Emotional Self-Regulation and Self-Care as Predictors of Quality of Life in Emerging Adults With Chronic Conditions

Abstract

This cross-sectional study examined associations among emotional self-regulation, self-care, and quality of life (QoL) among 111 Portuguese emerging adult university students (aged 18–29) with chronic conditions. Participants completed validated measures of emotion regulation (DERS-SF), self-care (SC-CII v4. c), and QoL (WHOQOL-bref). Hierarchical regression analyses revealed that self-care maintenance emerged as the strongest positive predictor across all QoL domains (physical, psychological, social, environmental), consistently surpassing emotional regulation factors after controlling for sociodemographics. Emotion regulation difficulties (strategies, goals, awareness, and non-acceptance) showed negative associations, particularly with physical, psychological, and environmental QoL, while age at diagnosis negatively predicted physical and psychological QoL. These findings underscore emotional regulation and self-care as critical intervention targets to enhance well-being during the university transition for emerging adults managing chronic illnesses.

Keywords

emotional self-regulation self-care chronic illness emerging adulthood quality of life

Emerging adulthood is marked by major personal, academic, and social transitions, particularly at the transition to higher education (Arnett, 2000). This stage requires autonomy, time management, and the capacity to form new social relationships to cope with early adult challenges (Arnett, 2000). For emerging adults with long-term physical conditions (LTPC), these developmental demands are intensified. Alongside typical university adjustments, they must also manage ongoing health responsibilities (Mooney et al., 2023). University lifestyles—characterized by alcohol use, irregular sleep, and social pressure—often conflict with treatment adherence, creating emotional and behavioral strain that requires ongoing adjustment (Guerriero et al., 2025).

Self-care thus emerges as a crucial adaptive mechanism. It involves promoting health, preventing illness, and managing health conditions independently or with minimal professional input (World Health Organization, 2025). For individuals with chronic conditions, effective self-care supports symptom control and long-term stability (Jin et al., 2023; Riegel et al., 2021). However, emerging adults with LTPCs frequently report feeling “in-between,” struggling with the transition to autonomous condition management and adult healthcare systems (Mooney et al., 2023). Within university settings, maintaining self-care demands sustained effort and has been shown to mediate the relationship between adverse experiences and depressive symptoms (Doudna et al., 2024).

Emotional self-regulation underpins consistent self-care (Mooney et al., 2023). It enables individuals to manage stress, regulate emotions, and sustain healthy routines under academic and social pressures. This capacity serves as a protective factor against psychological distress, substance use, and physical health deterioration (Robson et al., 2020). Emotional regulation skills—such as identifying, understanding, and managing emotional experiences—are associated with treatment adherence, resilience, and healthier lifestyles among people with chronic conditions (Wierenga et al., 2017). Conversely, emotional dysregulation increases vulnerability to exhaustion, disengagement from care, and reduced quality of life (QoL) (Kaufman et al., 2016).

QoL—comprising physical, psychological, social, and environmental domains—is shaped by both emotional regulation and self-care (Seifi & Moghaddam, 2018). Emotional regulation supports self-care behaviors, while consistent self-care reinforces emotional stability—together sustaining overall well-being. To explore this dynamic interplay, the present study examined how emotional regulation (strategies, non-acceptance, impulse control, goals, awareness, and clarity) and self-care (maintenance, monitoring, and management) contribute to predicting quality-of-life outcomes among university students with chronic health conditions.

Materials and Methods

Design and Participants

This cross-sectional study used snowball sampling to recruit Portuguese emerging adults. Recruitment targeted students primarily from the Egas Moniz School of Health and Science, with dissemination extending to affiliated university networks in the Lisbon area. Inclusion criteria were: (1) aged 18-29 years, (2) enrolled in university programs, (3) diagnosed with non-communicable chronic disease, and (4) fluent in Portuguese. Exclusion criteria included acute conditions and cognitive impairment preventing informed consent.

The principal investigator, either directly or through professors, made initial contact with students at the institution and invited them to complete the online questionnaire via a QR code. Rather than identifying seed participants in advance, a general invitation was extended to the university community, and students who met the inclusion criteria voluntarily responded to the survey. Participants were also asked to share the study invitation with other eligible peers. The survey link was disseminated through students’ WhatsApp groups, with a request to forward it to other individuals who might meet the eligibility criteria.

