological factors have an important impact upon the psychosocial functioning of young people with epilepsy. The purpose of this study was to identify factors that distinguish young people with epilepsy and high psychosocial functioning from those with lower levels. The participants were 114 young people (40 males, 74 females) with active epilepsy and a mean age of 17.92years (SD=3.90) who completed either a paper (60.5%) or a web-based survey (39.5%) comprising demographic, medical, and psychosocial measures. Psychosocial measures included family functioning, adolescent coping, anxiety, depression, and quality of life. A latent class analysis produced two psychosocial functioning groups based on participants' scores for anxiety, depression, and quality of life. Young people were more likely to be members of the group with poor psychosocial functioning if they had a seizure in the last month (Wald=5.63, p<.05), came from families with lower levels of communication and problem solving (Wald=5.28, p<.05), and made greater use of non-productive (emotion-focused) coping strategies such as wishful thinking, withdrawal, and worry (Wald=12.00, p<.01). The findings suggest that, in addition to standard medical treatment, clinicians may promote better outcomes by strengthening family functioning and encouraging less use of nonproductive coping strategies.

Suicide Ideation and Life Events in a Sample of Rural Adolescents

Adolescents experience both developmental and situational periods of transition along with myriad stressful life events when they enter and exit high school. These life events may be associated with thinking of, planning, and attempting suicide. Yet despite the development of prevention programs to treat at-risk individuals, suicide rates among adolescents have remained relatively high. Recent research suggests that suicidal ideation is associated with stressful life events and the use of maladaptive coping mechanisms, but studies have been limited to cross-sectional designs and clinical samples. We conducted a longitudinal study of 1345 rural adolescents (50.7% Hispanic) attending public schools in central Texas. The purpose of this analysis was to determine changes in suicide ideation rates over time and to test hypotheses about the life events and coping mechanisms associated with suicide ideation. Gender and race/ethnic differences in suicide were also explored. Rates of reported suicide ideation declined significantly from the first to the last year of high school (p=.015). Statistically significant relationships were found between suicide ideation, several types of life events, and maladaptive coping strategies. Gender and racial/ethnic differences were also found. Taken together, these findings suggest new approaches to developing and testing interventions that can assist specific populations of adolescents to learn how to cope with their life events in productive and health-promoting ways.

Adolescents in secure residential care: the role of active and passive coping on general well-being and self-esteem

Coping, general well-being and self-esteem play an important role during the process of adaptation to turning points in life-course. This study aimed to investigate the effect of coping on both the development of general well-being and self-esteem of adolescents with severe psychiatric problems in secure residential care. In addition, risk and protective factors were taken into account. Adolescents between the age of 16 and 18 (N = 172) were followed for 1.5 years. General well-being and self-esteem were assessed with the Lancashire Quality of Life Profile and the Self-Perception Profile for Adolescents, respectively. In addition, the Utrecht Coping List for Adolescents and the Structured Assessment of Violence Risk in Youth were administered. Results showed that the longitudinal relation between general well-being and self-esteem is no longer significant after adding active and passive coping to the model. The use of active coping strategies was associated with a higher self-esteem. The use of passive coping strategies was associated with a lower self-esteem and also a lower perceived general well-being. Having multiple risks in the individual and/or social/contextual domain affected the developmental pattern of general well-being. During treatment of adolescents with severe psychiatric problems in secure residential care, attention should be paid for enhancing those capabilities and skills, like coping, which help adolescents to fulfill their needs and consequently enhance their well-being. Enhancing the well-being of adolescents might in the long run decrease the chance of reoffending and/or psychiatric relapse.

Factors Promoting Mental Health of Adolescents Who Have a Parent with Mental Illness: A Longitudinal Study

BACKGROUND

Children of parents with mental illness have an elevated risk of developing a range of mental health and psychosocial problems. Yet many of these children remain mentally healthy.

OBJECTIVE

The present study aimed to get insight into factors that protect these children from developing internalizing and externalizing problems.

