Health Related coping

Because SCD is characterized by physical, often intense pain crises as well as other complications asso ciated with significant discomfort, addressing the role of disease-related stress and health coping skills is important in determining psychological and behavioral adjustment. Gil et al. (2003) documented significant relationships between daily pain level and mood such that increased pain predicted higher stress, lower mood, and lower levels of activity. The ways in which children and adolescents cope with pain have also been associated with psychological adjustment in several studies (Barakat et al. 2007; Gil et al. 1989, 1991, 1993). These studies have documented that negative thought patterns and passive coping approaches are often associated with higher levels of stress, more severe pain, and reduced activity. Conversely, proactive coping is associated with higher social, academic, and home activity levels and reduced need for health care (Gil et al. 1993). Moreover, Lewis and Kliewer (2007) found that the combination of active coping strategies and hope in children with SCD was predictive of lower levels of anxiety. Based on laboratory studies of pain and coping, Gil et al. (1997a) reported that children with SCD who use active cognitive and behavioral coping strategies are less likely to report pain during laboratory-based pain stimulation. Additionally, Brown et al. (1993b) documented an association between an internal health locus of control and better adjustment in children with SCD, suggesting that children who feel more control over health outcomes likely experience less psychological distress.

Another mechanism associated with coping is religion and/or spirituality, although this has not been studied frequently in pediatric populations. Limited research has suggested that spirituality is viewed as a strength and that praying can be conceptualized as a coping mechanism (Barbarin 1999; Harrison et al. 2005). Indeed, Barbarin (1999) noted that religion and spirituality, including a relationship with a community church and a personal relationship with God, were important resources in helping families and children adjust to SCD. In this study, a greater proportion of families with children who have SCD reported being religious compared with a group of control families, and a number of adolescent patients mentioned religion in their ability to understand and cope with their diagnosis (Barbarin 1999).

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