Data collection occurred between February and April 2024, and the sample size was determined by the total number of eligible participants who completed the online survey during this period. After data screening, 10 individuals aged 30 years or older were excluded (9.2% of initial responses), with minor participant attrition during online completion (estimated <5% based on partially completed responses), resulting in a final sample of 111 participants with chronic conditions. No additional cases were excluded.

Data Collection Procedures and Ethical Considerations

The study was approved by the Ethics Committee of Egas Moniz School of Health and Science (process no. 1308) and followed the 2013 Declaration of Helsinki. Data was collected between March and July 2024 through an online Qualtrics questionnaire distributed to university students and shared via social media and chronic disease support groups.

Instruments

Sociodemographic and Clinical Questionnaire: This 20-item questionnaire assessed age, sex, nationality, education level, marital status, and clinical data related to chronic illness (type, age at diagnosis, hospitalizations, medication, and comorbidities).

Difficulties in Emotion Regulation Scale – Short Form – Portuguese Version (DERS-SF; (Gouveia et al., 2022; Kaufman et al., 2016): The DERS-SF measures emotion regulation difficulties across six 3-item subscales (Strategies, Nonacceptance, Impulse, Goals, Awareness, and Clarity) using a 5-point Likert scale. Subscale and total scores are computed by averaging item responses.

Self-Care of Chronic Illness Inventory v4. c (SC-CII v4. c; (Riegel et al., 2018): This 29-item inventory evaluates self-care behaviors across three dimensions—Maintenance, Monitoring, and Management—rated on a 5-point Likert scale.

World Health Organization Quality of Life – bref (Group, 1994; Serra et al., 2006): The WHOQOL-bref assesses four domains—Physical, Psychological, Social, and Environmental—using 26 items on a 5-point Likert scale. Scores are standardized from 0 to 100, with higher values indicating better QoL.

Data Analysis

Analyses were conducted in SPSS version 29.0, with statistical significance set at p < .05. Descriptive statistics and internal consistency (Cronbach’s α) were calculated for all measures, followed by Pearson correlations examining links among emotion regulation, self-care, and QoL. Four hierarchical linear regression analyses were then conducted to examine the associations of sociodemographic variables, entered at step 1, and psychological variables, namely emotion regulation and self-care dimensions, entered at step 2, with each quality-of-life domain (physical, psychological, social, and environmental). Multicollinearity was assessed using variance inflation factors, with values below 5, and residual independence was evaluated using the Durbin-Watson statistic.

Results

Sample Characteristics

The sample comprised 111 Portuguese emerging adults (67 women, 60.4%; 44 men, 39.6%) aged 18–29 years (M = 22.95, SD = 2.39). The mean age at diagnosis was 15.63 years (SD = 5.96; range: 3–27). Most participants identified as Caucasian (91.9%), followed by Black (6.3%), bi-racial (0.9%), and Asian (0.9%). Regarding education, 57.7% were undergraduates, 40.5% master’s, and 1.8% doctoral students. Most were single (90.1%), 9% were in domestic partnerships, and 0.9% were married. Concerning living arrangements, 75.7% lived with their nuclear family, 13.3% with extended family, 9.9% with a partner, and one participant lived alone.

Participants reported various chronic conditions, mainly respiratory (35.1%), endocrine (16.2%), mental health (9.9%), gastrointestinal (9.0%), chronic pain (8.1%), neurological (6.3%), rheumatic (4. 5%), endometriosis (4.5%), hypertension (3.6%), and cancer (3.7%). Over half (53.2%) used daily medication, and 12.6% had been hospitalized in the past year.

Mean WHOQOL-BREF domain scores ranged from 58.56 ± 22.27 (psychological) to 68.86±15.04 (environmental) on the 0-100 scale, indicating intermediate functioning levels. Self-care scores on the SC-CII v4. c ranged from 44.29 ± 17.00 (monitoring) to 47.53 ± 12.66 (management) on the 0-100 scale, reflecting average engagement. Emotion regulation difficulties averaged 14.72 ± 4.67 on the DERS-SF total score, with subscale means ranging from 1.82 (impulse control) to 3.08 (goals) on the 1-5 Likert scale.