METHODS

Several possible individual, parent-child, and family protective factors were examined cross-sectionally and longitudinally in a sample of 112 adolescents. A control group of 122 adolescents whose parents have no mental illness was included to explore whether the protective factors were different between adolescents with and without a parent with mental illness.

RESULTS

Cross-sectional analyses revealed that high self-esteem and low use of passive coping strategies were related to fewer internalizing and externalizing problems. Greater self-disclosure was related to fewer internalizing problems and more parental monitoring was related to fewer externalizing problems. Active coping strategies, parental support, and family factors such as cohesion were unrelated to adolescent problem behavior. Longitudinal analyses showed that active coping, parental monitoring, and self-disclosure were protective against developing internalizing problems 2 years later. We found no protective factors for externalizing problems. Moderation analyses showed that the relationships between possible protective factors and adolescent problem behavior were not different for adolescents with and without a parent with mental illness.

CONCLUSIONS

The findings suggest that adolescents' active coping strategies and parent-child communication may be promising factors to focus on in interventions aimed at preventing the development of internalizing problems by adolescents who have a parent with mental illness.

Psychosocial challenges and strategies for coping with HIV among adolescents in Uganda: a qualitative study

Although more than 90% of youth perinatally infected with HIV live in sub-Saharan Africa, little is known about the psychosocial factors that impact their wellbeing, or how these youth cope with these challenges. The purpose of this study was to identify the psychosocial challenges and coping strategies among perinatal HIV-infected adolescents in Uganda. In-depth interviews were conducted with a purposive sample of 38 HIV-infected adolescents aged 12-19 years at a large HIV treatment center in Kampala. Data were analyzed thematically to identify themes and domains related to stressors and specific coping strategies. Psychosocial challenges included stigma/discrimination, relationship challenges such as HIV status disclosure, and medication difficulties. Coping strategies included medication adherence, concealment or limited disclosure of HIV status, treatment optimism, social support, rationalizing, social comparison, spirituality/religiosity, avoidance, and distraction. Age and gender differences also emerged: younger participants generally lacked specific coping strategies; compared to females, male adolescents reported greater use of avoidance/distraction techniques. Findings underscore the need to address stigma within homes and schools, and to equip adolescents with the comprehensive knowledge and skills to address their varied challenges.

The coexistence of coping resources and specific coping styles in stress: evidence from full information item bifactor analysis

BACKGROUND

Knowledge of coping styles is useful in clinical diagnosis and suggesting specific therapeutic interventions. However, the latent structures and relationships between different aspects of coping styles have not been fully clarified. A full information item bifactor model will be beneficial to future research.

OBJECTIVE

One goal of this study is identification of the best fit statistical model of coping styles. A second goal is entails extended analyses of latent relationships among different coping styles. In general, such research should offer greater understanding of the mechanisms of coping styles and provide insights into coping with stress.

METHODS

Coping Styles Questionnaire (CSQ) and Generalized Self-Efficacy Scale (GSES) were administrated to officers suffering from military stress. Confirmatory Factor Analyses was performed to indentify the best fit model. A hierarchical item response model (bifactor model) was adopted to analyze the data. Additionally, correlations among coping styles and self-efficacy were compared using both original and bifactor models.

RESULTS

Results showed a bifactor model best fit the data. Item loadings on general and specific factors varied among different coping styles. All items loaded significantly on the general factor, and most items also had moderate to large loadings on specific factors. The correlation between coping styles and self-efficacy and the correlation among different coping styles changed significantly after extracting the general factor of coping stress using bifactor analysis. This was seen in changes from positive (r = 0.714, p<0.01) correlation to negative (r =  -0.335, p<0.01) and also from negative (r =  -0.296, p<0.01) to positive (r = 0.331, p<0.01).

CONCLUSION

Our results reveal that coping styles have a bifactor structure. They also provide direct evidence of coexisting coping resources and styles. This further clarifies that dimensions of coping styles should include coping resources and specific coping styles. This finding has implications for measurement of coping mechanisms, health maintenance, and stress reduction.

