Psychological Adjustment to Chronic Illness

Chronic diseases, characterized by their persistence, significantly impact individuals’ lives, affecting their sense of self and adjustment. Helgeson and Zajdel (2017) examine how contextual factors, such as sex, social class, and race, influence chronic illness adjustment. While research on sexual orientation and gender identity is limited, existing studies suggest that women often report poorer psychosocial adjustment and more physical limitations compared to men with chronic diseases like diabetes, cancer, and heart disease (Helgeson & Zajdel, 2017).

Several factors influence adjustment to chronic disease, including sex, social class, race and ethnicity, and illness dimensions. Women often report worse health and more distress than men, potentially due to emotional contagion and other factors. Lower socioeconomic status is linked to poorer adjustment, possibly due to chronic stress and limited positive psychosocial resources. Racial and ethnic minorities often face disparities in disease severity, adherence, and coping strategies, though social support does not clearly account for these differences. Illness dimensions, such as perceived consequences, identity, and controllability, significantly impact adjustment, with stigma also contributing to poorer outcomes (Helgeson & Zajdel, 2017).

Chronic disease adjustment is influenced by illness centrality, comorbid conditions, and mental health status. Resilience factors, such as cognitive adaptation and personality traits like conscientiousness, facilitate adjustment, while vulnerability factors like neuroticism impede it. These factors interact with the ongoing strain of chronic illness, impacting psychological and physical well-being (Helgeson & Zajdel, 2017).

Various personality traits and coping strategies influence adjustment to chronic disease. Optimism, mindfulness, and agency are linked to better adjustment, often mediated by coping strategies like positive reappraisal and goal reengagement. However, the validity of post-traumatic growth reports is debated, with some suggesting they may reflect coping rather than actual growth (Helgeson & Zajdel, 2017).

Researchers have identified factors that influence disease adjustment, including illness acceptance, emotion regulation, and coping styles. Vulnerability factors such as pessimistic attributional style, unmitigated agency, and unmitigated communion can hinder adjustment. Avoidant coping and rumination are also linked to poor outcomes, often due to reduced social support and difficulty seeking help (Helgeson & Zajdel, 2017).

Social support, particularly emotional support, is crucial for chronic illness adjustment and self-management, especially for complex regimens like diabetes. While instrumental support can be beneficial, it may also undermine self-efficacy. Unsupportive behaviors, such as avoidance and criticism, can negatively impact adjustment, often through avoidance and undermined self-efficacy (Helgeson & Zajdel, 2017).

Studies show that unsupportive behaviors, such as criticism and conflict, are linked to poor outcomes for individuals with chronic illnesses. Overprotective behavior, while well-intentioned, can also be detrimental. Social control, involving attempts to influence a partner’s health behavior, has mixed effects on health outcomes, with positive and negative strategies showing varying correlations (Helgeson & Zajdel, 2017).

Dyadic coping, particularly communal coping involving shared illness appraisal and collaboration, is beneficial for both relationships and health outcomes in individuals with chronic illness. While explicit communal coping measures, such as self-report, are related to better relationship quality and reduced partner distress, implicit measures, like pronoun usage, show different effects. Future research should consider the interplay between individual, social, and demographic factors, including intersectionality, and explore the diverse range of caregiver relationships beyond spousal relationships (Helgeson & Zajdel, 2017).

Chronic disease impacts the sense of self and requires assimilation and accommodation for successful adaptation. Various factors, including resilience, vulnerability, social support, and dyadic coping, influence disease adjustment. Future research should consider the course of chronic disease and the specific factors affecting adjustment at each stage (Helgeson & Zajdel, 2017)

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Reference:

Helgeson, V. S., & Zajdel, M. (2017). Adjusting to chronic health conditions. Annual Review of Psychology, 68, 545–571. https://doi.org/10.1146/annurev-psych-010416-044014