Rogers v. Robson: Increased Malpractice Liability for Insurance Defense Counsel, 14 J. Marshall L. Rev. 589 (1981)

Poster Presentationstatus: publishe

Adjusting to chronic illness. The role of social support and illness identity

Having a chronic illness can pose major challenges in daily life. The degree to which patients succeed in integrating their illness into their identity could partially explain why certain patients experience difficulties, whereas others succeed in adjusting to their illness. Hence, the present project proposes the concept of illness identity to capture the degree to which chronic illness is integrated into one's identity and focuses on four illness identity dimensions: engulfment, rejection, acceptance, and enrichment. The main goal is to apply an integrative, developmental approach assessing these illness identity dimensions in three different chronic illnesses: Type 1 diabetes, congenital heart disease, and epilepsy. Such an approach allows for examining both illness-specific and trans-diagnostic processes and mechanisms. Three main research objectives will be addressed: (1) to examine the development of illness identity over time; (2) to investigate how the four illness identity dimensions may influence illness-specific and psychological functioning; and (3) to investigate how personality, illness perceptions, and coping are related to the four illness identity dimensions over time.status: publishe

Parental Illness Intrusiveness and Youth Glycemic Control in Type 1 Diabetes: Intergenerational Associations

Introduction. Type 1 Diabetes (T1D) is a chronic condition accompanied by strict treatment guidelines, impacting both the patient and the surrounding family. Although previous literature has examined specific associations linking parental and youth functioning, studies examining encompassing intergenerational models are scarce. The present multi-informant study investigated an intergenerational path-model, linking illness intrusiveness in parents to patient glycemic control. More specifically, parental functioning (illness intrusiveness and depressive symptoms) was expected to predict patient functioning (depressive symptoms, treatment adherence, and glycemic control) through parenting practices (overprotection and psychological control). Methods. 316 patient-mother dyads and 277 patient-father dyads participated at the first wave of an ongoing longitudinal study (patients with T1D, aged 14-25, living at home). Parents reported on their experience of illness-intrusiveness, their depressive symptoms, and patient’s treatment adherence. Patients indicated their depressive symptoms and treatment adherence. Medical records provided HbA1c-values. Parenting practices, as operationalized by the dimensions of overprotection and psychological control, were assessed in both parents and patients. Results. Structural equation modelling favored our hypothesized path model to an alternative, child-driven model. An adequate fit was found for both patient-mother and patient-father dyads. Parental functioning predicted patient functioning with parenting practices as intervening mechanisms. Parental illness intrusiveness was associated with parental depressive symptoms, both predicting overprotection and psychological control. Psychological control in particular predicted patient depressive symptoms, treatment adherence, and glycemic control. Discussion. These findings underscore the importance of the context when considering the functioning of youth with T1D. Longitudinal analyses are warranted to further investigate bidirectional or transactional pathways.status: publishe

Illness perceptions in youth with type 1 diabetes and their parents: A triadic approach

Objectives. Type 1 diabetes constitutes a challenging illness both for the patient and its immediate context. Especially parents play a crucial role in illness adaptation and management of adolescent and emerging adult patients. The present study addressed the combined role of patient and parental illness perceptions to understand how type 1 diabetes impacts both patient and parental functioning. Previous research focused mainly on the role of illness perceptions and patient self-regulation, but a triadic approach investigating how patient and parental illness perceptions interact in predicting functioning remains forthcoming. Methods. Selected from the Belgian Diabetes Registry, a total of 330 patients-mothers-fathers triads participated. Mean age of patients (52% female) was 18.25 (SD = 2.98). Patients and both their parents completed questionnaires on their own illness perceptions (Brief IPQ) and functioning (depressive symptoms, life satisfaction). Additionally, patients reported on their treatment adherence. HbA1 values were obtained from patients’ medical records. Results. A series of regression analyses indicated that, although a person’s own illness perceptions predicted his or her functioning, illness perceptions of other close relatives were also predictive. Further, significant two- and three-way interaction terms indicated that illness perceptions of different members of the triad interacted in predicting patient and parental functioning. For instance, with respect to the illness perception of personal control, treatment adherence was highest when both patients and mothers scored high on perceived personal control. Likewise, fathers’ life satisfaction was highest when both fathers and patients scored high on perceived personal control. Conclusions. The present study encourages researchers to take the family as a system into account when examining individual functioning, both of patients with type 1 diabetes and their parents.status: publishe