'Skills for growing up': supporting autonomy in young people with kidney disease

BACKGROUND AND OBJECTIVES

End-stage kidney disease (ESKD) may interfere with children's developmental task of acquiring autonomy and participation. The Skills for Growing Up tool encourages normal development towards independence and autonomy during paediatric rehabilitation. This study aimed to adapt this self-management tool for use in paediatric nephrology, and to test whether its use is feasible in daily practice.

DESIGN AND PARTICIPANTS

A Delphi study was conducted among patients, their parents, professionals and experts to adjust the tool for use in nephrology. Feasibility was studied through individual and group interviews with professionals in all Dutch paediatric nephrology centres.

RESULTS

Agreement was reached on the areas of social participation and medical management of ESKD. Compared with the original, the new instrument holds considerable more attention for autonomy in the renal healthcare area; for example, dealing with medication and transplantation. Professionals used and appreciated the tool, but the paper form was seen to limit feasibility.

CONCLUSIONS

Making the tool available online is important. The challenge for professionals is to move beyond the focus on medical management and to consider developmental tasks when coaching their patients into adulthood.

APPLICATION TO PRACTICE

The Skills for Growing Up-Nephrology (SGU-N) tool is a promising instrument for use by professionals in paediatric nephrology. Its use can help young people achieving autonomy and may contribute to their successful transition to adulthood and adult care.

Efficacy of psychosocial group intervention for children with chronic illness and their parents

OBJECTIVE

To investigate the efficacy of a cognitive-behavioral group intervention for children with chronic illnesses and to test the effect of an added parent component.

METHODS

Children (n = 194) and their parents participated in a multicenter randomized clinical trial comparing a child-only intervention and a parent-child intervention to a wait-list control group. Primary outcomes were parent- and self-reported internalizing and externalizing problems; secondary outcomes were child disease-related coping skills (information seeking, relaxation, social competence, medical compliance, and positive thinking). Assessments took place at baseline and at 6- and 12-month follow-ups. Intention-to-treat mixed-model analyses were performed to test the difference in change in outcomes.

RESULTS

The intervention had a positive effect on changes in parent-reported internalizing problems, child-reported externalizing problems, information seeking, social competence, and positive thinking. The additional effect of parental involvement was observed on parent-reported internalizing problems, child-reported externalizing problems, information seeking, and social competence. Illness severity and illness type did not moderate the effects. There were no intervention effects on child-reported internalizing problems, parent-reported externalizing problems, relaxation, or medical compliance. Of the families in the wait-list control group, 74% sought alternative psychological support during the intervention period.

CONCLUSIONS

This RCT supports the efficacy of a protocol-based group intervention for children with chronic illnesses and their parents. Adding a parental component to the intervention contributed to the persistence of the effects. Future research should focus on moderating and mediating effects of the intervention.

Cigarette smoking among college students with disabilities: National College Health Assessment II, Fall 2008-Spring 2009

BACKGROUND

People with disabilities are 1.5 times more likely to smoke than their peers without disabilities, intensifying risk of health related disparities and further loss of function. When compared with the general population, college students also have a higher smoking prevalence. This study explores smoking rates among college students with disabilities.

OBJECTIVE/HYPOTHESIS

College students with disabilities have an increased likelihood of smoking, as compared with students without disabilities. Type of disability also influences smoking rates.

METHODS

This study explores the association between smoking and disability using multiple regression analyses and data from the National College Health Assessment II (NCHA II), Fall 2008-Spring 2009 (N = 79,915). People with disabilities comprised 15.6% of the total sample: 3.4% reported a physical disability, 8.3% reported a mental disability, 2.5% reported a sensory disability, and 3.7% reported a learning disability.

RESULTS

Smoking prevalence among those reporting disabilities was 23.1% versus 15% in those without disabilities. Those reporting mental disabilities had the highest rates (29.9%), followed by those with learning disabilities (23.7%), sensory disabilities (19.8%), and physical disabilities (16.4%). Students with disabilities were 1.23 times more likely to report current smoking than those without any disabilities, controlling for other factors (OR 1.23, 95% CI 1.16-1.30).

