Measuring up: the significance of measurement invariance in cardiovascular research.

Cardiovascular research frequently involves comparing patient-reported outcomes across groups. These groups can include individuals from different countries or that have different cardiovascular conditions, and it is frequently assumed that their understanding of the assessed outcome is similar. However, to ascertain that this is indeed the case, measurement invariance needs to be evaluated. This psychometric property helps us understand whether a test measures the same underlying construct in the same way across different groups. In the absence of measurement invariance, conclusions regarding group comparisons of the construct at hand may be inappropriate. This methods corner paper provides an overview of measurement invariance as well as an example of how it can be evaluated.

Personal and illness identity in youth with type 1 diabetes: Developmental trajectories and associations.

OBJECTIVE: Having Type 1 diabetes (T1D) may complicate the normative developmental task of personal identity formation in adolescence and emerging adulthood. Besides exploring and committing to identity choices in different life domains, youth with T1D need to integrate their illness into their identity, a process labeled as illness identity. The present study examined whether youth with T1D belonging to different personal identity trajectory classes developed differently on four illness identity dimensions (acceptance, enrichment, engulfment, rejection). METHOD: This four-wave longitudinal study over a 3-year period used self-report questionnaires to examine how personal identity trajectory classes were related to illness identity over time in youth with T1D (baseline: n = 558; 54% female; age range = 14-25 years). Personal identity trajectory classes were identified using latent class growth analysis. Differential development of the four illness identity dimensions among these personal identity trajectory classes was examined using multigroup latent growth curve modeling. RESULTS: Five personal identity trajectory classes were identified: achievement, foreclosure, moratorium, carefree diffusion, and troubled diffusion. Individuals in achievement and foreclosure displayed highest levels of diabetes integration (i.e., high levels of acceptance and enrichment; low levels of engulfment and rejection), whereas individuals in troubled diffusion displayed lowest levels of illness integration (i.e., low levels of acceptance and enrichment; high levels of engulfment and rejection). CONCLUSIONS: The present study confirms that personal identity development relates to illness identity development over time in youth with T1D. Understanding the intricate link between personal and illness identity may help clinicians to tailor their interventions to patients' individual needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Longitudinal development of non-suicidal self-injury disorder in adolescence: Prospective prediction of stability and change by identity development, depression, trauma, and resilience.

BACKGROUND: With the introduction of non-suicidal self-injury disorder (NSSI-D) in DSM-5, the field obtained a standardised set of criteria to study those engaging in more severe and chronic NSSI. To date, no previous research has studied the development of NSSI-D longitudinally, leaving questions on its stability and potential prospective predictors unanswered. METHODS: 2162 community adolescents (M = 15.00 years, SD = 1.88, 53.9 % girls at T1) completed a set of self-report questionnaires for three consecutive years and were classified into three severity-based NSSI subgroups (no-NSSI, subthreshold-NSSI, NSSI-D). Multinomial logistic regression analyses were used to prospectively predict subgroup membership by age, gender, identity development, depressive symptoms, traumatic experiences, and resilience. RESULTS: At baseline, the sample was distributed over the no-NSSI group (88 %), the subthreshold-NSSI (6 %) and NSSI-D (6 %) groups. These groups respectively showed high (93.5 %), low (25 %) and moderate (47.5 %) stability over one-year intervals. Longitudinally, higher levels of identity confusion and trauma significantly increased the likelihood of transitioning to subthreshold-NSSI. Moreover, boys had a higher likelihood of transitioning from NSSI-D to no-NSSI over the course of one year. CONCLUSIONS: This three-year study provides the first indication of the longitudinal course of NSSI-D with the current set of DSM-5 criteria. Clinically, the results suggest the particular potential of identity confusion and trauma as prevention targets in community adolescents.

Psychological functioning of childhood cancer survivors: Longitudinal associations with the parental context.

