The fit between stress appraisal and dyadic coping in understanding perceived coping effectiveness for adolescents with type 1 diabetes.

This study examined whether perceived coping effectiveness (PCE) was associated with better diabetes management and was higher when adolescents’ dyadic coping was matched to shared stress appraisals. There were 252 adolescents with Type 1 diabetes who completed stress and coping interviews where they appraised mothers’ and fathers’ involvement in stress ownership (mine, indirectly shared, directly shared with parent), in coping (uninvolved, supportive, collaborative, or controlling), and rated their effectiveness in coping. Adolescents completed assessments of depressive symptoms (Children’s Depression Inventory), self-care behaviors (Self-Care Inventory), and efficacy of disease management (Diabetes Self-Efficacy). Glycosylated hemoglobin levels were obtained from medical records. Higher PCE was associated with fewer depressive symptoms, self-care behaviors, and efficacy across age and, more strongly for older adolescents’ metabolic control. Appraisals of support or collaboration from parents were more frequent when stressors were appraised as shared. PCE was enhanced when dyadic coping with mothers (but not fathers) was consistent with stress appraisals (e.g., shared stressors together with collaborative coping). Stress and coping is embedded within a relational context and this context is useful in understanding the coping effectiveness of adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping, control, and adjustment in type 2 diabetes.

The relationships of both coping strategies and perceived control to psychological and physiological adjustment were investigated in 115 adults (65 women, 50 men) with Type 2 diabetes. Results showed that (a) emotional preoccupation and palliative coping were positively correlated with depression and state anxiety, whereas perceived control was negatively correlated with depression, state anxiety, and hemoglobin A1c (HbA1c); (b) instrumental coping predicted lower depression; (c) perceived control moderated the relationships between instrumental coping and depression, and emotional preoccupation coping and HbA1c; and (d) emotional preoccupation coping mediated the relationships between perceived control and depression, and perceived control and state anxiety. Results are discussed in terms of the goodness-of-fit hypothesis (V. J. Conway & D. J. Terry, 1992), optimal coping, and the importance of perceived control in psychological and physiological adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depleted parental psychological resources as mediators of the association of income with adherence and metabolic control.

For adolescents with Type 1 diabetes, lower family income may be associated with poorer diabetes management through depleted parental psychological resources (i.e., higher parental depressive symptoms, lower parental acceptance). Adolescents (N = 252; 46% male) aged 10–14 years with Type 1 diabetes assessed the acceptance of their mother and father (e.g., “gives me the feeling that she likes me as I am”; “she doesn't feel she has to make me over into someone else”). Mothers provided information on family income and demographics. Both mothers and fathers reported their depressive symptoms. HbA1c scores were indexed via medical records. Lower family income was associated with higher (i.e., worse) HbA1c, more mother and father depressive symptoms, and less acceptance from both parents. Mediation analyses revealed that the relationship of lower family income with metabolic control occurred indirectly through lower maternal and paternal acceptance and lower adherence. Lower family income may impair the quality of parent—adolescent relationships that are beneficial for good diabetes management. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Peer relationships and diabetes: Retrospective and ecological momentary assessment approaches.

Objective: To examine the association of positive and negative aspects of friendship to psychological well-being, self-care behavior, and blood glucose control and to determine whether these relations were moderated by gender. Design: Adolescents with Type 1 diabetes (n = 76) completed baseline measures of friendship quality, depressive symptoms, and self-care. A measure of metabolic control was obtained from medical records. Adolescents also tested blood glucose periodically over the course of 4 days and completed ecological momentary assessments of interpersonal interactions and mood using PDAs. Main Outcome Measures: For between-groups analyses, primary outcomes were depressive symptoms, self-care behavior, and metabolic control. For within-groups analyses, primary outcomes were mood and blood glucose. Results: Results showed baseline reports of peer conflict but not support were associated with outcomes, particularly among girls. Conflict was more strongly related to poor metabolic control for girls than boys. Momentary interaction enjoyment and interaction upset were associated with mood, but were unrelated to blood glucose. Aggregate indices of enjoyable interactions were associated with fewer depressive symptoms and better self-care—especially among girls. Conclusions: These results suggest that the positive and negative aspects of peer relationships are related to the psychological well-being and physical health of adolescents with diabetes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computer-assisted intervention improves patient-centered diabetes care by increasing autonomy support.

