Original article
Spiritual Coping and Psychosocial Adjustment of Adolescents With Chronic Illness: The Role of Cognitive Attributions, Age, and Disease Group

https://doi.org/10.1016/j.jadohealth.2012.09.007Get rights and content

Abstract

Purpose

Spiritual coping is an important determinant of adjustment in youth with chronic illness, but the mechanisms through which it affects outcomes have not been elucidated. It is also unknown whether the role of spiritual coping varies by age or disease group. This study evaluated whether general cognitive attributions explain the effects of spiritual coping on internalizing and externalizing problems in adolescents with cystic fibrosis and diabetes and whether these relationships vary by age or disease group.

Methods

In this cross-sectional study, adolescents (N = 128; M = 14.7 yrs) diagnosed with cystic fibrosis or diabetes completed measures of spiritual coping and attributional style. Adolescents and their caregivers reported on adolescents' internalizing and externalizing problems.

Results

Overall, positive spiritual coping was associated with fewer internalizing and externalizing problems. Negative spiritual coping was related to more externalizing problems, and for adolescents with cystic fibrosis only, also internalizing problems. Optimistic attributions mediated the effects of positive spiritual coping among adolescents with diabetes. The results did not vary by age.

Conclusions

An optimistic attribution style may help explain the effects of positive, but not negative, spiritual coping on adjustment of youth with diabetes. Youth with progressive, life-threatening illnesses, such as cystic fibrosis, may be more vulnerable to the harmful effects of negative spiritual coping. Future research should examine whether addressing spiritual concerns and promoting optimistic attributions improves adolescents' emotional and behavioral functioning.

Section snippets

Participants

Participants included 128 adolescents diagnosed with type 1 diabetes (n = 82) or cystic fibrosis (n = 46) and their caregivers. Adolescents (M = 14.7 years, SD = 1.8) included 53% males and 84% Caucasians, 12% African Americans, and 4% other ethnicities. A summary of demographic information is provided in Table 1.

Procedure

University Institutional Review Board approval was obtained. Study procedures have been previously described [16] and are summarized here. Adolescents were recruited during outpatient

Preliminary analyses

The means and standard deviations for continuous variables and percentages for categorical variables are presented in Table 1. Correlations among continuous variables are presented in Table 2. Notably, positive spiritual coping was associated with more optimistic attributional style (p < .001) and fewer caregiver-reported conduct problems (p < .05). Negative spiritual coping was related to higher levels of caregiver-reported conduct problems (p < .05) and self-reported internalizing problems (p

Discussion

Adolescents with chronic illness often struggle with spiritual issues, but our understanding of the role of spiritual coping in their mental health is limited. This study examined the direct effects of positive and negative spiritual coping on adolescents' adjustment, the role of attributions as a mediator of these effects, and age and disease differences in these relationships. Consistent with previous research [7], [8], [9], [10], the results provide support for the importance of spiritual

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    • Cited by (0)

    Funding/Support: This research was supported in part by grants from the Cystic Fibrosis Foundation and from the Sigma Xi Grants-in-Aid of Research program to the third author and grant K01DA024700 from the National Institutes of Health to the second author.

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    Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.