The combination of physical and mental illness had a negative impact on self-perception among older adolescents, but not for younger ones, shows a new University of Waterloo study.

Researchers found that compared to adolescents with a physical illness only, their self-concept – the image we have of ourselves – was lower, but that was not the case for younger adolescents.

“Roughly 25 per cent of the adolescent population in Canada have a physical illness, and adolescence is already a time where mental illness is at increased risk,” said Dr. Mark Ferro, a researcher in the School of Public Health Sciences and Canada Research Chair in Youth Mental Health. “We know that adolescents with a physical illness tend to have lower self-concept, but this study shows that it's even worse for adolescents with co-existing physical and mental illnesses.”

Self-concept is shaped by many forces, including the expectations and judgments of important people in our lives, such as parents and friends, Ferro said. “It’s more than self-esteem; it’s our perceived self-identity and self-evaluation of characteristics such as physical appearance, social acceptance, athleticism and academic abilities.”

Ferro’s previous work showed that declines in adolescent self-concept precede declines in the mental health of those with physical illness. This makes assessing self-concept an important litmus test in monitoring adolescent mental health.

“If we intervene to support health self-concepts among adolescents with physical illness, we may be able to prevent or reduce symptoms of mental ill health later on, including depression and anxiety,” said Ferro.

In the study, researchers used data from the ongoing Multimorbidity in Children and Youth across the Life-course (MY LIFE), a prospective study of children and adolescents with diagnosed physical illnesses and their parents. The 116 adolescents in the study sample averaged 13 years of age and 60 per cent were male. More than 86 per cent were white and 18 per cent were children of immigrant parents. 

The researchers did not find any sex-based association between self-concept and co-existing physical and mental illnesses.

“This study shows us that there are a great many youths in need of support,” Ferro said. “Health-care providers and parents need to find opportunities to assess self-concept and support positive self-perceptions for these adolescents, especially when planning the transition from pediatric to adult health services.”

The study, “Self-concept in Adolescents with Physical-Mental Comorbidity,” was published in the Journal of Multimorbidity and Co-Morbidity. The co-authors are Mark Ferro, Megan Dol, Karen A. Patte, Scott Leatherdale and Lilly Shanahan.