Objective: To determine if a patient-centered, computer-assisted diabetes care intervention increased perceived autonomy support, perceived competence (from self-determination theory), and if these constructs mediated the effect of the intervention on ADA/NCQA recommended diabetes care outcomes. Design: A randomized controlled trial of 866 adult type 2 diabetes patients in heterogeneous primary care settings in Colorado. Main Outcome Measures: Perceived autonomy support, perceived competence, patient satisfaction, glycemic control (HbA1c), ratio of total to HDL cholesterol, diabetes distress, and depressive symptoms. Results: The computer-assisted intervention increased patient perception of autonomy support relative to a computer-based control condition ( p = .05). Change in perceived competence partially mediated the effects of increased autonomy support on the change in lipids, diabetes distress, and depressive symptoms. The construct of autonomy support was found to be separate from that of patient satisfaction. Conclusions: A patient-centered, computer-assisted intervention was effective in improving diabetes self-management outcomes, in part, because it increased patients' perception that their autonomy was supported which changed perceived competence. These findings support the self-determination model for health behavior change and the chronic care model and support the further study of the use of these technologies to motivate patients to improve their health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Glycemic control among Latinos with type 2 diabetes: The role of social-environmental support resources.

Objective: Although active diabetes self-management is required to achieve glycemic control, adherence is poor among ethnic minorities, especially Latinos. Research shows that individuals who report greater social-environmental support resources for disease management manage their diabetes more effectively than those with fewer support resources. Methods: Path analysis was conducted to investigate the value of a multiple-mediator model in explaining how support resources for disease management influence hemoglobin A1c (HbA1c) levels in a sample of 208 Latinos with Type 2 diabetes recruited from low-income serving community clinics in San Diego County. We hypothesized that the relationship between support resources for disease-management and HbA1c would be mediated by diabetes self-management and/or depression. Results: Participants who perceived greater support resources for disease-management reported better diabetes self-management (β = .40, p     

Parental negative affect and adolescent efficacy for diabetes management.

The authors investigated whether parental perceptions of adolescent efficacy are colored by parental negative affect and are associated with adolescents’ self-perceptions of efficacy for diabetes management. Adolescents (n = 183, M age = 12.53) with Type 1 diabetes and their mothers and fathers separately reported perceptions of adolescents’ efficacy for diabetes management and parents reported their own negative affect (depressed mood and trait anxiety). glycosolated hemoglobin (HbA1c) levels were obtained from medical records. The results indicated that parental negative affect was associated with parental perceptions of poorer adolescent efficacy beyond the association of HbA1c scores. The relationship between fathers’ negative affect and adolescents’ self-efficacy was mediated by fathers’ perceptions of adolescent efficacy. The results suggest that parental negative affect may negatively color their views of adolescents’ efficacy and, in the case of fathers’ beliefs, may relate to adolescent self-efficacy. Parental negative affect should be considered when evaluating perceptions of adolescents’ efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescents' and mothers' perceptions of the cognitive and relational functions of collaboration and adjustment in dealing with type 1 diabetes.

We examined how adolescents' and mothers' perceptions of cognitive and interpersonal functions of collaboration surrounding Type 1 diabetes differed and how they related to adolescent age, psychosocial, and diabetes adjustment. Adolescents (M = 14.16 years) and mothers completed questionnaires assessing the functions of collaboration for the adolescent, quality of the mother-adolescent relationship, emotional adjustment, and adherence to the diabetes regimen. Confirmatory factor analysis (CFA) of perceptions of collaboration confirmed three dimensions: collaboration to compensate for cognitive function, interpersonal enjoyment, and frequency of collaboration. Although adolescents' and mothers' views of interpersonal enjoyment and frequency of collaboration converged, their perceptions of compensation were unrelated. Mothers' perceptions of adolescents' compensation were unrelated to perceptions of enjoyment and frequency. Both adolescents and mothers perceived less compensation and less enjoyment of collaboration with increasing adolescent age, but only adolescents reported collaborating less frequently with higher age. Better emotional adjustment and adherence occurred when mothers and adolescents perceived enjoying collaboration (controlling for mothers' acceptance) regardless of age. Enjoying collaboration at an interpersonal level may be an important avenue for successful diabetes management during adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial discrimination stress, coping, and depressive symptoms among Asian Americans: A moderation analysis.