DISCUSSION

Results are consistent with previous research regarding the general adult population. Epidemiologic data demonstrating differences in risk behaviors for young adults with disabilities are important in allocation of resources. Findings of this study highlight the need for tailored smoking cessation programs for college students with disabilities.

Complex traumatic stress in the pediatric medical setting

There has been a recent increase in research focusing on child complex traumatic stress following prolonged or repeated trauma. These traumatic stress reactions often affect many aspects of the child's functioning, including psychological, behavioral, and physical health. In addition, complex traumatic stress experienced by youth with serious medical conditions may influence health issues such as medical adherence, emotional adjustment to illness, and pain management. This article reviews and delineates the current state of the literature on the impact of complex traumatic stress in childhood on mental and physical health as well as on these pediatric health-related issues. To date, few empirical studies have directly addressed this association. Several features associated with complex traumatic stress, such as emotion regulation difficulties, disruptive behavior, and family conflict, have indirectly been demonstrated to interfere with pediatric adherence, medical coping, and pain management. This demonstrates the need for more focused research in this area.

Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association

BACKGROUND

The goal of this statement was to review the available literature on surveillance, screening, evaluation, and management strategies and put forward a scientific statement that would comprehensively review the literature and create recommendations to optimize neurodevelopmental outcome in the pediatric congenital heart disease (CHD) population.

METHODS AND RESULTS

A writing group appointed by the American Heart Association and American Academy of Pediatrics reviewed the available literature addressing developmental disorder and disability and developmental delay in the CHD population, with specific attention given to surveillance, screening, evaluation, and management strategies. MEDLINE and Google Scholar database searches from 1966 to 2011 were performed for English-language articles cross-referencing CHD with pertinent search terms. The reference lists of identified articles were also searched. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. A management algorithm was devised that stratified children with CHD on the basis of established risk factors. For those deemed to be at high risk for developmental disorder or disabilities or for developmental delay, formal, periodic developmental and medical evaluations are recommended. A CHD algorithm for surveillance, screening, evaluation, reevaluation, and management of developmental disorder or disability has been constructed to serve as a supplement to the 2006 American Academy of Pediatrics statement on developmental surveillance and screening. The proposed algorithm is designed to be carried out within the context of the medical home. This scientific statement is meant for medical providers within the medical home who care for patients with CHD.

CONCLUSIONS

Children with CHD are at increased risk of developmental disorder or disabilities or developmental delay. Periodic developmental surveillance, screening, evaluation, and reevaluation throughout childhood may enhance identification of significant deficits, allowing for appropriate therapies and education to enhance later academic, behavioral, psychosocial, and adaptive functioning.

The Relationship Between Mental Health, Cultural Identity and Cultural Values in Non-English Speaking Background (NESB) Australian Adolescents

In Australia, acculturating adolescents from a non-English speaking background (NESB) face two important challenges: developing a cultural identity and establishing a set of cultural values. These challenges are achieved by balancing a native and Australian orientation. It was expected that NESB adolescents who did not achieve these tasks would experience poor mental health. This study focused on adolescents because a significant relationship between cultural identity, cultural values and mental health in this group will highlight a need for sensitivity to such cultural and developmental issues. Two hundred and sixty-three NESB adolescents completed questionnaires that assessed cultural identity (Australian and native), cultural values (individualism and collectivism), state mental health (depression, anxiety and stress) and trait mental health (positive affectivity [PA] and negative affectivity [NA]). Results indicated that high Australian pride and high native pride are associated with lower depression, anxiety, stress and NA, and higher PA. Results also indicated that adolescents high on individualism and collectivism reported lower depression and stress, and higher PA. Furthermore, adolescents with a separated cultural identity (high native pride and low Australian pride) reported the highest levels of depression, but adolescents with separated cultural values (high collectivism and low individualism) reported the lowest levels of depression and anxiety. We concluded that cultural identity and cultural values are differentially related to mental health, and such relationships, albeit moderate, emerge during adolescence.