Pearson Correlation Analysis

Pearson correlation analyses revealed significant associations among quality-of-life domains, perceived autonomy, and difficulties in emotion regulation. All quality-of-life dimensions—physical, psychological, social, and environmental—were moderately to strongly and negatively correlated with emotion regulation difficulties, indicating that poorer QoL is linked to greater problems in emotion regulation. The strongest associations were observed for the psychological (r = −.59, p < .001) and social (r = −.57, p < .001) domains. Regarding perceived autonomy, both self-care maintenance (r = −.31, p < .001) and self-care management (r = −.21, p < .05) correlated negatively with emotion regulation difficulties, suggesting that lower perceived autonomy in chronic illness is associated with greater emotional dysregulation. As expected, the subdimensions of emotion regulation (awareness, strategies, nonacceptance, impulses, goals, and clarity) were strongly intercorrelated (rs = .60–.91, ps < .001) and showed consistent negative associations with all quality-of-life domains.

Hierarchical Regression Analyses

Hierarchical multiple regression analyses were conducted to examine associations of self-regulation variables with four domains of QoL—physical, psychological, social, and environmental—after accounting for sociodemographic factors (age, sex, and age at diagnosis).

Physical QoL. The final model explained 47.9% of the variance ( $R^{2} = . 479$ ; $Δ R^{2} = . 341$ ; $p < . 001$ ). Self-care maintenance showed a positive association ( $β = . 26$ ), whereas goals ( $β = - . 24$ ) and strategies ( $β = - . 29$ ) were negatively associated. Age at diagnosis was also negatively associated ( $β = - . 20$ ).

Psychological QoL. The model accounted for 56.2% of the variance ( $R^{2} = . 562$ ; $Δ R^{2} = . 382$ ; $p < . 001$ ). Self-care maintenance ( $β = . 27$ ) was positively associated, while strategies showed a strong negative association ( $β = - . 48$ ). Impulsivity ( $β = . 23$ ) and age ( $β = . 19$ ) were positively associated, whereas age at diagnosis was negatively associated ( $β = - . 25$ ).

Social QoL. The model explained 46.9% of the variance ( $R^{2} = . 469$ ; $Δ R^{2} = . 346$ ; $p < . 001$ ). Self-care maintenance showed the strongest positive association ( $β = . 38$ ), while strategies were negatively associated ( $β = - . 26$ ). Sociodemographic variables were not significantly associated in the final model.

Environmental QoL. The model accounted for 49.4% of the variance ( $R^{2} = . 494$ ; $Δ R^{2} = . 410$ ; $p < . 001$ ). Self-care maintenance was positively associated ( $β = . 32$ ), while awareness ( $β = - . 26$ ) and non-acceptance ( $β = - . 24$ ) showed negative associations.

Consistently across all models, self-care maintenance demonstrated positive associations with QoL domains, whereas specific emotion regulation difficulties (in terms of strategies, awareness and non-acceptance) were associated with lower QoL scores. No severe multicollinearity was detected (all VIFs <3.5).

Discussion

This study investigated how emotional self-regulation and self-care relate to QoL among emerging adult university students with chronic illnesses. The findings indicate that greater difficulties in emotional regulation are associated with poorer self-care and lower QoL across physical, psychological, social, and environmental domains. These associations may be particularly relevant during emerging adulthood—a developmental period marked by instability, identity exploration, and growing autonomy —when chronic illness management coincides with heightened autonomy demands (Arnett, 2000). In this population, managing a chronic illness alongside these developmental challenges may be linked to disrupted emotional processing and coping, potentially contributing to diminished well-being. (Jin et al., 2023; McCracken & Vowles, 2014; Wierenga et al., 2017).