Ziekte-identiteit bij jongeren met type 1 diabetes

Een belangrijke taak voor jongeren is het ontwikkelen van een eigen identiteit, dus een beeld van wie ze zijn en wat ze willen doen in het leven. Voor jongeren met type 1 diabetes is deze taak extra uitdagend, omdat zij ook hun diabetes een plaats moeten geven in hun leven en identiteit. De vraag is dus op welke manier jongeren met type 1 diabetes dit doen. Wij noemen dit ziekte-identiteit en onderscheiden daarbij vier verschillende manieren. Bij de eerste twee manieren krijgt de diabetes geen geschikte plaats in de identiteit. De eerste manier is overspoeling, waarbij de jongere het gevoel heeft dat de diabetes volledig bepaalt wie hij/zij is. De tweede manier is verwerping, wat inhoudt dat de jongere diabetes niet ziet als een deel van wie hij/zij is en er geen rekening mee wilt houden in zijn/haar leven. Bij de derde en vierde manier is er wel sprake van integratie. De derde manier is aanvaarding, waarbij de jongere de diabetes ziet als een deel van zijn/haar persoon, maar de diabetes niet allesbepalend is. De vierde manier is verrijking, waarbij de jongere het gevoel heeft dat hij/zij als persoon sterker geworden is door de diabetes. Deze vier manieren werden onderzocht aan de hand van vragenlijsten bij 571 Vlaamse jongeren tussen 14 en 25 jaar met type 1 diabetes. Uit dit onderzoek bleek dat de manier waarop jongeren diabetes integreren in hun persoon of identiteit een mogelijke rol speelt in hoe ze zich voelen en hoe hun diabeteszorg verloopt.status: publishe

Illness Identity in Youth with Type 1 Diabetes

Objectives. An important task for adolescents and emerging adults with type 1 diabetes is integrating diabetes into one’s identity. Four so-called illness identity dimensions have been identified: engulfment, rejection, acceptance, and enrichment. To examine individual differences in these illness identity dimensions, the present study focuses on configurations of these four illness identity dimensions and how they relate to diabetes-specific and psychological functioning. Methods. A sample of 575 patients (14-25 years of age) with type 1 diabetes completed questionnaires on illness identity, psychological functioning, and treatment adherence. HbA1c-values were collected from patients’ medical records. Cluster analysis was used to identify different configurations. Analyses of variances were used to identify differences among the clusters in diabetes-specific and psychological functioning. Results. Five clusters were retained and this solution was rather stable across sex (Cohen’s kappa=0.77): Engulfment-Rejection (13.0% of the sample), Rejection (17.8%), Engulfment-Enrichment (18.7%), Acceptance (25.0%), and Acceptance-Enrichment (25.5%). No differences in age, illness duration, or sex were found among the clusters. The Engulfment-Rejection showed the least optimal profile (i.e., high on depressive symptoms, low on satisfaction with life, low on treatment adherence, and high HbA1c-values). Acceptance and Acceptance-Enrichment showed the most optimal profile (i.e., low on depressive symptoms, high on satisfaction with life, high on treatment adherence, and low HbA1c-values). Conclusions. Five clusters were identified, each characterized by their own unique profile scores on the illness identity dimensions. These clusters were differentiated on diabetes-specific and psychological functioning. Hence, these clusters provide clinically meaningful profiles.status: publishe

Illness identity: capturing the influence of illness on the person’s sense of self

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