OBJECTIVE: The long-term psychological effects of childhood cancer vary, with childhood cancer survivors reporting depressive symptoms, fear of cancer recurrence, and benefit finding. As cancer is considered a family disease, investigating the parental context may provide insight into such individual differences in psychological functioning of survivors. This study examined the directionality of effects among parental sense of incompetence, parenting dimensions (responsiveness, psychological control, and overprotection), and survivor psychological functioning (depressive symptoms, fear of cancer recurrence, and benefit finding). METHOD: This three-wave longitudinal study (covering 2 years) included 125 Dutch-speaking childhood cancer survivors (ages 14-24, 95.2% diagnosed < 18 years, and time since diagnosis 2-22 years), 114 mothers, and 91 fathers. Survivors reported (SR) about their psychological functioning and perceived parenting. Mothers reported (MR) and fathers reported (FR) about parenting and sense of incompetence. Cross-lagged panel models were estimated for each informant's perspective on parenting separately. RESULTS: Different relations were obtained for each informant. Primarily unidirectional relations were found from parental sense of incompetence to maladaptive parenting (psychological control across informants and maternal overprotection SR) and from parenting to survivor functioning. Maternal and paternal responsiveness SR positively predicted survivors' benefit finding and negatively predicted survivors' depressive symptoms, respectively. Responsiveness MR and overprotection MR positively predicted survivors' fear of cancer recurrence and depressive symptoms, respectively. One consistent reverse pathway emerged: maternal and paternal responsiveness SR negatively predicted maternal and paternal sense of incompetence, respectively. CONCLUSION: The results support parent-driven processes impacting survivors' psychological functioning and stress the need to focus on multiple perspectives when investigating family dynamics. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comparing youth with and without type 1 diabetes on perceived parenting and peer functioning: a propensity weighting approach.

The premise of this study was to gain more insight into whether type 1 diabetes (T1D) can impact how youth perceive parents and peers. To address limitations of previous observational studies comparing youth with T1D to control youth, propensity weighting was used to mimic a randomized controlled trial. A total of 558 youth with T1D and 426 control youth (14-26y) completed questionnaires on parental responsiveness, psychological control, overprotection, friend support, extreme peer orientation, and a host of background and psychological functioning variables. The groups were statistically weighted to become as comparable as possible except for disease status. The analysis plan and hypotheses were preregistered on the open science framework. Youth with T1D perceived their mothers to be more overprotective, perceived fewer friend support, and were less extremely oriented toward peers than control youth. There were no group differences for paternal overprotection and paternal and maternal responsiveness and psychological control. Mothers of youth with T1D seem at risk to practice overprotective parenting and clinicians could play an important role in making mothers aware of this risk. However, the absence of group differences for the maladaptive parenting dimension of psychological control and adaptive dimension of responsiveness are reassuring and testify to the resilient nature of youth with T1D and their families. Additionally, there is accumulating evidence that T1D could interfere with engaging in supportive friendships.

Trajectories of adaptive and disturbed identity dimensions in adolescence: developmental associations with self-esteem, resilience, symptoms of depression, and borderline personality disorder features.

To advance our understanding of adolescents' identity formation and how it may play into their psychological functioning, this study investigated developmental trajectory classes of adaptive and disturbed dimensions of identity formation, and whether adolescents belonging to different trajectory classes develop differently on self-esteem, resilience, symptoms of depression, and borderline personality disorder (BPD) features. Three-wave longitudinal data from 2,123 Flemish adolescents was used (54.2% girls; Mage = 14.64, range = 12-18 at T1). Results pointed to four trajectory classes of identity formation: adaptive identity, identity progression, identity regression, and diffused identity. The adaptive identity class presented with stable high levels of self-esteem and resilience, and stable low levels of symptoms of depression and BPD, whereas opposite results were obtained for the diffused identity class. The identity progression class reported an increase in self-esteem and resilience as well as a decrease in symptoms of depression and BPD, whereas opposite results were obtained for the identity regression class. These results emphasize that adaptive and disturbed dimensions of identity formation are closely related to markers of well-being and psychopathology among adolescents, and could help identify adolescents with an increased risk for negative psychological functioning or increased opportunity for positive psychological functioning.

Identity formation in adolescent and emerging adult cancer survivors: a differentiated perspective and associations with psychosocial functioning.

OBJECTIVE: Identity formation was investigated in adolescent and emerging adult cancer survivors from a (neo-)Eriksonian perspective by comparing survivors to control participants. In survivors, associations between identity and clinical/demographical variables and general and illness-specific functioning were investigated. DESIGN: Childhood cancer survivors (n = 125; Mage: 19.54; 47% male) were matched on age and gender with healthy controls (2:1). MAIN OUTCOME MEASURES: All participants completed identity questionnaires. Survivors reported on demographics, well-being (depressive symptoms, life satisfaction, physical functioning), and illness-specific experiences (PTSS, illness centrality, cancer self-identity, benefit finding, cancer-related worries). Medical records provided clinical information. RESULTS: Survivors did not differ from controls on identity synthesis or confusion or on the identity statuses resulting from cluster analysis on the identity dimensions (achievement, foreclosure, moratorium, diffusion). Identity synthesis related to better well-being and illness experiences, whereas confusion related to worse well-being and illness experiences. Youth in moratorium and diffusion reported lower well-being and more negative illness experiences. Associations between identity and demographical and clinical characteristics were inconsistent. CONCLUSIONS: This study revealed no significant differences in identity formation between cancer survivors and controls. However, survivors who struggle in their identity quest should be identified as they are at risk for poorer well-being and negative illness experiences.

