Adversity or Advantage? Daily Stress Responses of Adolescents With Chronic Illnesses Compared to Healthy Adolescents

Abstract

Purpose Navigating the challenges of adolescence is inherently stressful, but potentially even more so for adolescents living with chronic illnesses. Two contrasting preregistered hypotheses regarding daily stress responses were compared. The stress sensitization hypothesis states that living with chronic illnesses heightens vulnerability to daily stressors, potentially leading to mental health problems. In contrast, according to the stress inoculation hypothesis, adolescents with chronic illnesses can demonstrate enhanced resilience, due to previous experiences with stress.
Methods Stress reactivity and recovery were examined using daily evening reports on stressful events and positive and negative affect collected over 3 weeks among 167 Dutch adolescents with chronic illnesses and 1,190 healthy controls (N_observations = 9,921, 58.68% female, mean age = 14.03). Using dynamic structural equation modeling, we computed both immediate affect response to a stressful experience and recovery patterns, that is, the effect on negative and positive affect the next day.
Results Affective reactivity or recovery from daily stress did not differ between adolescents with chronic illnesses versus healthy controls (p = .042–.898, d = 0.00–0.19). Affective recovery, in terms of positive emotions, was related to depressive symptoms (ß = −0.01, p = .008).
Discussion Living with chronic illnesses does not inherently predispose adolescents to higher vulnerability to daily stressors, nor does it act as a general protective factor that increases resilience. Our findings do not support either hypothesis, but suggest heterogeneity: some adolescents are more vulnerable, while others demonstrate greater resilience. This pattern highlights the importance of identifying individual factors, such as depressive symptoms, that predict which adolescents are most vulnerable to the effects of daily stressors.