A Multi-Informant, Multi-Method Exploration of Resilience and Pain Adaptation in Youth with Juvenile Idiopathic Arthritis

Abstract

The application of resilience theory to the context of secondary chronic pain conditions such as juvenile idiopathic arthritis (JIA) is a burgeoning research area. To better understand how to promote pain adaptation in this population, this dissertation aimed to identify the psychosocial correlates and prognostic factors associated with JIA pain (Study 1), examine the role of youth and parent perfectionism in contributing to the youth’s psychological health (Study 2), and explore the relative importance (RI) of resilience resources and mechanisms contributing to the pain adaptation of youth with JIA (Study 3). Upon systematically reviewing the literature (Study 1), 516 unique associations between psychosocial factors and JIA pain intensity, frequency, and sensitivity were identified. Greater pain was correlated with unhelpful pain beliefs, lower parent/child self-efficacy, reduced social functioning, parent/child internalizing symptoms, and lower child wellbeing and health-related quality of life (HRQoL). Prognostically, greater pain was predicted by pain beliefs, internalizing symptoms, and lower well-being. Studies 2 and 3 used data collected from 156 youth with JIA (13-18 years) and a parent through an online survey. Structural equation models in Study 2 demonstrated support for select preregistered hypotheses, wherein perfectionism largely served as a risk factor. Positive relationships between dimensions of youth perfectionism and internalizing symptoms were partially explained through pain catastrophizing (self-oriented perfectionism) and self-concealment of symptoms (socially prescribed perfectionism). Parent self-oriented perfectionism was associated with greater catastrophizing and pain-related fears, and fewer youth depression symptoms; although, no indirect effects were observed. In Study 3, the RI of evidence-based youth and parent resilience resources and mechanisms were simultaneously explored in predicting distinct recovery, sustainability, and growth outcomes (i.e., pain intensity, functional disability, HRQoL, benefit finding). Within-person resources and mechanisms were positively correlated. The RI of predictors varied across outcomes; however, child pain acceptance, followed by youth/parent self-efficacy and youth optimism were the most robust predictors of pain adaptation across models. Taken together, these studies identify the resources and mechanisms that are key to promoting pain adaptation in the context of JIA which has important theoretical and clinical implications for helping youth with JIA to optimize living in the face of adversity.