Various colors of resilience in the face of disease-related challenges

Nowadays, one in four individuals under the age of twenty-five is living with one or more chronic conditions. Youth living with a chronic condition experience disease-related challenges and more often develop depressive symptoms and behavioral problems compared to their healthy peers. However, there are large inter-individual differences, and not all youth with similar chronic conditions experience similar difficulties; many children and adolescents seem to be resilient. Yet, what exactly does the term "resilience" encompass? Over the years, resilience researchers have portrayed resilience in various colors. This thesis aimed to better understand the various colors of resilience in adolescents facing disease-related challenges. It is divided into two parts. The first part of this thesis focused on resilience in the face of the increasing prevalence of chronic conditions in youth, while the second part explored resilience in the face of the COVID-19 pandemic.

This thesis begins with a scoping review investigating the definitions and measures of resilience used in the pediatric field. This review revealed that, at present, no unified approach is used in pediatric healthcare research to define and measure resilience due to variations in definitions and measurement tools across articles. We recommend using the definition introduced by Kalisch et al.: “resilience is a dynamic process that involves adaptation to a stressor leading to the maintenance or quick recovery of mental health”. Using this definition, this thesis investigates resilience in three distinct studies by tracking the mental wellbeing of adolescents with chronic conditions before, during, and/or after facing disease-related adversities. Our study populations included individuals with cystic fibrosis, adolescents with asthma, and adolescents diagnosed with various chronic conditions, ranging from having an autoimmune disease or a congenital heart disease to a general pediatric condition.

The second part of this thesis focused on the resilience of healthy adolescents during the COVID-19 pandemic by investigating whether adolescent mental wellbeing changed during various lockdown periods with varying stringencies compared to pre-pandemic levels. Moreover, this thesis evaluated the mental wellbeing of adolescents with and without chronic conditions during the COVID-19 pandemic to gain insight into who might function more resiliently during the pandemic.

In conclusion, this thesis explored various colors of resilience by drawing insights from the literature, by identifying new research avenues for disease-related challenges, and by examining strategies to integrate resilience research into pediatric healthcare. Through these efforts, I have endeavored to paint a more complete picture of resilience in the face of disease-related challenges.