Different components of emotional regulation and self-care showed differential associations with specific quality-of-life domains. Emotion regulation difficulties (strategies, goals) were negatively associated with physical and psychological QoL across models, while self-care maintenance showed consistent positive associations across all four domains. In the social domain, strategies showed negative associations with interpersonal functioning, whereas self-care maintenance was positively associated. Environmental QoL showed negative associations with awareness and non-acceptance difficulties alongside positive associations with self-care maintenance (Mooney et al., 2023; World Health Organization, 2025).

These findings highlight that, for emerging adults with chronic conditions, emotional regulation and self-care operate within a broader developmental context of identity formation and autonomy building. Age at diagnosis emerged as a consistent negative correlate of physical and psychological QoL across hierarchical models, suggesting that earlier illness onset may compound the developmental challenges characteristic of emerging adulthood. Chronic illness appears to impose additional self-regulatory demands that can strain these developing capacities (Mooney et al., 2023). Accordingly, emotional regulation processes—such as goal-directed behavior, impulse control, and emotional acceptance—interact dynamically with self-care behaviors to shape adaptation and QoL. This perspective aligns with evidence showing that emerging adults with chronic health conditions report lower QoL than their healthy peers, yet higher perceived health competence has been associated with better outcomes (Lang et al., 2022). Enhancing perceived health competence alongside emotional regulation and self-care strategies may offer promise for improving adaptive functioning and well-being during this transitional stage.

Among emotional regulation dimensions, difficulties in Goals, Clarity, and Awareness showed the strongest associations with QoL. Difficulties identifying, understanding, and acting according to emotions have been linked to frustration, reduced motivation, and limited emotional support (Robson et al., 2020; Wierenga et al., 2017). These vulnerabilities were associated with challenges in autonomy development, healthy habit formation, decision-making and communication. Emotion regulation during this stage also reflects ongoing neurodevelopmental maturation, integrating affective and cognitive control systems (Pozzi et al., 2021). Chronic illness was associated with greater emotional vulnerability and social withdrawal, which showed links to poorer well-being (Lang et al., 2022). Emotional clarity, goal-directed coping, and perceived competence in self-management emerged as significant correlates of resilience in this population (Table 1).

Table 1.

Hierarchical Regression Models for QoL Domains (Controlling for Sociodemographics)

Variables	Physical QoL β	t	Psychological QoL β	t	Social QoL β	t	Environmental QoL β	t
Age at diagnosis	−.20*	−2.49	−.25***	−3.38	−.05	−0.67	−.15	−1.88
Age	.14	1.71	.19*	2.44	.14	1.68	.02	0.21
Sex	−.11	−1.44	−.03	−0.44	−.03	−0.38	−.09	−1.24
Goals	−.24*	−2.20	−.20*	−1.99	—	—	—	—
Self-care maintenance	.26*	3.45	.27***	3.81	.38***	4.95	.32	4.02***
Strategies	−.29**	−2.72	−.48***	−4.07	−.26	−2.41	—	—
Impulses	—	—	.23*	2.55	—	—	—	—
Clarity	—	—	—	—	−.20	−1.84	−.13	−1.42
Awareness	—	—	—	—	—	—	−.26**	−2.82
Non-acceptance	—	—	—	—	—	—	−.24**	−2.66
R²	.479		.562		.469		.494
ΔR²	.341***		.382***		.346***		.410***

Note. β = standardized regression coefficient; t = t-statistic; p = significance level; R² = coefficient of determination; ΔR² = change in explained variance between steps. No severe multicollinearity was detected (all VIFs <3).

*p < .05, **p < .01, ***p < .001.

Self-care behaviors—particularly those related to maintenance and management—emerged as the dominant correlates across all QoL domains, with effect sizes consistently surpassing emotional regulation factors. This primacy aligns with theoretical models emphasizing self-care as the proximal mechanism linking psychological capacities to health outcomes in chronic illness populations (Doudna et al., 2024; Riegel et al., 2021). Nonetheless, many emerging adults struggle to sustain these behaviors due to academic demands, time constraints, or limited healthcare access. Emotional barriers such as low self-esteem, stigma, and illness-related exhaustion have been linked to poorer adherence (Riegel et al., 2021). Recent findings indicate that physical self-care may mitigate the psychological effects of adverse experiences, suggesting that self-care functions not merely as a healthy routine but as a resilience process (Doudna et al., 2024). However, current interventions often overemphasize physical maintenance while neglecting psychological and technological dimensions that could enhance long-term engagement (Riegel et al., 2021).

