Health-related Quality of Life in College Students with and without Childhood-Onset Asthma

Psychosocial functioning and adjustment to university settings: comparing students with chronic illnesses to healthy peers

Purpose: College students with chronic illnesses are vulnerable to poor adjustment, but it remains unclear how these students differ from healthy peers. This study compares psychosocial adjustment and risky behavior between students with and without chronic illnesses. Participants: Participants (N = 629, 78% Caucasian, 77% Female) were recruited from universities. Methods: Participants completed measures of illness history, anxiety, depression, stressful life events, social support, and risky behavior. Results: College students with chronic illnesses demonstrated significantly greater symptoms of anxiety F(1,620) = 8.742, p < .003, depression F(1,614) = 26.947, p < .001, more stressful life events F(1,476) = 23.671, p < .001, and lower social support F(1,613) = 15.645, p < .001. No differences in risky behaviors between groups emerged F(1,601) = 3.432, p = .064. An indirect effect of health status on risk-taking behavior was observed [b = .677, 95% CI (.351, 1.072)] partially mediated by depression. Conclusion: College students with chronic illnesses demonstrated worse psychosocial outcomes than healthy students, warranting programs to support these students. Depressive symptoms partially mediated risky behavior.

Quality of Life in Adolescents and Young Adults With a Chronic Medical Condition: The Role of Perceived Maturity and Transition Readiness

INTRODUCTION

Adolescents and young adults (AYA) with a chronic medical condition (CMC) attending college must learn to manage their own healthcare (i.e., transition readiness). Maturity has been linked to positive outcomes in AYAs. Research has established a positive relationship between transition readiness and quality of life. The current study aimed to examine a model of perceived maturityàtransition readinessàmental and physical quality of life.

METHOD

AYA (N = 153) with a CMC completed self-report questionnaires.

RESULTS

The perceived maturity→transition readiness→mental quality of life indirect path was significant (ab = 1.96, 95% CI = 0.53 to 3.62). The perceived maturity→transition readiness→physical quality of life direct and indirect paths were not significant.

DISCUSSION

Results showed that maturity and transition readiness are positively associated. Transition readiness may be one mechanism by which maturity results in enhanced quality of life.

PRACTICE IMPLICATIONS

Findings highlight the value of enhancing strengths such as maturity to promote AYA independence/autonomy.

The role of executive functioning, healthcare management, and self-efficacy in college students' health-related quality of life

Objective: Examine how executive functioning (EF), healthcare management, and self-efficacy relate to college students' health-related quality of life (HRQOL). Participants: Undergraduates completed questionnaires at baseline (Time 1; n = 387) and 18-24 months later (Time 2; n = 102). Methods: Participants reported on their EF and healthcare management skills at Time 1 and self-efficacy and mental and physical HRQOL at Time 2. Results: Students with fewer EF problems reported higher mental and physical HRQOL at both timepoints and those with higher healthcare management skills had higher mental and physical HRQOL at Time 1. Higher self-efficacy mediated the relation between EF and mental HRQOL, and the relation between healthcare management and mental HRQOL. Conclusions: Findings illustrate two potential pathways by which self-management, in healthcare settings or daily living, contributes to mental HRQOL during emerging adulthood. Assessing EF and healthcare management could help identify those at risk of low HRQOL and provide information that can inform interventions in college settings.

Being Unprepared: A Grounded Theory of the Transition of Asthma Self-Care in College Students

PURPOSE

The purpose of this study was to conceptualize the basic social process of how college students transition from home-based asthma management to independent self-care management.

DESIGN AND METHODS

Classical grounded theory was used to explore the transition of asthma self-care in college students. Seventeen college students with asthma from a Midwestern urban university were interviewed.