"HIV isn't me…": HIV+ adolescents' experiences in a positive context of support and treatment

We describe the experiences of a sample of Canadian HIV+ youth whose intact adolescent identities contrast sharply with the expected identity challenges of persons living with a serious, chronic disease. We first showcase the positive HIV+ identities emerging from the successful management of HIV+ status through long-term HIV-related medical care and established pharmaceutical regimes. Second, we describe the medical, familial, and broader social context of support in which these adolescents' are negotiating HIV. Finally, we highlight the youth's expectations of future, specific identity and role challenges regarding intimacy and sexuality-related to disclosure of their private HIV+ identities and their embodied HIV+ status. Continued social and medical supports will be key to their emergence into adulthood as healthy HIV+ persons; with such supports, these youths' experiences highlight the capacity for living optimally with HIV.

A cognitive behavioral based group intervention for children with a chronic illness and their parents: a multicentre randomized controlled trial

BACKGROUND

Coping with a chronic illness (CI) challenges children's psychosocial functioning and wellbeing. Cognitive-behavioral intervention programs that focus on teaching the active use of coping strategies may prevent children with CI from developing psychosocial problems. Involvement of parents in the intervention program may enhance the use of learned coping strategies in daily life, especially on the long-term. The primary aim of the present study is to examine the effectiveness of a cognitive behavioral based group intervention (called 'Op Koers') 1 for children with CI and of a parallel intervention for their parents. A secondary objective is to investigate why and for whom this intervention works, in order to understand the underlying mechanisms of the intervention effect.

METHODS/DESIGN

This study is a multicentre randomized controlled trial. Participants are children (8 to 18 years of age) with a chronic illness, and their parents, recruited from seven participating hospitals in the Netherlands. Participants are randomly allocated to two intervention groups (the child intervention group and the child intervention combined with a parent program) and a wait-list control group. Primary outcomes are child psychosocial functioning, wellbeing and child disease related coping skills. Secondary outcomes are child quality of life, child general coping skills, child self-perception, parental stress, quality of parent-child interaction, and parental perceived vulnerability. Outcomes are evaluated at baseline, after 6 weeks of treatment, and at a 6 and 12-month follow-up period. The analyses will be performed on the basis of an intention-to-treat population.

DISCUSSION

This study evaluates the effectiveness of a group intervention improving psychosocial functioning in children with CI and their parents. If proven effective, the intervention will be implemented in clinical practice. Strengths and limitations of the study design are discussed.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN60919570.

Anxiety, locus of control, and coping strategies among end-stage renal disease patients undergoing maintenance hemodialysis

End-stage kidney disease (ESKD) patients on maintenance hemodialysis (MHD) have a lot of anxiety. Anxiety and coping are associated with the locus of control; the present investigation aimed to study the state and trait anxiety, locus of control, and active and passive coping among patients on MHD. Thirty MHD patients and 30 controls were administered State-Trait Anxiety Inventory, Rotter's Locus of Control Scale, and Coping Responses Inventory. There were significantly higher scores on state and trait anxiety, respectively (67.53 ± 10.89 vs. 59.40 ± 6.97, P < 0.01, and 62.97 ± 8.45 vs. 58.07 ± 7.06, P < 0.05), and locus of control (11.27 ± 3.55 vs. 9.04 ± 1.86, P < 0.01) in patients as compared to controls. On coping responses, patients and controls differed on positive reappraisal (54.33 ± 4.67 vs. 51.17 ± 3.12, P < 0.01), seeking guidance and support (58.07 ± 5.51 vs. 53.27 ± 4.22, P < 0.01), problem solving (51.03 ± 4.70 vs. 47.57 ± 4.73, P < 0.01), cognitive avoidance (60.27 ± 6.76 vs. 56.80 ± 4.08, P < 0.05), acceptance or resignation (61.67 ± 6.30 vs. 58.83 ± 4.23, P < 0.01), emotional discharge (68.07 ± 6.78 vs. 64.30 ± 4.50, P < 0.05), approach coping (205.57 ± 10.55 vs. 189.70 ± 11.37, P < 0.01), and avoidance coping (255.30 ± 16.45 vs. 241.10 ± 10.50, P < 0.01). A higher prevalence of anxiety trait could be the cause of anxiety in MHD patients besides the medical problems. The locus of control among patients though a mixed one was significantly more toward externalism. Thus, there is a need to identify this group well in advance and prepared not only medically but also psychologically for MHD.