Topical Review: Youth With Type 1 Diabetes: What Is the Role of Peer Support?

The literature on the role of peer support for psychological well-being and disease management among youth with type 1 diabetes (T1D) is mixed. In this topical review, we use self-determination theory (SDT) as a framework to understand the conditions under which peer support is helpful or unhelpful regarding psychological well-being and diabetes management. We briefly review the literature to support our claim that existing research on peer support is inconsistent. A primary reason for the inconsistency is that previous work largely focuses on diabetes instrumental and informational support from peers, which have the potential to threaten SDT needs for autonomy, competence, and relatedness. Instrumental and informational support may set youth with T1D apart from peers at a time when fitting in with peers is crucial. Instead, we argue that emotional support from and companionship with peers best meet the SDT need of relatedness while not posing direct threats to autonomy or competence. We also note that some youth have extremely high needs for relatedness such that they prioritize connecting with peers over diabetes management. We conclude by calling for more research to adopt a SDT theory approach to examine the role of peer support in the lives of youth with T1D and for health care professionals to expand their focus from the specifics of diabetes to the broader social context.

Associations between cancer-related distress and fatigue in childhood cancer survivors: A longitudinal study.

BACKGROUND AND AIMS: A chronic feeling of fatigue occurs in up to 85% of childhood cancer survivors (CCS). This phenomenon has a detrimental effect on quality of life, reintegration in daily life activities and psychosocial functioning of the patient. Therefore, it is important to elucidate potential individual risk and protective factors. METHODS: CCS who were treated in the University Hospital of Leuven, completed two annual questionnaires on cancer-related distress (fear of cancer recurrence and post-traumatic stress, resilience and fatigue). Associations between distress and fatigue levels were examined by performing cross-lagged panel analyses. Resilience was included as a potential moderator. These models included all within-time associations, stability paths, and cross-lagged paths. Gender and time since diagnosis were included as covariates. RESULTS: In total, 110 CCS participated in this study, aged 14-25 years (average time since diagnosis 12.2 years; 41.8% boys; diagnosed with leukemia/lymphoma [49%], solid tumor [15%], brain tumor [16%] or other [20%]). Fear of cancer recurrence and post-traumatic stress at baseline positively predicted fatigue 1 year later. Cross-lagged panel analyses showed that resilience did not buffer the effect of fear of cancer recurrence on fatigue, in contrary to our expectations. Stability coefficients were high for all study variables. CONCLUSION: This study indicates associations between cancer-related distress (fear of cancer recurrence and post-traumatic stress), resilience and cancer-related fatigue over time in CCS. Interventions to improve fatigue levels could be focusing on both tackling cancer-related distress, while improving resilience levels as well.

Illness Perceptions and Illness Identity in Adolescents and Emerging Adults With Neuromuscular Disorders.

BACKGROUND: Neuromuscular disorders (NMD) are intrusive medical conditions with implications for psychosocial development. OBJECTIVES: This paper explores illness perceptions and illness identity dimensions of youth with NMD. First, we compare illness identity outcomes and illness perceptions of NMD patients with a comparison group of adolescents with type 1 diabetes mellitus (DM). Second, we report about the relationships between NMD-related variables and illness perceptions and illness identity. METHODS: Scores on the Brief Illness Perception Questionnaire and the Illness Identity Questionnaire were compared between a group of NMD patients (N = 59; 12-22 years) and an age- and gender-matched group of DM patients (N = 118). NMD-related variables included time since diagnosis, prognosis, wheelchair use, and physical limitations. RESULTS: Youth with NMD scored significantly higher on two of the four illness identity dimensions than youth with DM. NMD patients reported significantly less positive illness perceptions, experienced more physical symptoms, and had a lower score on understanding of their illness. Within the NMD group, wheelchair-users have a better understanding of their disease than those who are not wheelchair-bound. CONCLUSIONS: The present study is the first to investigate illness identity and illness perceptions in NMD. More research is needed to provide insight in the identity formation process of the growing group of adolescents with NMDs.

