1. Friends’ Perspective: Friendship Changes Following Serious Illness Onset in Adolescence Eva C Igler, MA, Ellen K Defenderfer, MS, Gina A Erato, BS, Karley A Wentz, BS, W Hobart Davies, PhD 1Department of Psychology, University of Wisconsin-Milwaukee
Table 1: Reported changes in friendship
Table 6: Understanding of friend’s experience
INTRODUCTION
Theme
Percentage
No Change
47%
Negative Change
23%
Stronger Friendship
14%
Self-reflection 2%
Unsure 1%
Theme
Percentage
Did not understand
33%
Yes understood
17%
Somewhat understood
14%
Respondent expressed empathy 7%
Impossible to fully understand 6%
Tried to understand 3%
Friendships are an important form of social support that contribute to overall quality of life for adolescents diagnosed with a serious illness (Decker, 2007; La Greca, Bearman & Moore, 2002).
Few studies have examined friendship changes after illness onset in older children and adolescence
There is little information from the perspective of healthy friends on friendship changes following the onset of a serious illness.
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“They never were around anymore so it was harder to connect”
“We stopped fighting and became good friends again.”
“No, I could feel for him and try my best to help him through the situation, but could not truly relate to pain and helplessness.”
Table 2: Reported challenges to maintaining the friendship
SPECIFIC AIM
Respondents reported a significant change in amount of time spent with the ill friend outside of school across all time categories (φ = 0.33 – 0.64, p < .01).
Theme
Percentage
Communications/Logistics
21%
No Challenges
20%
Friend’s emotional changes
12%
Change in friend’s functioning
10%
To examine the effects of childhood serious illness on friendships from the friend’s perspective.
Figure 1: Change in time spent with ill friend *
METHODS * *
Participants:127 (18%) of the 719 young adults (18-24 years old) indicated an experience with a friend diagnosed with a serious illness from ages
Procedures: As part of a larger online survey, the participant answered questions regarding their experience with a friend diagnosed with a chronic illness during late childhood or adolescence.
Measure: The survey consisted of questions regarding the type of illness, approximate age of onset, communication with the ill friend, changes to the friendship and friendship challenges post-diagnosis.
Data Analysis: Qualitative responses were analyzed using the Delphi coding method to majority agreement (Jones & Hunter, 1995).
Inter-rater agreement was ≥ 85%.
To analyze change in the Likert scale items a phi-coefficient was used.
“Loss of contact, enthusiasm for once loved activities, etc., really brings you as a friend down too because when you’re younger there’s only so much you can do to help.” * *
Table 3: Experience visiting ill friend at home or in the hospital
Theme
Percentage
Negative affect
22%
Positive affect
12%
Visit at home 6%
Visit at hospital 1%
*p < .01
Respondents reported a significant change in the amount of time spent communicating (in person, talk on the phone, text, , through social media) with the ill friend across all time categories (φ = , p < .01).
“I was worried I might say something wrong or offensive. I also didn’t want them to feel pity from me because she hated that.”
Figure 1: Change in time spent communicating with friend before and after diagnosis * *
Table 4: Why friend didn’t visit * * *
Theme
Percentage
Unable
21%
Not close enough friends
11%
Friend died 5%
Wasn’t allowed 4%
Didn’t want visitors
RESULTS
Participant characteristics:
Mean = 22 years, SD = ±1.7
80% non-Hispanic Caucasian
57% Female
Friend characteristics:
Mean age of illness onset: 15, SD = ± 1.8
59% female
44% Physical illness (e.g., cancer)
28% Mental illness (e.g., depression)
20% Injury (e.g., TBI)
*p < .01
“She couldn’t have guests very often- or she didn’t want to see anyone.”
CONCLUSIONS
Table 5: Reported communication regarding friend’s illness
The results suggest a significant portion of adolescent friendships experience various challenges after serious illness onset including: challenges with communication, the friend’s physical or emotional functioning, and understanding their friend’s illness experience.
Although participants reported not understanding the friend’s illness experience, many participants reported no or limited discussion.
A substantial portion of respondents reported a significant change in time spent with the friend and time spent communicating with their friend after illness/injury onset.
This study is one of the first to examine the change in friendship following serious illness from the perspective of a healthy friend. It provides preliminary data suggesting that a percentage of friendships likely experience negative changes after serious illness onset in adolescence. This necessitates further investigation.
This study also provides information regarding potential areas for intervention in order to help adolescents with serious/chronic illnesses maintain healthy friendships post illness onset.
Theme
Percentage
Didn’t talk about the illness
27%
Positive discussion
18%
Negative discussion
15%
Limited discussion
10%
“I wanted the time together to be fun and not all about the illness.”
“It was none of my business”

2. References
Decker, C. J. (2007). Social support and adolescent cancer survivors: A review a the literature. Psycho-Oncology, 16, 1-11.
Jones, J., & Hunter, D. (1995). Consensus methods for medical and health services research. The British Medical Journal, 311,
La Greca, A. M., Bearman, K. J., and Moore, H. (2002). Peer relations of youth with pediatric conditions and health risks: Promoting social support and healthy lifestyles, Developmental and Behavioral Pediatrics, 22,