Coping Strategies and Social Support for Transition Readiness Among Youth With Sickle Cell Disease

Suboptimal transitions from pediatric to adult health care can negatively impact disease outcomes, medication regimen adherence, and disease self-management in adulthood. Little is known about whether the presence of coping strategies in young adults (YAs) with sickle cell disease (SCD) is associated with higher transition readiness scores.

To evaluate whether coping strategies and social support are associated with higher transition readiness scores in YAs with SCD.

This cross-sectional study was a subanalysis of baseline data from a prospective randomized clinical trial of YAs aged 17 to 25 years with SCD planning to transition to an adult sickle cell clinic within the next 12 months at 5 institutions across Connecticut, New York, Ohio, and Pennsylvania. The recruitment period was from January 15, 2019, to December 31, 2022. Analysis used data from this time period and was conducted from September 30, 2024, to June 30, 2025.

Measures included the Transition Readiness Assessment Questionnaire (TRAQ) to assess transition readiness, the Medical Outcomes Study-Social Support Survey (MOS-SSS) emotional/informational subscale to assess social support, and the Brief-COPE (problem-focused, emotion-focused, and avoidant subscales) to assess coping strategies. Bivariate and multivariable linear regression analyses were used to assess differences of transition readiness. Covariates included worry (PedsQL Sickle Cell Disease Module worry I), age, gender, SCD disease severity, and social support.

The final cohort included 373 YAs (mean [SD] age, 18.9 [1.9] years; 190 female [51.5%]), with 335 of 367 reporting race as Black (91.3%) and 335 of 365 reporting ethnicity as non-Hispanic/Latino (91.8%). Unadjusted analysis found that overall coping (mean difference, 0.14; 95% CI, 0.01-0.27; P = .03), problem-focused coping (mean difference, 0.18; 95% CI, 0.09-0.27; P < .001), and the emotional/informational subscale of the MOS-SSS (mean difference, 0.13; 95% CI, 0.07-0.19; P < .001) were associated with higher transition readiness scores. Adjusted linear regression analysis showed that problem-focused coping (mean difference, 0.10; 95% CI, 0.003-0.19; P = .04) was associated with transition readiness even after adjusting for age, gender, disease severity, worry, recruitment site, and social support.

In this cross-sectional study in a national cohort of adolescents and YAs with SCD, problem-focused coping strategies were associated with higher levels of transition readiness. These findings suggest important intervention targets for supporting transitioning adolescents with SCD.