Exploring the information needs of adolescents and their parents throughout the kidney transplant continuum

CONTEXT

Adolescents are at higher risk for organ loss than are all other age groups, but no studies have been conducted to examine the specific information needs of adolescents. A better understanding of adolescents' information needs is essential for developing programs tailored to their unique requirements.

OBJECTIVE

To explore information needs of adolescents who have undergone kidney transplantation in order to inform development of an education program.

DESIGN

A qualitative descriptive design was used. Focus groups (n = 2) were conducted by using a semistructured interview guide. Transcribed data were organized into categories that reflected emerging themes by using simple content analysis.

PARTICIPANTS AND SETTING

A convenience sample of 8 adolescents (50% female) who varied in age, donor type, and time since transplantation were recruited from a large Canadian tertiary care pediatric center.

RESULTS

Adolescents articulated that the process of undergoing kidney transplant was very stressful and affected all aspects of their lives. In particular, adolescents identified 4 main stressors: changes in body image, wanting to be normal, pain, and breakdown in communication processes. The 2 strategies that assisted adolescents in coping with these stressors were (1) gaining knowledge about the transplantation process and (2) experiencing understanding through social support. They wanted information provided to them gradually throughout the transplant experience with choices given as to how they receive the information.

CONCLUSION

Adolescents were united in their call for information, self-management strategies, and meaningful social support to better manage their kidney transplant and prepare for transition to adult health care.

Exploring the Information Needs of Adolescents and Their Parents Throughout the Kidney Transplant Continuum

Context

Adolescents are at higher risk for organ loss than are all other age groups, but no studies have been conducted to examine the specific information needs of adolescents. A better understanding of adolescents' information needs is essential for developing programs tailored to their unique requirements.

Objective

To explore information needs of adolescents who have undergone kidney transplantation in order to inform development of an education program.

Design

A qualitative descriptive design was used. Focus groups (n = 2) were conducted by using a semistructured interview guide. Transcribed data were organized into categories that reflected emerging themes by using simple content analysis.

Participants and Setting

A convenience sample of 8 adolescents (50% female) who varied in age, donor type, and time since transplantation were recruited from a large Canadian tertiary care pediatric center.

Results

Adolescents articulated that the process of undergoing kidney transplant was very stressful and affected all aspects of their lives. In particular, adolescents identified 4 main stressors: changes in body image, wanting to be normal, pain, and breakdown in communication processes. The 2 strategies that assisted adolescents in coping with these stressors were (1) gaining knowledge about the transplantation process and (2) experiencing understanding through social support. They wanted information provided to them gradually throughout the transplant experience with choices given as to how they receive the information.

Conclusion

Adolescents were united in their call for information, self-management strategies, and meaningful social support to better manage their kidney transplant and prepare for transition to adult health care.

Coping and psychological adjustment in adolescents with vertically acquired HIV

Children with vertically acquired HIV face the challenges of adolescence in addition to the demands of coping with their illness. The relationship between coping and psychological adjustment has been widely studied in adults and children with chronic diseases but it is poorly understood in adolescents with HIV. This study aimed to identify whether a UK sample of adolescents with vertically acquired HIV had poor psychological adjustment and to clarify the relationship between coping and psychological adjustment in this sample. Thirty adolescents with vertically acquired HIV (aged 11-17) filled in questionnaires of coping and psychological adjustment and a correlational design was used to determine if specific coping styles were related to quality of psychological adjustment. Results showed that younger children had lower levels of psychological adjustment than older adolescents, although as a group the adolescents scored within normal ranges. Psychological adjustment was significantly related to two coping styles, Ventilating feelings and Being humorous. Exploratory analysis examined the extent of HIV disclosure in this sample and the degree of satisfaction felt about the nature of communication about the diagnosis. The results showed that participants had few confidants but were satisfied with the nature of communication about their status. The level of satisfaction was not related to adjustment. On the basis of the results, potential clinical implications for adolescents with vertically acquired HIV who might be struggling not only with the challenging demands of adolescence but also with their illness are discussed. The need to adopt a developmental approach to coping and psychological adjustment is emphasized.

