Psychological impact of chronic illness and disability — branching viva

Station 1 — Opening presentation (set the frame)

A 14-year-old with type 1 diabetes has a rising HbA1c, has missed three months of school, and is withdrawn. What is going on, and what is your framework? ^[4]

Expected answer: Recognise this as the psychological impact of a chronic illness, not a metabolic problem. Apply the biopsychosocial model (biological, psychological, social, system domains) and lead with the resilience-oriented principle: most chronically ill children adapt well, so the strategy is routine screening, not reactive referral. ^{[4] [2]}

Station 2 — The adjustment-to-disorder continuum

Where is this child on the continuum, and what is the gate question? ^[5]

Expected answer: Place her on the continuum from healthy adjustment, through an adjustment distress reaction, a subthreshold/risk state, to a diagnosable psychiatric disorder. The gate question is "does this meet DSM-5-TR criteria for a disorder?" — persistent anhedonia, hopelessness, sleep and appetite disturbance and functional decline for at least two weeks cross into a major depressive disorder regardless of the illness. The chronic illness explains the stressor; it does not exempt the child from the diagnosis. ^[5]

Station 3 — Mechanism: why is outcome "mediated"?

Explain the disability-stress-coping cascade. What is the modifiable mediator? ^[3]

Expected answer: The illness is a sustained stressor; outcome depends on appraisal and coping, moderated by family functioning, self-efficacy, support and adherence — hence mediated, not determined. Coping is the modifiable mediator: problem-focused, engaged coping predicts adaptation; avoidance and disengagement predict deterioration. Describe the maintaining feedback loop (low mood → non-adherence → worse control → disruption → deeper low mood) and that breaking any node helps. ^{[2] [3]}