Gothenburg Empowerment Scale (GES): psychometric properties and measurement invariance in adults with congenital heart disease from Belgium, Norway and South Korea.

BACKGROUND: Patient empowerment is associated with improvements in different patient-reported and clinical outcomes. However, despite being widely researched, high quality and theoretically substantiated disease-generic measures of patient empowerment are lacking. The few good instruments that are available have not reported important psychometric properties, including measurement invariance. The aim of this study was to assess the psychometric properties of the 15-item Gothenburg Empowerment Scale (GES), with a particular focus on measurement invariance of the GES across individuals from three countries. METHODS: Adults with congenital heart disease from Belgium, Norway and South Korea completed the GES and other patient-reported outcomes as part of an international, cross-sectional, descriptive study called APPROACH-IS II. The scale's content (missing data) and factorial validity (confirmatory factor analyses), measurement invariance (multi-group confirmatory factor analyses), responsiveness (floor and ceiling effects) and reliability (internal consistency) were assessed. RESULTS: Content validity, responsiveness and reliability were confirmed. Nonetheless, metric but not scalar measurement invariance was supported when including the three countries, possibly because the scale performed differently in the sample from South Korea. A second set of analyses supported partial scalar invariance for a sample that was limited to Norway and Belgium. CONCLUSION: Our study offers preliminary evidence that GES is a valid and reliable measure of patient empowerment in adults with congenital heart disease. However, cross-country comparisons must be made with caution, given the scale did not perform equivalently across the three countries.

Development of Peer Relationships From Adolescence into Emerging Adulthood: Comparing Males and Females With and Without Type 1 Diabetes.

OBJECTIVE: Friendships and romantic relationships are important sources of support that contribute to well-being for youth across adolescence and emerging adulthood and may be especially important for those with a chronic illness. We examined gender differences in trajectories of peer relationships among those with type 1 diabetes (T1D) and how they differ from those without. METHODS: Individuals with T1D (N = 132) and controls (N = 131) completed questionnaires across 11 years (M age = 12 years at baseline). Trajectories of friend support, conflict, and companionship were estimated from ages 11 to 23. Romantic support and conflict trajectories were estimated from ages 17 to 23. RESULTS: Females experienced more friend support than males, especially in comparison to males with T1D. Control females experienced highest levels of romantic support and lowest levels of romantic conflict. In comparison to control males, males with T1D experienced less friend support in early adolescence and less companionship in late adolescence and emerging adulthood. In comparison to control females, females with T1D experienced less friend support in late adolescence and more romantic conflict in emerging adulthood. CONCLUSIONS: Findings that males with T1D report less friend support and companionship compared to control males, and females with T1D report less friend support and more romantic conflict than control females are of concern as these results suggest those with T1D may be missing out on important aspects of peer relationships. Understanding the broader social network of peer relationships may be useful to clinicians as they assist individuals in garnering support in general and for their diabetes.

Diabetes support from romantic partners during early emerging adulthood.

We examined support for type 1 diabetes in casual versus committed romantic relationships and links to blood glucose, self-care, and affect in 101 young adults (Mage 18.8). Individuals provided survey and daily measures of support and blood glucose and affect during a 14-day diary period. Survey data indicated individuals viewed partners as helpful, with partners in committed relationships rated more helpful than those in casual relationships. Daily assessments indicated partners were seen as only moderately helpful. Individuals in committed relationships discussed diabetes with partners on more diary days than those in casual relationships. When individuals in any relationship type experienced more helpful partner support than their average, they reported higher positive and lower negative affect. However, those in casual relationships also experienced more negative affect and higher mean blood glucose the next day. Results suggest tradeoffs between immediate benefits and subsequent costs of partner support to adults in casual relationships.

Worries and Benefit Finding in Cancer Survivors and Parents: A Longitudinal Study.

