Author ORCID Identifier


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Degree Name

Doctor of Philosophy



First Advisor

Bruce Rybarczyk


Psychosocial needs are associated with worse health outcomes for patients with multiple chronic conditions (MCC). The Biopsychosocial Model provides a framework for conceptualizing the influence that psychosocial factors have on the management of disease. To date, research has primarily focused on examining the relation between psychosocial factors and chronic disease onset. Therefore, the temporal relation between psychosocial factors and disease management remains poorly understood. The current study aimed to 1) describe patients’ psychosocial needs and their prioritization, 2) examine reciprocal relations between anxious symptoms, depressive symptoms, social needs, and MCC management, and 3) qualitatively explore patient definitions of health in the context of MCC. Data came from the Enhanced Care Planning (ECP) study, a randomized controlled trial of primary care patients with MCC; all participants were included (n = 175). Patients had an average of 1.01 psychosocial needs (SD = 1.44), 27.0% of patients endorsed a mental health need and 33.3% endorsed having a social need, though very few patients prioritized either type of need. Four cross-lagged regression models were run with three waves of data. When anxious symptoms and MCC management were examined alone, better MCC management predicted greater future anxious symptoms. When all psychosocial variables were examined together, anxious symptoms predicted better future MCC management. No support was found for a relation between depressive symptoms or total social needs with chronic disease management. Finally, when defining health, patients identified four states which were of particular interest to them: health condition management, pain management, mental wellness, and social connectedness. They described health as an active and complex interaction between several stable factors (i.e., healthcare, social context, and physical environment) and a range of dynamic psychosocial factors. Collectively, these findings highlight the relevance of psychosocial factors to patients’ everyday lives and perceived ability to be healthy. Further research is necessary to examine a broader scope of health-related needs among patients with MCC, assess the nuanced relation between anxiety levels and chronic disease management, and to elucidate how psychosocial factors differentially relate to various metrics of health.


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