title: Adolescent's subjective perceptions of chronic disease and related psychosocial factors: highlights from an outpatient context study.
abstract: Adolescents with chronic disease (CD) can be more vulnerable to adverse psychosocial outcomes. This study aims: 1) to identify differences in psychosocial variables (health-related quality of life, psychosomatic complaints, resilience, self-regulation and social support) among adolescents who feel that CD affects or does not affect school/peers connectedness (measured by self-reported participation in school and social activities); and 2) to assess the extent to which psychosocial variables are associated with connectedness in school and peer domains.
  
  
  
  A cross-sectional study was conducted in 135 adolescents with CD (51.9% boys), average age of 14 ± 1.5 years old (SD = 1.5). Socio-demographic, clinical, and psychosocial variables were assessed, using a self-reported questionnaire, which included the Chronic Conditions Short Questionnaire, KIDSCREEN-10 Index, Symptoms Check-List, Healthy Kids Resilience Assessment Module Scale, Adolescent Self-Regulatory Inventory, and Satisfaction with Social Support Scale. Descriptive statistics, GLM-Univariate ANCOVA and Logistic Regression were performed using the IBM Statistical Package for Social Sciences (SPSS), version 22.0. The significance level was set at p < 0.05.
  
  
  
  Thirteen to eighteen percent of the adolescents felt that CD affected participation at school (PSCH) and participation in leisure time with friends (PLTF). These adolescents presented lower results for all psychosocial study variables, when compared with adolescents who did not feel affected in both areas of participation. From the studied psychosocial variables, the most important ones associated with PSCH (after controlling for age, gender, diagnosis, and education level of father/mother) were self-regulation and psychosomatic health. Concerning the PLTF, social support was the sole variable explaining such association.
  
  
  
  The present study pointed out the association between psychosocial variables; and living with a CD and school/peers connectedness. The need to focus on the assessment of the effects of a CD on adolescents' lives and contexts is suggested, as well as on the identification of vulnerable adolescents. Such identification could help to facilitate the maximization of social participation of adolescents with CD, and to plan interventions centered on providing support and opportunities for a healthy youth development. For that purpose, a complex and multifactorial approach that includes clinicians, schools, family, and peers may be proposed.
authors.affiliation: FMH, Faculdade de Motricidade Humana (Projecto Aventura Social-Social Adventure Team), Universidade de Lisboa, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal. gaudi_t@hotmail.com.|William James Center of Research, ISPA-Instituto Universitário, Ciências Psicológicas, Sociais e da Vida, Rua Jardim do Tabaco, n°34, 1149-041, Lisbon, Portugal. gaudi_t@hotmail.com.
authors.forename: Teresa
authors.initials: T
authors.lastname: Santos
authors.affiliation: FMH, Faculdade de Motricidade Humana (Projecto Aventura Social-Social Adventure Team), Universidade de Lisboa, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal.|ISAMB, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.|William James Center of Research, ISPA-Instituto Universitário, Ciências Psicológicas, Sociais e da Vida, Rua Jardim do Tabaco, n°34, 1149-041, Lisbon, Portugal.
authors.forename: Margarida Gaspar
authors.initials: MG
authors.lastname: de Matos
authors.affiliation: FMH, Faculdade de Motricidade Humana (Projecto Aventura Social-Social Adventure Team), Universidade de Lisboa, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal.|ISAMB, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.|CIPER, Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal.
authors.forename: Adilson
authors.initials: A
authors.lastname: Marques
authors.affiliation: FMH, Faculdade de Motricidade Humana (Projecto Aventura Social-Social Adventure Team), Universidade de Lisboa, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal.|ISAMB, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
authors.forename: Celeste
authors.initials: C
authors.lastname: Simões
authors.affiliation: William James Center of Research, ISPA-Instituto Universitário, Ciências Psicológicas, Sociais e da Vida, Rua Jardim do Tabaco, n°34, 1149-041, Lisbon, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Leal
authors.affiliation: Departamento de Pediatria do Hospital de Santa Maria, CAML, Centro Académico de Medicina de Lisboa, FM, Faculdade de Medicina/Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisbon, Portugal.
authors.forename: Maria do Céu
authors.initials: MD
authors.lastname: Machado
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D001294:Attitude to Health; D002908:Chronic Disease / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D010379:Peer Group; D010465:Perception; D011581:Psychological Tests; D011788:Quality of Life; D055500:Resilience, Psychological; D057566:Self Report; D000068356:Self-Control; D012944:Social Support
keywords: Adolescents; Chronic health conditions; Health-related quality of life; Psychosocial factors; Psychosomatic health; Resilience; Self-regulation; Social support