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

Abstract

This study examines the way coping styles and locus of control contribute to the prediction of psychosocial adjustment in adolescents with a chronic illness. Psychosocial adjustment of 84 adolescents aged 13–16 years with a chronic illness was assessed with measures of social adjustment, global self-esteem and behavior problems. Linear regressions were performed with demographic factors (age and gender) and stress-processing factors (coping style and locus of control) as predictor variables. Results indicated that coping styles were related to most aspects of social adjustment. The coping styles ‘seeking social support’ and ‘confrontation’ were important predictors for positive social adjustment; the coping style ‘depression’ was a predictor for poor adjustment, viz. low social self-esteem and high social anxiety. Avoidance and locus of control were not strongly associated with psychosocial adjustment. Clinical implications of these findings were discussed in terms of preventive interventions for adolescents with a chronic illness.

Introduction

A chronic illness may interfere with the developmental tasks of adolescents by making them more vulnerable to psychological and social problems (e.g. Gortmaker, Walker, Weitzman, & Sobol, 1990; Lavigne & Faier-Routman, 1992). However, there is wide variation in the psychosocial functioning of adolescents with a chronic illness (Lavigne & Faier-Routman, 1993). The majority of these adolescents function quite well, but a substantial subgroup develop clinically significant psychological or social problems. Several models have been developed to identify factors that contribute to this variation (e.g. Garmezy, Masten, & Tellegen, 1984; Pless & Perrin, 1985; Stein & Jessop, 1982). Wallander, Varni, Babani, Banis, and Wilcox (1989), who put mediating factors in psychosocial adjustment in a risk-resistance framework elaborated one of the most detailed models. They identified disease/disability parameters, functional dependence and psychosocial stressors as risk factors, while resistance factors included intrapersonal factors (e.g. temperament, problem solving ability), social-ecological factors (e.g. family environment, family members’ adaptation, social support), and stress processing factors (cognitive appraisal and coping strategies).

Resistance factors are thought to moderate the negative effects of risk factors on psychosocial adjustment besides their direct relation with psychosocial adjustment. Therefore, resistance factors are key parameters in preventing adjustment problems of chronically ill adolescents. This is confirmed in a meta-analysis carried out by Lavigne and Faier-Routman (1993), who found that resistance factors such as family/parent or child measures were stronger predictors in relation to child adjustment than disease/disability parameters were.

As identified in the model of Wallander et al. (1989), increasing attention is being paid to the relationship between stress-processing factors and the psychosocial adjustment of children and adolescents with a chronic disease. Lavigne and Faier-Routman (1993) illustrated the importance of coping as a mediating factor by reporting relatively high correlations between coping and adjustment. The mediating effect may vary between coping strategies. This was demonstrated by Spirito, Stark, Williams, Stamonlis, and Alexan (1988), who found that children with a chronic disease who were referred for adjustment problems used coping strategies that differed from those of children with a chronic disease and no apparent adjustment problems. Children with adjustment problems were more likely to use social withdrawal and wishful thinking than children without apparent adjustment problems were. Within this context, researchers have discussed categories of coping strategies that reflect effective coping. People with effective coping styles generally deal directly with the stressor by using active coping strategies. For example, Jorgensen and Dusek (1990) demonstrated in a healthy sample that optimally adjusted adolescents exhibited a higher percentage of active coping efforts (i.e. making decisions, seeking social support, and talking about problems with friends) than psychosocially less adjusted peers. Active coping is also associated with better illness-related adjustment (Gil, Williams, Thompson, & Kinney, 1991; Grey, Cameron, & Thurber, 1991). Avoidance or depressive coping behaviors characterizes people with less effective coping styles. Frank, Blount, and Brown (1997) found that avoidance coping and depressive attitudes predicted the risk for adjustment difficulties, that is depression and anxiety, in children with cancer. Likewise, Grey et al. found that avoidance was correlated with worse adjustment in children and adolescents with diabetes mellitus. In sum, the results of studies of coping in pediatric populations generally have favored the efficacy of more active efforts over more passive coping.

In addition to coping strategies, the appraisal of stress is a stress-processing factor that mediates between risk factors and adjustment. Specifically, expectations of control over one's environment—the locus of control (LOC)—seem to be a mediator in adaptation. Research suggests that persons with an internal LOC are better adjusted than persons with an external LOC are (e.g. Benson & Deeter, 1992; Steinhausen, Schindler, & Stephan, 1983). Also, an internal LOC seems to be predictive for illness-related adjustment (e.g. Jacobson et al., 1990; Miles, Sawyer, & Kennedy, 1995).

Although relevant research has been done with regard to coping and LOC as resistance factors in relation to psychosocial adjustment, several methodological problems limit the conclusions of these investigations. First, research specifically pertaining to adolescents is scarce. In most studies, results are presented for a group of children and adolescents with a broad age-range. Consequently, developmental differences in cognitive appraisal and in the use of coping strategies are masked. These stress-processing factors develop with age: coping strategies of children differ from coping strategies of adolescents (Carlson, Ricci, & Shade-Zeldow, 1990; Compas, Malcarne, & Fondacaro, 1988; Reid, Dubow, & Carey, 1995). Second, as far as we know, social adjustment has been outside the scope of most studies regarding resistance factors in chronically ill adolescents. Usually, psychological maladjustment factors such as behavior problems or depression are studied, but social maladjustment factors, such as social anxiety or social skills, have been rarely included. Finally, literature on coping in chronic illness focuses mainly on coping with illness-specific situations. Less attention has been given to the general coping styles of chronically ill adolescents. General coping styles may be more predictive for the psychosocial development of chronically ill adolescents than illness-related coping, because these styles reflect how the adolescents cope with developmental tasks. Moreover, “no current research suggests that children cope differently with illness-related stressors than with general stressors” (cited from Ryan-Wenger, 1996).

Therefore, the purpose of this study is to examine the contribution of two relevant resistance factors in the prediction of psychological and social adjustment of chronically ill adolescents: coping styles and LOC. The age-range is restricted to 13–16 years. In addition to psychological functioning variables, i.e. behavior problems and global self-esteem, we included several social adjustment variables: social activities, social self-esteem, social anxiety, and social skills. Adolescents with a variety of chronic conditions were included in the current study. Generally, investigators have failed to find an association of psychosocial functioning with diagnosis; the chronicity of the condition appears to be the common factor associated with psychosocial maladjustment (Siefert, Wittman, Farquar, & Talsma, 1992; Stein & Jessop, 1989; Wallander et al., 1989).