Pathways of Resilience in Young People Living with Chronic Skin Conditions

Background: Chronic skin conditions are common in young people. The developmental transition from adolescence to adulthood involves social, psychological and physical change, and youth with chronic skin conditions may experience greater challenges due to additional difficulties posed by managing and coping with their skin condition. Resilience involves the capacity of an individual to navigate towards resources which sustain and improve their wellbeing, as well as the capacity of their surrounding environment to provide and facilitate access to these resources in contextually and culturally meaningful ways. Where a young dermatology patient is well-resourced (e.g., within their social, physical and built environments), their capacity for positive adaptation, for resilience, may be improved. Therefore, the identification of factors which can promote resilience and subsequently help young dermatology patients to sustain wellbeing becomes an important topic of investigation. Aim: The purpose of this doctoral research was to examine resilience in individuals exposed to chronic skin conditions in youth using Ungar’s (2021) multisystemic resilience framework. This research aimed to answer the overarching question: what system factors operating at what level can result in sustained or improved mental health outcomes in young people exposed to chronic skin conditions? Study 1: A systematic review and meta-analysis aimed to explore the nature of adversity in terms of the psychological impacts of chronic skin conditions in young dermatology patients. The narrative synthesis included forty-five studies. Four meta-analyses were performed with moderate-high quality studies, one for each outcome: diagnosed mental disorders; mental health symptoms; suicidal behaviour; and socio-emotional and behavioural difficulties. Findings demonstrate the pooled prevalence of comorbid mental health difficulties in youth with chronic skin conditions. Study 2: A qualitative, empirical study aimed to gain a deeper understanding of resilience processes in young dermatology patients. An interpretative phenomenological approach was applied, and six themes were generated. Findings highlight the difficulties experienced by young dermatology patients, particularly during adolescence, including challenges with healthcare providers, mobility disruptions and stigmatisation. Findings offer insight into how young people can be supported during their transition into adulthood. Study 3: A longitudinal, empirical study aimed to explore resilience in a cohort of adolescents in relation to the development of psychological outcomes (suicidal ideation and depressive symptoms) in the context of chronic skin conditions. Moreover, it aimed to understand the contribution of risk and protective factors across multiple system levels. Suicidal ideation and depressive symptoms for many young people remains low and stable from adolescence into adulthood. However, exposure to more severe disease in adolescence may increase the risk of suicidal ideation during this transitional period. Accounting for chronic skin conditions, various factors within the social and built environments (e.g., good family functioning and healthy air quality) may help to sustain psychological functioning during this period Conclusions: The findings of this doctoral research enrich our knowledge of multisystemic resilience and add a novel contribution by investigating this concept in the context of exposure to chronic skin conditions. This research demonstrates that within permitting environments, young dermatology patients can navigate towards resources which can help to sustain and improve their wellbeing. Lastly, it adds an innovative perspective to the psychodermatology literature and offers a pathway of investigation and intervention through multisystemic resilience.