The purpose of our study was to explore: (a) the association between racial discrimination stress and depressive symptoms, and (b) how coping (e.g., individualistic/collectivistic and dispositional/situation-specific coping) attenuated or strengthened this association specifically among Asian Americans. Data were collected from 201 Asian Americans in a large Midwestern state university through an online survey. Results from a hierarchical regression indicated that racial discrimination stress significantly predicted depressive symptoms over and beyond perceived general stress and perceived racial discrimination. For the moderation effect, the simple effect analyses indicated that low utilization of reactive coping strategies and a high helpfulness rating of family support reduced the strength of association between racial discrimination stress and depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Learning to Live With What You Can't Rise Above": Control Beliefs, Symptom Control, and Adjustment to Tinnitus.

The relations between 3 types of perceived control, symptom severity, and 2 adaptational outcomes, depressive symptoms and psychological well-being, were examined in a sample of 319 people with tinnitus. Consistent with previous studies of control and adjustment to chronic health conditions, general health and symptom control were associated with better psychological adjustment, and retrospective control was associated with worse psychological adjustment. Only symptom control emerged as a significant moderator in the symptom severity--adjustment relationship, such that stronger beliefs in one's ability to control symptoms were most strongly associated with better adjustment among those with more severe tinnitus symptoms. These findings were consistent with coping perspectives and cognitive adaptation theory and suggest that symptom-related perceptions of control may be an effective coping resource to nurture in chronic health contexts with severe symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with increased uncertainty in the field of work and family life.

Globalization, demographic aging, and individualization and pluralization of life courses have led to individuals' increasing uncertainty regarding their future. The effects of social change on the lives of individuals, however, may depend on coping processes. The authors analyzed whether perceived uncertainty due to social change, problem-focused coping, and distancing from demands would be related to depressive symptoms in 1,975 German adolescents and adults. A higher number of perceived demands in the areas of work and family life (e.g., perceived increase of difficulties with finding adequate jobs and of instability of one's intimate relationship) were associated with higher levels of depressive symptoms. In addition, higher levels of problem-focused coping were related to fewer depressive symptoms, whereas higher levels of distancing from demands were related to more depressive symptoms. Problem-focused coping buffered the effect of family-related demands but not of work-related demands on depressive symptoms. Finally, distancing from demands buffered the effects of family-related demands but amplified the effects of work-related demands on depression. In sum, the present study supports the main effects model and the interaction effects model of coping. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mood regulation expectancies, coping responses, depression, and sense of burden in female caregivers of Alzheimer's patients

This study focused on the role of generalized expectancies for negative mood regulation in coping among caregivers to Alzheimer's disease patients. Self-report measures were used to obtain information on expectancies, hassles, coping strategies, depressive symptoms, and sense of burden from 73 female primary caregivers in support groups. Stronger expectancies for negative mood regulation were associated with less severe depressive symptoms, even with stress levels and coping responses controlled. These expectancies were also associated with less avoidant coping, but were unrelated to active coping. Burden and depressive symptoms were strongly related, but correlated differently with other variables.     

Stress, coping, and psychological adjustment of adults with sickle cell disease.

Examined a transactional model of psychological adjustment to chronic illness with 109 African-American adults with sickle cell disease (SCD). Good psychological adjustment was associated with lower levels of perceived daily stress and stress regarding SCD illness tasks, higher efficacy expectations, less use of palliative coping methods, less use of negative thinking/passive adherence pain-coping strategies, and family functioning characterized by high levels of support and low levels of conflict and control. Overall, the underlying stress and coping conceptual model accounted for 44–50% of the variance in psychological adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multisystemic therapy for adolescents with poorly controlled type I diabetes: Stability of treatment effects in a randomized controlled trial.