RESULTS

Being Unprepared emerged as the basic social process used by students transitioning from home-based management of their asthma to managing their asthma in college. Being Unprepared conceptualizes a process by which participants engaged in relying on others, primarily their mother, to manage their asthma while in high school. This reliance on others continued when participants became college students with asthma where they were found lacking preparation for self-management in college exemplified by their being relatively unprepared for dealing with the unexpected stressors associated with starting college or for managing asthma episodes safely and effectively as students. Participants acknowledged that they were unprepared for managing their asthma independently and the need for becoming better prepared for their own safe asthma self-management.

CONCLUSIONS

Youth with asthma may be at risk for poor health outcomes as they transition to self-care in college. The grounded theory, Being Unprepared, derived from empirical data can provide a scientific basis for deriving practice protocols.

PRACTICE IMPLICATIONS

These findings can be used to inform parents and healthcare providers about the need for early intervention designed to prepare students with asthma for the transition to college while in high school. The theory concepts can be operationalized as instrument items for future research studies.

Hassles predict physical health complaints in undergraduate students: a dynamic structural equation model analysis of daily diary data

OBJECTIVE

Daily hassles and physical health complaints are common among undergraduate students, and both are related to negative academic and psychosocial outcomes. However, the extent to which hassles or health complaints persist from day to day is underexplored, and studies examining whether hassles predict health complaints or vice versa, are lacking. This study aimed to examine the temporal stability and to define the temporal relationship between daily hassles and health symptoms in undergraduate students.

DESIGN

Participants (n = 255, mean age = 19.2 years, 69% female, 53% White) completed 14 consecutive daily diaries of hassles and health complaints.

MAIN OUTCOME MEASURES

Daily reports of the Brief College Students Hassles Scale and the Patient Health Questionnaire-15.

RESULTS

Hassles and health complaints demonstrated stability through autocorrelations. Hassles significantly predicted subsequent health complaints, but health complaints did not significantly predict subsequent hassles. However, the two paths did not differ significantly.

CONCLUSION

Students reporting elevations in one or both domains may benefit from interventions aimed at reducing daily hassles, in order to promote better perceived health and well-being.

Examining Uncertainty in Illness in Parents and Children With Chronic Kidney Disease and Systemic Lupus Erythematosus: A Mediational Model of Internalizing Symptoms and Health-Related Quality of Life

To examine if parent illness uncertainty is indirectly associated with child depression, anxiety, and HRQOL in the CKD/SLE population. Parent-child dyads (N = 31) from outpatient rheumatology and nephrology clinics included children (ages 9-18) diagnosed with CKD (Stage 1, 2, or nephrotic syndrome) or SLE. Parents completed demographic and uncertainty measures and children completed uncertainty, depression, anxiety, and HRQOL measures. This cross-sectional study examined mediational models using the percentile bootstrapping method. Parent uncertainty had an indirect effect on child depression, anxiety, and HRQOL through the mediator, child uncertainty. In other words, parents' illness uncertainty regarding their child's condition correlates to the child's illness uncertainty, which then is associated with the child's mental health and wellbeing. Reverse mediations illustrated that parent uncertainty did not mediate child uncertainty and outcome variables. Results extend previous research by examining parent and child illness uncertainty in understudied conditions (CKD/SLE) and the relationship to outcome variables commonly related to depression (e.g., anxiety and HRQOL). Findings allow health psychologists and medical personnel to understand the impact of uncertainty on the child's wellbeing and HRQOL. Clinical implications, including using specialized interventions to address illness uncertainty, are discussed.

Differences in quality of life among college student electronic cigarette users

PURPOSE

The purpose of this study was to explore an association between e-cigarette use and Quality of Life (QOL) among college students.

METHODS

During February 2016, 1,132 students completed an online survey that included measures of tobacco use and the WHOQOL-BREF instrument. Differences were tested using Chi-square, Fisher's exact test, and ANOVA, and regression was used to assess possible relationships.

