An Integrative Review of Biological Variants and Chronic Stress in Emerging Adults With Chronic Conditions.

PURPOSE: The purpose of this integrative review was to evaluate and synthesize studies that incorporated biological measures and examined their associations with chronic stress and anxiety in adolescents and emerging adults with chronic health conditions.

DESIGN: An integrative literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to identify studies published between 2005 and 2015.

METHODS: Using key terms, three databases (PubMed/Medline, PsycInfo and the Cumulative Index to Nursing and Allied Health Literature) were searched by a research librarian. Additional publications with relevance to the topic were identified from citing and cited literature. The full text of 61 publications was reviewed. The final group of articles analyzed for this review included 36 peer-reviewed publications and meeting abstracts.

FINDINGS: Studies varied considerably in characteristics, theoretical frameworks, phenotypes of interest, and study measures. Few studies evaluated genomic variants; those that did often examined small samples and a limited number of biological factors.

CONCLUSIONS: Studies of chronic stress and anxiety in adolescents and emerging adults with chronic health conditions are currently limited in scope and impact. A more comprehensive approach will facilitate translation into practice to improve short- and long-term health outcomes.

CLINICAL RELEVANCE: Precision and genomic healthcare initiatives support the relevance of this work for nurses in all areas of clinical practice. Genomic testing is expanding to include individuals in all age groups, with and without diagnosed conditions. As psychological and behavioral phenotypes may influence self-management outcomes of adolescents and emerging adults with chronic health conditions, further research in this area is warranted.