Psychological effects of illness in adolescence. I. Anxiety, self-esteem, and perception of control.

Three hundred and forty-nine healthy adolescents were compared with 168 adolescents with various chronic or serious diseases on standardized measures of trait anxiety, self-esteem, and health locus of control (perception of self-control over health and illness). No differences in anxiety or self-esteem were found between healthy and ill groups or between various ill groups. Patients with oncologic, renal, cardiac, and rheumatologic disorders perceived significantly less control over their health than did healthy adolescents and patients with cystic fibrosis or diabetes mellitus. Stability of prognosis was related to low anxiety, as was length of time since diagnosis. Other physician-rated variables including course of disease, visible signs of illness, severity, and number of hospitalizations did not relate to psychologic variables. The data are interpreted as casting doubt upon the supposition that chronic or serious disease inevitably leads to psychopathology in adolescents. The overall pattern presented was one of psychologic normalcy, and attitudes regarding control over health are seen as reflecting realistic perceptions on the part of patients. The importance of looking at the effects of serious disease upon day-to-day functioning, as opposed to emphasizing inferred psychologic deviance, is stressed.

Psychologic effects of illness in adolescence. II. Impact of illness in adolescents--crucial issues and coping styles.

Adolescent perceptions of the impact of illness were measured through the administration of an original questionnaire to 345 healthy adolescents and 168 adolescents with diabetes mellitus, cystic fibrosis, cancer, and cardiac, renal, or rheumatologic diseases. Total impact of illness (e.g., leukemia or colds) did not differ between ill and healthy respondents, and the nature of adolescent concerns were similar for both groups. Restriction of freedom was seen as the major disruption brought about by illness, with other areas of impact including relations with peers, siblings, and parents. Adolescents with cancer were most likely to view treatment as highly disruptive and, along with rheumatologic patients, expressed greatest disruption of body image secondary to disease and treatment. Perceived school disruption was most common in cardiac and oncologic patients, with the former also expressing a high degree of concern about sexuality. Females in all groups reported more impact of illness on physical appearance than did males; this difference was greatest in adolescents with cancer, rheumatologic diseases, and cystic fibrosis. The essentially healthy psychologic status of chronically ill adolescents is noted, as is the generally hopeful and positive quality of patient responses.