RESULTS

E-cigarettes were used by 6.97% of the participants, either solo or along with traditional cigarettes. Bivariate analyses suggest that male college students are more likely than females to use e-cigarettes, either solo or in combination with traditional cigarettes (χ2 =19.4, P < .01). Lesbian, gay, and bisexual students are more likely than heterosexual students to use traditional cigarettes, either solo or in combination with e-cigarettes (χ2 = 32.9, P < .01). Multivariate models suggest that for every 10-unit increase in overall QOL, psychological well-being, social relations or environmental health the adjusted odds of being a sole cigarette user were significantly lower (all, P < .01), respectively. For every 10-unit increase in psychological well-being the adjusted odds of being a dual user was significantly lower (OR = .83, P = .026).

CONCLUSIONS

Findings indicate that lower quality of life appears to be connected to tobacco use.

Meta-Analysis: Caregiver and Youth Uncertainty in Pediatric Chronic Illness

Objective

To conduct a systematic review on the construct of illness uncertainty in caregivers and youth as related to the following: demographic and illness variables, psychological functioning, illness-related distress, and reaction/coping style.

Methods

A meta-analysis was conducted with articles assessing the associations between illness uncertainty and variables of interest that were published between November 1983 and June 2016 ( n = 58).

Results

Psychological functioning and illness-related distress had primarily medium effect sizes. Demographic and illness variables had small effect sizes. More positive and fewer negative reaction/coping styles were associated with less illness uncertainty, with primarily small effects.

Conclusions

Illness uncertainty may be an important factor that influences psychological functioning and distress and coping in the context of pediatric chronic illness. However, additional research is needed to determine more precise mean effect sizes, as well as the potential efficacy of intervention to address uncertainty. adolescents, children, chronic illness, coping skills and adjustment, meta-analysis, parents, psychosocial functioning.

Research Review: Childhood chronic physical illness and adult emotional health - a systematic review and meta-analysis

BACKGROUND

Childhood chronic physical illness is associated with a greater vulnerability for emotional problems (i.e. depression and anxiety) in childhood. However, little is known about life-long effects of childhood chronic physical illness on mental health. The present study aims to systematically review evidence for associations between eight chronic physical illnesses with childhood onset (arthritis, asthma, cancer, chronic renal failure, congenital heart disease, cystic fibrosis, type 1 diabetes, and epilepsy) and adult emotional problems.

METHODS

A database search of MEDLINE, PsycARTICLES, PsycINFO, and ScienceDirect was undertaken, and random effects meta-analyses were used to synthesise evidence from eligible studies.

RESULTS

In total, 37 studies were eligible for the systematic review (n = 45,733) and of these, 34 studies were included in the meta-analyses (n = 45,358). There were overall associations between childhood chronic physical illness and adult depression (OR = 1.31; 95% CI [1.12, 1.54]) and anxiety (OR = 1.47; 95% CI [1.13, 1.92]). Separate meta-analyses for childhood asthma, type 1 diabetes and cancer were also conducted, with cancer being significantly associated with adult depression (OR = 1.19; 95% CI [1.00, 1.42]).

CONCLUSIONS

The effects of childhood chronic physical illness on the risk of emotional problems persist beyond childhood and adolescence. Mental health prevention and intervention strategies targeting children with chronic physical illnesses can have long-term benefits.

Illness uncertainty and illness intrusiveness as predictors of depressive and anxious symptomology in college students with chronic illnesses

OBJECTIVE

To examine predictors of psychological functioning in college students with chronic illnesses.

PARTICIPANTS

Participants (N = 1413) included 364 students with self-reported diagnoses of asthma or allergies, 148 students with other chronic illnesses (eg, epilepsy, type 1 diabetes), and 901 healthy students. Data were collected between November 2013 and May 2015.

METHODS

Participants completed online measures of psychosocial functioning, including illness uncertainty, illness intrusiveness, depression, and anxiety.

RESULTS

Students with chronic illnesses other than asthma or allergies evidenced the greatest levels of anxious (p <. 05), but not depressive symptomology. Additionally, this group reported greater illness uncertainty and intrusiveness (p <. 05) compared to their peers. Uncertainty and intrusiveness independently predicted depressive and anxious symptoms for students in both illness groups.

