e-ISSN: 2671-3659
p-ISSN: 2671-3675
Founded: 2021
Period: Biannually
Publisher: Balkan Studies Foundation


Psychosocial Factors in Chronic Illness Management in Western Balkans: The Case of Albania, Montenegro, Kosovo, and North Macedonia

Ledion Musaj Mr., University of Tirana Author 0009-0004-4804-451X
Anxhelo Dema European University of Tirana Author 0009-0001-9783-5359




This study aims to evaluate the psychological and social aspects related to prolonged illness management among individuals diagnosed with chronic illness in the Balkans. Data were collected using self-report measures, including the Patient Activation Measure, Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), revised Illness Perception Questionnaire (IPQ-R), Family Support Scale (FSS), Zarit Burden Interview, Patient-Provider Communication Scale, Chronic Illness Anticipated Stigma Scale (CIASS), and Perceived Discrimination Scale. The study involves 250 participants who completed surveys online and conducts multiple regression analysis to examine the interrelationships among the different factors. The results indicate moderate degrees of psychosocial suffering, with depression and anxiety being major factors. Effective coping strategies, familial support, and good communication with medical professionals are positively linked to improved overall results, while heavier burden placed on caregivers and perceived discrimination both exhibit negative correlations with health outcomes. The study emphasizes the need for specialized approaches that reflect a cultural sensibility related to chronic illness management struggles encountered by the population of the Balkans.


Chronic İllness, Family Support, Balkan, Anxiety, Depression


  • Alonzo, A. A., & Reynolds, N. R. (1995). Stigma, HIV and AIDS: An exploration and elaboration of a stigma trajectory. Social Science & Medicine, 41(3), 303–315.
  • Antoni, M. H., & Dornelas, E. A. (2020). Cognitive-behavioral stress management for individuals living with HIV: Facilitator guide (2nd ed.). Oxford University Press.
  • Benkel, I., Ljungqvist, E., Arnby, M., & Molander, U. (2019). Not thinking that this means the end when you are seriously ill but doing something positive about it: A qualitative study of living with a life-changing disease. Diseases (Basel, Switzerland), 7(3), 53.
  • Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4(1), 92–100.
  • Charmaz, K., & Paterniti, D. A. (2015). Health, illness, and healing: society, social context, and self.Oxford University Press.
  • Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357.
  • Dunst, C. J., Jenkins, V., & Trivette, C. M. (1984). Family Support Scale: Reliability and validity. Journal of Individual, Family, and Community Wellness, 1(4), 45–52.
  • Heaney, C. A., & Israel, B. A. (2008). Social networks and social support. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (4th ed., pp. 189–210). Jossey-Bass.
  • Hibbard, J. H., Stockard, J., Mahoney, E. R., & Tusler, M. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Services Research, 39(4 Pt 1), 1005–1026.
  • Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.
  • Levett, J., & Kyriopoulos, J. (2006). Public health in the Balkan region: One school’s experience. European Journal of Public Health, 16(3), 234–236.
  • Lorig, K., & Holman, H. (2018). Living a healthy life with chronic conditions: Self-management of heart disease, arthritis, diabetes, depression, asthma, bronchitis, emphysema, and other physical and mental health conditions (5th ed.). Bull Publishing Company.
  • Martire, L. M., & Helgeson, V. S. (Eds.). (2017). Close relationships and the management of chronic illness. Springer.
  • Mirbolouk, M., Boakye, E., Obisesan, O., Osei, A. D., Dzaye, O., Osuji, N., Erhabor, J., Stokes, A. C., El-Shahawy, O., Rodriguez, C. J., Hirsch, G. A., Benjamin, E. J., DeFilippis, A. P., Robertson, R. M., Bhatnagar, A., & Blaha, M. J. (2022). E-cigarette use among high school students in the United States prior to the COVID-19 pandemic: Trends, correlates, and sources of acquisition. Preventive Medicine Reports, 29, 101925.
  • Moss-Morris, R., Weinman, J., Petrie, K., Horne, R., Cameron, L., & Buick, D. (2002). The revised Illness Perception Questionnaire (IPQ-R). Psychology & Health, 17(1), 1–16.
  • Priebe, S., Bogic, M., Ajdukovic, D., Franciskovic, T., Galeazzi, G. M., Kucukalic, A., Lecic-Tosevski, D., Morina, N., Popovski, M., Wang, D., & Schützwohl, M. (2010). Mental disorders following war in the Balkans: A study in 5 countries. Archives of General Psychiatry, 67(5), 518–528.
  • Rolland, J. S. (2019). Families, illness, and disability: An integrative treatment model (2nd ed.). Guilford Press.
  • Roter, D. L., & Hall, J. A. (2021). Doctors talking with patients/patients talking with doctors: Improving communication in medical visits (3rd ed.). Praeger.
  • Sahle, B. W., Chen, W., Melaku, Y. A., Akombi, B. J., Rawal, L. B., & Renzaho, A. M. N. (2020). Association of psychosocial factors with risk of chronic diseases: A nationwide longitudinal study. American Journal of Preventive Medicine, 58(2), e39–e50.
  • Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.
  • Street, R. L., Jr., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counseling, 74(3), 295–301.
  • Vukovic, O., Tosevski, D. L., Jasovic-Gasic, M., Damjanovic, A., Zebic, M., Britvic, D., Stepanovic, J., Djordjevic-Dikic, A., Beleslin, B., & Ostojic, M. (2014). Type D personality in patients with coronary artery disease. Psychiatria Danubina, 26(1), 46–51.
  • Williams, D. R., Yan, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of Health Psychology, 2(3), 335–351.
  • Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The Gerontologist,