OBJECTIVE: The interplay and longitudinal associations between positive and negative illness-related experiences in childhood cancer survivors and their families remain unclear. Therefore, benefit finding, cancer-related worries, depressive symptoms, and life satisfaction were prospectively investigated in childhood cancer survivors and parents. Directionality of effects and interactions between benefit finding and cancer-related worries in predicting general well-being were examined. METHODS: Childhood cancer survivors (n = 125 at T1; aged 14-25), mothers (n = 133 at T1), and fathers (n = 91 at T1) completed two annual questionnaires on benefit finding, cancer-related worries, depressive symptoms, and life satisfaction. Cross-lagged panel analyses including benefit finding, cancer-related worries, their interaction, and depressive symptoms or life satisfaction were conducted in survivors, mothers, and fathers. RESULTS: Relatively high stability coefficients were found for all study variables. In survivors, cancer-related worries predicted relative increases in depressive symptoms and benefit finding over time. Benefit finding predicted relative increases in life satisfaction over time and buffered negative effects of cancer-related worries on life satisfaction. In mothers and fathers, positive correlated change at T2 (the correlation between residuals at T2) indicated that relative change in benefit finding over time was positively related to relative change in cancer-related worries. CONCLUSION: Benefit finding was related both to positive well-being and negative illness experiences, which calls for more research to unravel the different functions of benefit finding over time. Clinicians should be encouraged to attend to positive illness experiences along with more negative ones to obtain a more nuanced view on the illness experiences of survivors and their families.

Illness identity and adjusting to type I diabetes: A four-wave longitudinal study.

OBJECTIVES: Prior research has linked illness identity-or the extent to which the illness is integrated into one's identity-to diabetes-specific functioning. Four illness identity dimensions have been identified: rejection, acceptance, engulfment, and enrichment. As longitudinal research on this topic is scarce, this study examined developmental trajectories of illness identity and prospective associations between illness identity and diabetes-specific functioning. METHOD: Adolescents and emerging adults with Type I diabetes, aged 14 to 25 (Mage = 19; 54% girls), participated in a four-wave longitudinal study spanning 3 years (N = 559 at Time 1). Participants filled out questionnaires on illness identity, treatment adherence, and diabetes-specific distress. Hemoglobin A1c (HbA1c) values were obtained from participants' medical records. To chart the development of illness identity over time, we performed latent growth curve modeling. Cross-lagged analysis was used to examine prospective associations between illness identity and diabetes-specific functioning. RESULTS: We observed small linear increases in acceptance (Mslope = .05, p < .01) and engulfment (Mslope = .03, p < .05) and a small linear decrease in rejection (Mslope = -.08, p < .001) across waves (with scale scores ranging between 1 and 5). Rejection negatively predicted and enrichment positively predicted treatment adherence 1 year later, which, in turn, positively predicted enrichment and negatively predicted engulfment over time. Furthermore, rejection and engulfment positively predicted diabetes-specific distress 1 year later. Finally, diabetes-specific distress and HbA1c positively predicted engulfment 1 year later. Standardized cross-lagged coefficients ranged between |.05| and |.11|. CONCLUSIONS: We identified small but interesting changes in three out of four illness identity dimensions. Prospective associations between illness identity and diabetes-specific functioning were bidirectional in nature. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Diabetes-specific friend support in emerging adults with type 1 diabetes: Does satisfaction with support matter?

Youth with type 1 diabetes (T1D) must adhere to a complex treatment regimen to prevent health complications. Friends may provide diabetes-specific support to help youth manage diabetes, but evidence on whether youth benefit from diabetes-specific friend support is inconclusive. The present study first investigated whether satisfaction with friend support was linked to psychological distress and diabetes management. Second, it was investigated whether self-esteem mediated these relations. To this end, 324 Dutch-speaking emerging adults (17-28 years) with T1D completed questionnaires on diabetes-specific friend support, self-esteem, diabetes-specific distress, depressive symptoms, and self-care. HbA1c values were obtained from patients' physicians. Receiving diabetes-specific support from friends was associated with more diabetes-specific distress, but not for youth who were satisfied with the received support. Diabetes-specific friend support was not associated with other outcomes. Self-esteem did not mediate these relations. These results suggest that associations between diabetes-specific friend support and diabetes management are limited and that support satisfaction should be taken into consideration when examining the role of friend support for youth with T1D.

A guide to improve your causal inferences from observational data.

True causality is impossible to capture with observational studies. Nevertheless, within the boundaries of observational studies, researchers can follow three steps to answer causal questions in the most optimal way possible. Researchers must: (a) repeatedly assess the same constructs over time in a specific sample; (b) consider the temporal sequence of effects between constructs; and (c) use an analytical strategy that distinguishes within from between-person effects. In this context, it is demonstrated how the random intercepts cross-lagged panel model can be a useful statistical technique. A real-life example of the relationship between loneliness and quality of life in adolescents with congenital heart disease is provided to show how the model can be practically implemented.