CONCLUSIONS

Compared to peers with asthma or allergies, college students with other chronic illnesses reported higher levels of anxious symptoms. Illness uncertainty and intrusiveness appear to be predictors of psychological distress, regardless of illness.

Asthma-specific cognitions, self-focused attention, and fear of negative evaluation in adolescents and young adults diagnosed with childhood-onset asthma

The present study examined the impact of asthma-specific thought intrusion (TI) and thought suppression (TS) on two cognitive-affective variables (self-focused attention and fear of negative evaluation) among adolescents and young adults (AYAs) diagnosed with childhood-onset asthma. Participants were 290 AYAs who completed assessment questionnaires and participated in a written exercise electronically. Asthma-TI and TS were reported by participants following participation in a writing assignment. Asthma-TI was associated with increased private, public, and social anxiety self-focused attention, and greater fear of negative evaluation. Interestingly, asthma-TS was not associated with these same outcome variables. Findings suggest illness-specific cognitions are associated with cognitive-affective variables and it may be important to assess for illness-specific intrusive thoughts following asthma-focused medical appointments. Additionally, findings suggest the importance of assessing asthma-TI and TS separately in order to better understand thoughts about health and psychological functioning.

College Students’ Health and Short-Term Career Outcomes

This study examined the role of work volition in the relation between college students’ health and several short-term career outcome variables. The responses of 393 students to an online survey revealed that the number of the last 30 days that were deemed unhealthy was significantly related to work volition, and work volition was associated with major satisfaction, leadership aspirations, educational persistence intentions, and real versus ideal career aspiration discrepancy. Path analysis results were consistent with a model specifying work volition as a mediator of the associations between unhealthy days and the career variables. It therefore appears lower work volition may be a risk factor for students with health-related challenges. When conducting career assessment and counseling, career counselors and other providers should consider the perceived career-choice constraints that college students with chronic illnesses and general symptomatology perceive. Limitations and future research directions are discussed.

Pathways maintaining physical health problems from childhood to young adulthood: The role of stress and mood

OBJECTIVE

Poor physical health in childhood is associated with a variety of negative health-related outcomes in adulthood. Psychosocial pathways contributing to the maintenance of physical health problems from childhood to young adulthood remain largely unexamined, despite evidence that factors such as negative mood and stress impact physical health.

DESIGN

The current study tested the direct and indirect effects of ongoing health, chronic stress, health-related chronic stress, and depressive symptoms at age 20 on the link between health problems in childhood and young adulthood (age 21) in a longitudinal sample (n = 384).

MAIN OUTCOME MEASURES

The hypotheses were tested using a multiple mediation path analysis framework; the primary outcome measure was a composite index of health status markers in young adulthood.

RESULTS

The proposed model provided an adequate fit for the data, with significant total indirect effects of the four mediators and significant specific indirect effects of health-related chronic stress and depressive symptoms in maintaining health problems from childhood into young adulthood.

CONCLUSIONS

Health problems are maintained from early childhood into young adulthood in part through psychosocial mechanisms. Depressive symptoms and health-related chronic stress have significant, unique effects on the relationship between health problems in early childhood and young adulthood.

Self-esteem, Self-focused Attention, and the Mediating Role of Fear of Negative Evaluation in College Students With and Without Asthma

OBJECTIVE

The current study investigated the mediating role of fear of negative evaluation on the relationship between self-focused attention and self-esteem among college students with and without asthma.

PARTICIPANTS

Young adults with (n = 148) and without (n = 530) childhood-onset asthma were recruited from a college student population.

METHODS

Self-focused attention and fear of negative evaluation measures were completed. Participants also answered questions about inclusion in a social activity.

RESULTS

Higher levels of self-focused attention and fear of negative evaluation were associated with lower self-esteem in both groups within the context of social activity participation. Fear of negative evaluation mediated the relationship between self-consciousness and self-esteem. No significant differences were found between groups.

