Original article
Identity Development, Coping, and Adjustment in Emerging Adults With a Chronic Illness: The Sample Case of Type 1 Diabetes

https://doi.org/10.1016/j.jadohealth.2008.04.005Get rights and content

Abstract

Purpose

The present study focused on identity development in emerging adults (aged 18–30 years) with type 1 diabetes. The three study aims were to examine the following: (1) whether identity development was affected by having diabetes, as compared with development in a nondiabetic sample; (2) how identity development was related to depressive symptoms, coping with diabetes, and diabetes-related problems in the diabetic sample; and (3) whether the pathways from identity development to problems with diabetes and depressive symptoms were mediated through coping strategies in the diabetic sample.

Methods

A total of 194 emerging adults with type 1 diabetes and 344 nondiabetic emerging adults participated.

Results

First, using analyses of variance, some mean identity differences between the diabetic and comparison samples were found, with emerging adults with diabetes scoring lower on proactive identity exploration. Using cluster analysis, we found that the same identity types or statuses emerged in both the diabetic and nondiabetic samples. Second, in emerging adults with diabetes, these identity statuses were differentially related to diabetes-related problems, depressive symptoms, and illness coping, with the identity statuses representing a strong sense of identity being accompanied by less diabetes-related problems and depressive symptoms and more adequate coping strategies. Third, using structural equation modeling, the pathways from a strong sense of identity to diabetes-related problems and depressive symptoms were mediated through adaptive and maladaptive coping.

Conclusions

Clinicians should be sensitive to the normative task of identity development in emerging adults with diabetes because identity development can function as a resource in coping with and adjusting to diabetes.

Section snippets

Coping and adjustment in diabetes

Type 1 diabetes creates serious intrusions into the lives of emerging adults, who must negotiate a delicate balance between adhering to a diabetes management regimen and addressing normative developmental tasks [6]. Consequently, diabetes management may conflict with issues relating to identity and psychosocial development [3]. Having diabetes might delay (or even prevent) some emerging adults from addressing important developmental tasks such as identity development [7]. Several studies,

Participants and procedure

The Belgian Diabetes Registry [22] prospectively registered 5,559 diabetic patients. Of these patients, 1,111 fulfilled the following criteria: Dutch speaking, presence of type 1 diabetes, age 18–30 years, and available home address. The first 500 individuals were invited to participate, and 194 returned the completed questionnaires (39% participation rate). The mean age of diabetes onset was 15 years. A sample of 344 emerging adults without diabetes was also used (53.7% participation rate).

Research question 1

Table 2 provides mean identity scores for the combined sample (N = 538). A multivariate analysis of variance (MANOVA) conducted by diabetic status, with the identity dimensions as dependent variables, yielded a significant multivariate effect, Wilks' λ = .97; F(5,530) = 3.00; p < .05, η2 = .03. Follow-up univariate analyses in Table 2 indicated that individuals with diabetes scored lower on exploration in breadth and in depth.

We next extracted identity statuses using two-step cluster analysis

Discussion

Emerging adulthood, with identity development representing a core developmental issue [1], is a critical juncture in the course of physical health and psychosocial development [33]. Consequently, the present study investigated the impact of identity development on psychosocial and illness-specific outcomes in a sample of emerging adults aged 18–30 years with type 1 diabetes. Illness coping was examined as a mediator of this identity-outcome pathway.

First, with respect to research question 1,

Acknowledgment

The first author is a Postdoctoral Researcher at the Fund for Scientific Research Flanders (FWO).

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