Person-related protective and vulnerability factors of psychopathology symptoms in non-clinical adolescents

Psychopathology in youths is thought to originate from a dynamic interplay of a variety of protective and vulnerability factors. In this study, a large multi-ethnic sample of non-clinical adolescents (N = 376) completed questionnaires for measuring a wide range of person-related protective and vulnerability factors as well as psychopathology symptoms, in order to explore (a) the relations among various protective and vulnerability factors, and (b) the unique contributions of these protective and vulnerability factors to different types of psychological problems. Results indicated that the overlap among protective and vulnerability factors was quite modest. Further, it was found that factors clustered in theoretically meaningful components reflecting protection, vulnerability, and more specific aspects of coping and social support. Finally, data indicated that each type of psychopathology symptoms was associated with a typical set of protective and vulnerability factors. Although these results should be interpreted with caution because of the cross-sectional nature of the study, they may nevertheless guide future research exploring multifactorial models of psychopathology in youths.

Coping strategies of adolescents living with HIV: disease-specific stressors and responses

This study examined disease-specific stressors and coping responses employed by youth with HIV. Data were analyzed from Adolescent Impact, a multi-site study of 166 adolescents infected with HIV in three major US cities. Participants identified HIV-related stressors during a face-to-face interview. Coping strategies were measured using the adolescent version of the Kidcope. Emotional and behavioral functioning were assessed with the Youth or Adult Self Report symptom checklists. Medication-related stressors were most common (30%) and reported more often by perinatally infected youth, whereas youth infected through risk behaviors reported more disclosure-related stressors. Passive emotional regulation was perceived as the most used and most helpful coping strategy overall. Youth reporting medication adherence-related stressors used resignation most frequently. A two-factor model (Passive and Active Coping) emerged. The Passive Coping factor included strategies that do not directly approach the problem, whereas Active Coping included strategies that involve an active approach. Youth with moderately advanced disease (CD4 200-500 cells/mm(3)) used a Passive Coping style more often than healthier youth (CD4 > 500 cells/mm(3)). Additionally, Passive Coping was associated with greater emotional and behavioral problems. Youth infected with HIV may benefit from interventions promoting adaptive coping responses to HIV-specific stressors, particularly medication adherence.

Conceptualization and measurement of coping during adolescence: a review of the literature

PURPOSE

The purpose of this review was to examine the conceptualization and measurement of coping in adolescent research.

DESIGN

A review of the literature published and abstracted in four scientific databases was undertaken between July 2008 and June 2009 with the following key words: adolescent(s), cope/coping, stress(ors), and adaptation/psychological.

METHODS

A total of 367 articles were initially identified, and review of published abstracts yielded 104 empirical articles to retrieve and examine more closely for inclusion. Criteria for inclusion in the review were that the study (a) measured coping, (b) presented original data, (c) primarily targeted adolescent participants, (d) was reported in English, and (e) was published between 1998 and June 2009. Fifty-nine subsequent articles were organized using a matrix approach that facilitated cross-study comparisons of purpose, sample, and dependent variables.

FINDINGS

Fewer than half of the studies reviewed included a specific statement defining coping. Instead, many authors described coping in the context of stress response by identifying particular types or ways of coping or naming specific coping strategies used. The theoretical frameworks guiding examination of coping varied across studies. A range of measures, congruent with adolescent developmental processes, were used to assess adolescent coping. A wide range of stress-related risks or conditions were examined, including psychological stressors such as eating disorders, suicidal ideation, and depression; physical stressors such as chronic illness, HIV infection, sports participation, violence, or sexual abuse; familial stressors such as domestic violence or interparental conflict; social stressors such as romantic relationships or difficulties in settings such as school, prison, or a homeless shelter; and societal stressors such as discrimination.

