Identity formation in adolescent and emerging adult cancer survivors: a differentiated perspective and associations with psychosocial functioning

Abstract

Objective

Identity formation was investigated in adolescent and emerging adult cancer survivors from a (neo-)Eriksonian perspective by comparing survivors to control participants. In survivors, associations between identity and clinical/demographical variables and general and illness-specific functioning were investigated.

Design

Childhood cancer survivors (n = 125; M_age: 19.54; 47% male) were matched on age and gender with healthy controls (2:1).

Main outcome measures

All participants completed identity questionnaires. Survivors reported on demographics, well-being (depressive symptoms, life satisfaction, physical functioning), and illness-specific experiences (PTSS, illness centrality, cancer self-identity, benefit finding, cancer-related worries). Medical records provided clinical information.

Results

Survivors did not differ from controls on identity synthesis or confusion or on the identity statuses resulting from cluster analysis on the identity dimensions (achievement, foreclosure, moratorium, diffusion). Identity synthesis related to better well-being and illness experiences, whereas confusion related to worse well-being and illness experiences. Youth in moratorium and diffusion reported lower well-being and more negative illness experiences. Associations between identity and demographical and clinical characteristics were inconsistent.

Conclusions

This study revealed no significant differences in identity formation between cancer survivors and controls. However, survivors who struggle in their identity quest should be identified as they are at risk for poorer well-being and negative illness experiences.

Keywords:

• Childhood cancer survivors
• adolescence
• emerging adulthood
• identity

Disclosure of interest

The authors report no conflict of interest.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, K.L. The data are not publicly available due to privacy and/or ethical restrictions.

Notes

1 For reasons of clarity and to be consistent with a large amount of former studies, we will use the term ‘survivors’ throughout the current manuscript to refer to youth who have had cancer.

2 In the preregistration of this manuscript, hypotheses concerning individual identity dimensions were also formulated. Based on a suggestion by a reviewer, we have now only focused on identity confusion/synthesis and on the identity statuses (which are constellations of scores on the different identity dimensions).

3 For all Objectives, analyses on the separate identity dimensions were also preregistered and conducted. Those results can be found in footnotes and/or supplementary material.

4 Differences between survivors and controls were non-significant on the individual identity dimensions as well.

5 For the identity dimensions, the multivariate effect for gender was significant, yet univariate analyses were non-significant. No differences for cancer diagnosis, relapse, and treatment intensity occurred. Age related positively to exploration in depth (r=.18; p=.044) and age at diagnosis related positively exploration in breadth (r=.18; p=.040). Correlations with time since diagnosis were non-significant.

Additional information

Funding

This work was supported by Research Foundation Flanders (Grant 1126418 N to Sofie Prikken) and by Research Council KU Leuven (Grant C14/15/036 to Prof. dr. Koen Luyckx).