The prediction of psychological well-being in children and adolescents with chronic, life threatening illnesses

[摘要] A life threatening illness has the potential to disrupt the child's world at a time when significant developmental changes are taking place. Extensive literature exists on the impact of illness on the developing child however current salutogenic research has provided evidence that psychological well-being is attainable regardless of disease status, and that children with life threatening illnesses like cancer can be as psychologically well-adjusted as healthy ones. There is a need to develop a better understanding of psychological well-being despite serious risks such as life threatening illnesses. The current study aims to identify factors that promote well-being in children with life threatening illnesses, as measured by life satisfaction as a component of well-being. A mixed method sequential explanatory design was used in this study. An availability sample of children aged 10-18 years (N=44) was recruited from oncology treatment centres in Durban and Bloemfontein, South Africa. The whole sample participated in the quantitative study using self-report measures. The objectives of the quantitative component of the study were to identify factors that explain the variance in life satisfaction and to investigate the differences in coping resources between children with high and low levels of life satisfaction. The following self-report measures were used to gather quantitative data: Satisfaction with Life Scale, Coping Resources Inventory, Fortitude Scale and Children's Hope Scale. Descriptive statistics were calculated for all scales and Pearson product moment correlation coefficients were determined between all subscales. A hierarchical regression analysis was used to determine the relationship between the predictor and criterion variables. The Mann Whitney U test was used to determine the significance of differences in children with high and low levels of life satisfaction. The quantitative findings suggested average levels of life satisfaction for the whole group even when compared to children without illness. Satisfaction with life correlated significantly with hope and social support (1% level of significance) and with cognitive coping (5% level of significance). The predictor variables accounted for 38.9% of the variance in life satisfaction. A strong interdependence was found between coping resources. The difference between children with high and low levels of life satisfaction was in their sense of hope and appraisal of social support. The goal of the qualitative component of the study was to explore the children's experiences of the impact of the illness on their well-being. For this component of the study, participants with high life satisfaction scores were recruited (n=6). Semi-structured interviews were conducted and analysed using thematic content analysis. Insight into the significant impact of cancer was gained as well as the most frequently used coping resources and strategies that facilitate coping and well-being. The most frequently used coping resources included maintaining a sense of hope, utilising social support and gathering developmentally appropriate information, as well as cognitive coping which included cognitive reformulation, internal positive dialogue and finding meaning and purpose. Respondents also reported emotional, relational and spiritual coping. Concluding findings were that social support, hope and cognitive coping were the most powerful predictors of life satisfaction and that the difference between children with high and low levels of life satisfaction was related to sense of hope and appraisal of social support. A limitation of this study was the small sample size. Cultural variations were found in the information seeking behaviours and concept of family in terms of social support. Further investigation of these, especially for the South African context, is recommended. Knowledge of these well-being predictors for children with long term illnesses should be considered in health care policy formulations, and intervention programmes for enhancing well-being and identifying children at risk for adjustment difficulties.

[发布机构] University of the Free State