A Person-Centered Perspective on the Role of Peer Support and Extreme Peer Orientation in Youth with Type 1 Diabetes: A Longitudinal Study.

BACKGROUND: Despite clear evidence that peers are crucial for youth development, research on the role of peers for youth with Type 1 diabetes (T1D) is scarce. PURPOSE: The present study identified trajectory classes of perceived peer functioning in youth with T1D, based on peer support and extreme peer orientation (EPO). Further, classes were compared with respect to their trajectories of depressive symptoms, diabetes-specific distress, treatment adherence, and HbA1c values. METHODS: Five hundred and fifty-nine youth (14-25 years) with T1D completed questionnaires at baseline, 1, 2, and 3 years later. Latent class growth analysis identified classes of perceived peer functioning. Multigroup latent growth curve modelling assessed whether these classes were characterized by different trajectories of general and diabetes-specific functioning. RESULTS: A socially normative class (48%) was characterized by trajectories of high support and low EPO over time. A socially reserved class (29%) was characterized by low support and EPO, and a socially oriented class (17%) by high support and EPO. Finally, a socially vulnerable class (6%) was characterized by low support and high EPO. The normative class functioned significantly better over time than the other classes. The vulnerable class functioned significantly worse compared to the reserved class, despite experiencing equally low levels of support. CONCLUSIONS: The results underscore the need to take youths' orientation toward the peer context into account alongside support when tapping into the role of peers, because individuals with low levels of support and EPO functioned substantially better than individuals with similar low levels of support but high levels of EPO.

Illness intrusiveness in parents of youth with type 1 diabetes: A longitudinal study.

OBJECTIVE: Type 1 diabetes in youth has a wide-ranging impact on families. This study aimed at a better understanding of experiences and difficulties that parents may encounter in their lives. Parental illness intrusiveness (ie, a parent's perception that the illness of one's child interferes with one's personal life) was prospectively examined in mothers and fathers. METHODS: Parental dyads (n = 291) completed four annual questionnaires on parental illness intrusiveness, depressive symptoms, and treatment adherence of their child. Youth reported on their treatment adherence. RESULTS: First, cross-lagged models showed that mothers' illness intrusiveness predicted relative increases in both mothers' and fathers' illness intrusiveness over time. Similar effects were found for fathers. Second, paired-samplest tests revealed higher illness intrusiveness in mothers at baseline. Latent growth curve modeling showed that mothers' illness intrusiveness generally decreased over time, while fathers' illness intrusiveness remained constant. Third, from a person-centered approach, multivariate latent class growth analysis identified three classes of parental couples: one with low and decreasing illness intrusiveness (54%), one with slightly elevated illness intrusiveness that remained stable over time (37%), and one with high illness intrusiveness that decreased in mothers but remained stable in fathers (9%). More parental depressive symptoms were reported in this latter class, while treatment adherence did not differ among the classes. CONCLUSIONS: Most parents in this sample reported rather low illness intrusiveness over time, yet some experienced a major impact of the illness. Examining parental illness intrusiveness may provide a better understanding of the specific challenges parents are confronted with.

The Social Context and Illness Identity in Youth with Type 1 Diabetes: A Three-Wave Longitudinal Study.

Youth with type 1 diabetes are confronted with the challenging task of integrating diabetes into their identity. This integration process, referred to as illness identity, may play an important role in how youth with type 1 diabetes cope with normative and illness-specific challenges. In line with socio-ecological theorizing, the present study investigated the longitudinal interplay between illness identity and two important social contexts for youth, the parent and peer contexts. A total of 559 (54.5% female; mean age = 18.8 years) adolescents (14-17 years) and emerging adults (18-25 years) with type 1 diabetes completed questionnaires at three time-points with intervals of one year. A total of 98% of these participants had the Belgian nationality, and all of them spoke Dutch. At each time point, illness identity (i.e., acceptance, enrichment, rejection, and engulfment), peer support, extreme peer orientation, parental responsiveness, parental psychological control, and parental overprotection were self-assessed. The present findings show that overprotective parenting may lead to youth feeling engulfed by their diabetes. Further, when type 1 diabetes becomes adaptively integrated into youth's identity, the data suggest that youth may be better prepared to engage in healthy peer relationships. Thus, the present findings show that illness identity may be affected by the social context, and in turn may have an impact on parent and peer relationships as well. In general, the present findings underscore the importance of adaptive illness integration for youth with type 1 diabetes, and further emphasize the importance of achieving a coherent identity.