CONCLUSIONS

Findings indicate significant relationships among self-focused attention, fear of negative evaluation, and self-esteem in the context of social activity participation. Further examination of self-esteem regarding participation in social activities among college students appears warranted.

The development of the Lifestyle and Habits Questionnaire-brief version: relationship to quality of life and stress in college students

The authors describe the development and preliminary evaluation of the Lifestyle and Habits Questionnaire-brief version (LHQ-B). Three hundred seventy-seven undergraduate students (ages 18-25) participated. Responses were collected through either a web-based or face-to-face survey. Data reductive procedures were used with a preexisting lifestyle inventory to create an abbreviated measure. The relationship between lifestyle domains and indicators of wellbeing (levels of stress and quality of life (QOL)) were also examined. Eight lifestyle domains, encompassing 42 items, were identified and found to have good psychometric properties. The resulting LHQ-B measure can be self-administered/scored and contains norm-referenced feedback. The domains of psychological health, physical health and exercise, and sense of purpose were the best predictors of QOL while psychological health, social concern, and the accident prevention domains predicted levels of stress. The results support the use of the LHQ-B in lifestyle research or as a self-administered measure promoting self-awareness of lifestyle behaviors/attitudes in young adults (18-25 years).

Time and risk preferences and the use of asthma controller medication

OBJECTIVES

We investigated the role of risk tolerance, time preference, and asthma-specific attitudes in adherence to asthma control medications.

METHODS

Students with persistent asthma completed an online survey on asthma beliefs, risk tolerance, and time preference (n = 47). The time preference questions measure the degree to which the individual discounts future outcomes and essentially prefers immediate gratification to delayed gratification. The risk tolerance questions indicate the individual's dislike of uncertainty about outcomes. We analyzed the relationship between the independent and dependent variables.

RESULTS

Feelings of embarrassment and concern about medication, as well as risk tolerance and time preference, were found to be significant predictors of adherence to control medication in the logistic regression. Analysis of probabilities associated with different profiles shows that at high rates of risk tolerance and discounting of future outcomes, the probability of adherence is near 0 regardless of asthma-specific attitudes. Asthma attitudes have a statistically significant effect for individuals with low rates of risk tolerance and time preference.

CONCLUSIONS

The risk tolerance and time preferences of the target group should be considered when designing an asthma-intervention program. Individuals who strongly prefer immediate gratification over future benefits and are willing to tolerate uncertain outcomes are unlikely to adhere to controller medication, regardless of their asthma attitudes. In contrast, efforts to affect relevant attitudes will be most fruitful for individuals with low rates of risk tolerance and time preference. However, as we cannot extrapolate these results to a larger population, we must view them with caution.

Depression, Anxiety, and Health-Related Quality of Life in Adolescents and Young Adults With Allergies and Asthma

The current study sought to compare rates of depressive symptoms, anxious symptoms, and health-related quality of life (HRQOL) in adolescents and young adults (AYAs) with allergies, asthma, and healthy controls. Participants were undergraduate students aged 18 to 29 years with self-reported allergies (N = 79), asthma (N = 79), and with no history of a chronic illness (N = 79). Participants completed the Center for Epidemiologic Studies Depression Scale, the Zung Self-Rating Anxiety Scale, and the SF-36 Health Survey Questionnaire as self-report measures of depressive symptoms, anxious symptoms, and HRQOL, respectively. A series of ANCOVAs (analysis of covariance; allergies vs asthma vs healthy controls) was conducted to examine differences between the groups. The results of the current examination suggest that AYAs with allergies are indeed at risk for experiencing higher rates of depressive and anxious symptoms and poorer HRQOL than healthy AYAs. Furthermore, they are experiencing psychosocial concerns on par with or worse than those of AYAs with asthma. Allergies, often perceived as a relatively benign illness, have commonly been overlooked in discussions of psychosocial concerns related to chronic illnesses. The results of the current study suggest that young adults with allergies are also an important population to examine.