The primary purpose of the present study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, improved regimen adherence, metabolic control, and rates of hospitalization for diabetic ketoacidosis (DKA) among adolescents with chronically poorly controlled Type 1 diabetes 6 months after the completion of treatment. A randomized controlled trial was conducted with 127 adolescents and their families. Mean participant age was 13.2 years. Sixty-three percent of participants were African American, and 51% were female. Data were collected at baseline, treatment termination, and 6-month follow-up. Changes in glycated hemoglobin (HbA1c), frequency of blood glucose testing (BGT), and rate of DKA admissions were assessed. In intent-to-treat analyses, a main effect of MST on DKA admissions was found at both treatment termination and follow-up. Improvements in BGT were moderated by family composition; only 2-parent MST families maintained improvements at follow-up. Improvements in HbA1c for the MST group at treatment termination were lost at follow-up. Results show that intensive, home-based psychotherapy created stable reductions in serious lapses in adherence, as indexed by episodes of DKA, among youth with poorly controlled diabetes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental involvement in diabetes management tasks: relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus

OBJECTIVES: The goal of this study was to identify parental behaviors that relate to adherence and metabolic control in a population of young adolescents with insulin-dependent diabetes mellitus (IDDM), and to understand the interrelationships among the variables of parental involvement, adherence to blood glucose monitoring, and glycemic control. STUDY DESIGN: A cross-sectional design was used to investigate parental involvement in diabetes regimen tasks in 89 youth, aged 10 to 15 years, with IDDM. Levels of parental involvement in blood glucose monitoring (BGM) and insulin administration were evaluated through interviews. Assessment of adherence was made by physicians or nurses, independent of patient or parent reports of adherence. Glycemic control was assessed with glycosylated hemoglobin (HbA1c) (reference range, 4% to 6%). RESULTS: There were significant differences in the mean HbA1c values between the older (13 to 15 years of age) (HbA1c = 8.9% +/- 1.03%) and younger (10 to 12 years) patients (HbA1c = 8.4% +/- 1.06%) (p < 0.02). Parental involvement in BGM was significantly related to adherence to BGM (number of blood sugar concentrations checked daily) in both groups of adolescent patients. The younger patients monitored their blood glucose levels more frequently than did the older patients, 39% of the younger patients checked sugar concentrations four or more times daily compared with only 10% of the older group (p < 0.007). In a multivariate model controlling for age, gender, Tanner staging, and duration of diabetes, the frequency of BGM was a significant predictor of glycemic control (R2 = 0.19, p < 0.02). Increased frequency of BGM was associated with lower HbA1c levels. When the frequency of BGM was zero or once a day, the mean HbA1c level was 9.9% +/- 0.44 (SE); when the frequency of BGM was two or three times a day, the mean HbA1c level was 8.7% +/- 0.17; and when the frequency of BGM was four or more times daily, the mean HbA1c level was 8.3% +/- 0.22. CONCLUSIONS: Parental involvement in BGM supports more frequent BGM in 10- to 15-year-old patients with IDDM. This increased adherence to BGM is associated with better metabolic control (i.e., lower HbA1c levels). These findings suggest that encouraging parental involvement in BGM with 10- to 15-year-old patients with IDDM may help to prevent the well-documented deterioration in glycemic control and adherence to treatment that often occurs in later adolescence.     

Minority stress, perceived bicultural competence, and depressive symptoms among ethnic minority college students.

Based on biculturalism theory (LaFromboise, Coleman, & Gerton, 1993), the present study examined the direct effect of perceived bicultural competence (PBC) on depressive symptoms, and PBC as a potential coping resource to moderate the association between minority stress and depressive symptoms. Participants were 167 Asian American, African American, and Latino/a American students at a predominantly White Midwest university. Results from a hierarchical regression analysis suggested that (a) minority stress was positively associated with depressive symptoms after controlling for perceived general stress, (b) PBC was negatively associated with depressive symptoms after controlling for perceived general stress and minority stress, and (c) the interaction between minority stress and PBC was significant in predicting depressive symptoms. Results from a simple effect analysis supported the hypothesis that a higher level of PBC buffers the association between minority stress and depressive symptoms. Furthermore, post hoc exploratory analyses of the components of PBC suggested that 2 components, Social Groundedness and Cultural Knowledge, may be especially important coping resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adherence, body mass index, and depression in adults with type 2 diabetes: The mediational role of diabetes symptoms and self-efficacy.