CONCLUSIONS

Coping is an important construct in understanding how adolescents react to the extensive stressors and adjustments they experience. Coping is a complex construct yet worthy of examination because it can be a critical point of intervention in the health trajectory of adolescents and young people. Research is needed to advance the conceptualization and measurement of adolescent coping such that interpretation of findings across studies is enhanced. In this way, future research, including interventions targeting coping, will work synergistically to advance the science and adolescent well-being.

CLINICAL RELEVANCE

Nursing and other healthcare providers working with adolescents understand the need for interventions that promote use of healthy coping strategies and minimize unhealthy coping. Findings from this study demonstrate the state of coping conceptualization and measurement in adolescent research and indicate a need for research that will advance the science and improve the usefulness of adolescent coping data.

Anxiety and depression affects life and sleep quality in adults with beta-thalassemia

PURPOSE

The aim of this study was to investigate the association of anxiety and depression symptoms with health related quality of life (HRQoL) and sleep quality in patients with beta-thalassemia.

METHODS

In a cross-sectional study between 2006 and 2007, 292 thalassemic patients were assessed for symptoms of anxiety and depression (Hospital Anxiety Depression Scale; HADS), HRQoL (Short Form-36, SF-36) and quality of sleep (Pittsburgh Sleep Quality Index; PSQI). Linear regression models were used to determine possible predictive value of high anxiety and depressive symptoms on HRQoL and sleep quality, separately.

RESULTS

Mental and physical quality of life scores were predicted by symptoms of depression and somatic comorbidities. Total sleep quality was predicted by anxiety symptoms and somatic comorbidities.

CONCLUSIONS

Screening for anxiety and depression in patients with thalassemia is essential. Further studies should test if appropriate treatment of these conditions may improve patients HRQoL and sleep quality or not.

Almost normal: experiences of adolescents with implantable cardioverter defibrillators

PURPOSE

The purpose of this study was to describe the experiences of adolescents with implantable cardioverter defibrillators (ICDs).

DESIGN AND METHODS

This qualitative study explored the lived experiences of 14 adolescents with ICDs using face-to-face, semistructured interviews.

RESULTS

Six themes were identified: life interrupted; still the same, except; sometimes it's tough; it cuts both ways; unique joule; and living life regular.

PRACTICE IMPLICATIONS

These findings suggest that nurses could make a significant impact on the lives of adolescents with ICDs by focusing their efforts away from viewing the adolescent through an illness lens and more toward a normalization lens.

Psychosocial aspects and psychiatric disorders in young adult with thalassemia major

Beta-thalassemia major (TM), a chronic, genetically determined hematological disorder, has received little investigation on the psychological aspects of the disease and the psychosocial adjustment of patients with this anemia. Unfortunately, the few psychological studies referred on the literature are generally limited to the investigation of the only children with thalassemia major. The study was planned to assess the self-image, the quality of life, the way of coping and to investigate the existence of psychiatric disorders in young adults with thalassemia major. 147 patients were included in the study. Patients were psychologically investigated by three interviews: the first connects some psychosocial information, the second submits patients to the psychological test and the third gives back the results obtained by the test. The psychological test consists of the ways of coping questionnaire (WCQ), the Machover's test, The short form 36-health survey questionnaire (SF-36) and symptom-check-list-90 revised (SCL-90-R) were performed on all patients. Vis-à-vis identity and self-image were found to be low with feeling of insufficiency and being exposed to vulnerability in 80% of patients with TM. Evaluation of mean values of symptomatological dimensions in these patients showed a personality characterized by somatization (SOM), depression (DEP) and obsessive-compulsive traits. The principal coping strategy used is escape-avoidance. No statistically significant differences occurred to relation to gender, age, level education and SCL-90-R and WCQ scores. Estimation of the SF-36 scores showed that the emotional role and social function values were considerably lower than in all of the domain. As a result, the study showed that most of the patients with TM had severe psychosocial problems. Relying on these data, it was concluded that medical therapy of these patients should be supported with psychological aid and psychiatric treatment.