Several participant characteristics contextualize these associations. The majority living with nuclear family members may have provided social support buffering isolation, while simultaneously limiting opportunities for full autonomy development—a key emerging adulthood task. The predominance of respiratory and endocrine conditions, which require consistent daily self-management, likely contributed to the observed links between self-care maintenance and physical QoL. Similarly, undergraduate students facing dual academic and illness management demands may explain the prominent role of goal-directed emotional regulation in QoL outcomes. The observed patterns align with findings among healthy university students, where self-care maintenance appears to mediate transition stress effects on well-being [(Doudna et al., 2024). Emotional regulation difficulties and inconsistent self-care showed similar associations with QoL across student populations. However, emerging adults with chronic illnesses likely face compounded demands of academic transition alongside illness management, suggesting these mechanisms may operate with particular intensity in this subgroup. This highlights the value of targeted support beyond general student wellness programs (Supplemental Material).

This study’s limitations include a small, convenience-based online sample. Recruitment via social media may have introduced sampling bias, and the overrepresentation of women limits generalizability. Minor participant attrition occurred during online data collection. Furthermore, the heterogeneity of chronic illness types precluded condition-specific analyses. Additionally, all clinical and sociodemographic data were self-reported without independent verification, potentially introducing recall bias or misclassification of chronic conditions and university enrollment status. Future research should involve larger, more gender-balanced samples and explore illness-specific dynamics to clarify how emotional regulation and self-care jointly influence well-being in emerging adulthood.

Supplemental Material

Supplemental material - Emotional Self-Regulation and Self-Care as Predictors of Quality of Life in Emerging Adults With Chronic Conditions

Supplemental material for Emotional Self-Regulation and Self-Care as Predictors of Quality of Life in Emerging Adults With Chronic Conditions by Mariana Marques, Patrícia Gouveia, & Elisa Kern de Castro in Emerging Adulthood

Supplemental Material

Supplemental material - Emotional Self-Regulation and Self-Care as Predictors of Quality of Life in Emerging Adults With Chronic Conditions

Footnotes

Author Note

This research was conducted as part of a master’s dissertation in Clinical and Health Psychology at Egas Moniz School of Health & Science (first author).

ORCID iD

Elisa Kern de Castro

Ethical Considerations

The study was approved by the Ethics Committee of Egas Moniz School of Health & Science (process no. 1308) and conducted in accordance with the 2013 Declaration of Helsinki.

Funding

This work was supported by FCT - Fundação para a Ciência e Tecnologia, I.P. by project reference UID/4585/2025 and DOI identifier .

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Transparency and Openness Statement

All data are available upon request.

Supplemental Material

Supplemental material is available online.

Author Biographies

Mariana Marques, MSc, is a clinical psychologist with a master’s degree in clinical and health psychology from the Egas Moniz School of Health and Science, Portugal. Her professional interests include emotional regulation and health promotion. She is beginning her professional career in private clinical practice.

Patrícia Gouveia, PhD, is a clinical psychologist and an Assistant Professor of Psychology at the Egas Moniz School of Health and Science, Portugal. She holds a PhD and MSc in Health Psychology from ISPA – Instituto Universitário and a degree in Clinical Psychology from Instituto Superior de Ciências da Saúde Egas Moniz. Her research focuses on psychological assessment, self-regulation, and clinical child and adolescent psychology. She collaborates with the Egas Moniz Center for Interdisciplinary Research (CiiEM).

Elisa Kern de Castro, PhD, is a clinical psychologist and Assistant Professor of Psychology at the Egas Moniz School of Health and Science, Portugal. She earned her PhD in Clinical and Health Psychology from Universidad Autónoma de Madrid (Spain) and her MSc in Developmental Psychology from Universidade Federal do Rio Grande do Sul (Brazil). Her research examines medical trauma, psychological aspects of chronic diseases, child-caregiver relationships, self-regulation, and well-being and quality of life.

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