Objective: Evidence indicates that depression is linked to the development and worsening of diabetes, but the mechanisms underlying this link are not well understood. The authors examined the hypothesis that diabetes-related symptoms mediate the effect of both behavioral adherence and body mass index (BMI) on depression. In addition, they examined whether a prior finding that self-efficacy mediates the effect of behavioral adherence and BMI on depression would replicate with a larger sample size (W. P. Sacco, K. J. Wells, C. A. Vaughan, A. Friedman, S. Perez, & R. Morales, 2005). Also, the relative contributions of diabetes-related symptoms and self-efficacy to depression were evaluated. Design and Participants: Cross-sectional design involving adults diagnosed with Type 2 diabetes (N = 99). Main Outcome Measures: The primary outcome measure was depression (Patient Health Questionnaire: Nine Symptom Depression Checklist). Predictors of depression were diet and exercise adherence (Summary of Diabetes Self-Care Activities Questionnaire), diet and exercise self-efficacy (Multidimensional Diabetes Questionnaire), diabetes symptoms (Diabetes Symptom Checklist), and BMI (based on height and weight data from medical records). Results: Path and mediation analyses indicated that adherence and BMI each contributed to depression indirectly, via their effects on self-efficacy and diabetes-related medical symptoms. Conclusion: Results provide evidence consistent with two independent pathways by which BMI and adherence could increase depression in people with Type 2 diabetes. The first pathway indicates that the effects of higher BMI and poor adherence on depression are mediated by lower self-efficacy perceptions. The second pathway indicates that the effect of higher BMI on depression is mediated by increased diabetes symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The yellow brick road and the emerald city: Benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer.

Predictors and outcomes of benefit finding, positive reappraisal coping, and posttraumatic growth were examined using interviews and questionnaires from a longitudinal study of women with early-stage breast cancer followed from primary medical treatment completion to 3 (n=92) and 12 months (n=60) later. Most women (83%) reported at least 1 benefit of their breast cancer experience. Benefit finding (i.e., identification of benefits, number of benefits), positive reappraisal coping, and posttraumatic growth had distinct significant predictors. Positive reappraisal coping at study entry predicted positive mood and perceived health at 3 and 12 months and posttraumatic growth at 12 months, whereas benefit finding did not predict any outcome. Findings suggest that benefit finding, positive reappraisal coping, and posttraumatic growth are related, but distinct, constructs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Goal adjustment capacities, coping, and subjective well-being: The sample case of caregiving for a family member with mental illness.

This study examined the associations between goal adjustment capacities, coping, and indicators of subjective well-being in 2 waves of data from individuals who provide care for a family member with mental illness. We hypothesized that goal adjustment capacities would predict higher levels of subjective well-being by facilitating coping with caregiving stress. Results showed that goal disengagement was associated with effective care-specific coping (e.g., less self-blame and substance use). Goal reengagement was also associated with effective care-specific coping (e.g., positive reframing), but at the same time it predicted the use of less effective strategies (e.g., venting and self-distraction). Moreover, goal disengagement predicted lower levels of caregiver burden and depressive symptoms and buffered the longitudinal effect of caregiver burden on increases in depressive symptoms. Goal reengagement, by contrast, predicted higher levels of caregiver burden and purpose in life and buffered the cross-sectional association between caregiver burden and depressive symptoms. Finally, effective (and less useful) care-specific coping statistically explained the adaptive (and maladaptive) effects of goal adjustment capacities on participants' well-being. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Benefit Finding in Multiple Sclerosis and Associations With Positive and Negative Outcomes.

This study examined the direct and stress-buffering effects of benefit finding on positive and negative outcomes. A total of 502 people with multiple sclerosis completed a questionnaire at Time 1 and, 3 months later, at Time 2 (n=404). Measures of illness were collected at Time 1, and number of problems, stress appraisal, benefit finding, subjective health, and negative (global distress, negative affect) and positive (life satisfaction, positive affect, dyadic adjustment) outcomes were measured at Time 2. Factor analyses showed the Benefit Finding scale to have 2 dimensions: Personal Growth and Family Relations Growth. Hierarchical regressions showed that after controlling for the effects of demographics, illness, problems, and appraisal, benefit finding showed strong direct effects on the positive outcomes. Benefit finding did not have a direct effect on distress or subjective health but had a weak association with negative affect. Family Relations Growth had a stress-buffering effect on distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)