Diabetes is a chronic illness that must be acknowledged and cared for over the course of one's lifetime. Some patients manage to cope with daily life stress without having it affect their diabetes-related outcomes better than others. Research in stress and coping has showed that emotion-focused coping is considered less adaptive when the stressor can be controlled (Vitaliano, DeWolfe, Maiuro, Russo, & Katon, 1990
), as is the case in coping with diabetes. Thus, this study was designed to investigate resilience resources and coping patterns as potential sources for these individual differences.
Not surprisingly, several demographic variables were associated with coping patterns. Maladaptive coping patterns were typically more common in women, younger patients, those with less years of education and those with less years of diabetes duration. This is consistent with other coping research showing that younger adults and women use more emotion-focused coping than older adults or men (Jensen, Nygren, Gamberale, Goldie, & Westerholm, 1994
; Tamres, Janicki, & Helgeson, 2002
; Yeung & Fung, 2007
). We also found that women had lower resilience resources than men. This finding is consistent with others that suggest men have more personal resources than women (e.g., Kling, Hyde, Showers, & Buswell, 1999
). Interestingly, increased attention to the genetics of resilience has revealed the heritability of resilience to be higher in men versus women (Boardman, Blalock, & Button, 2008
). Given this, more research is needed exploring the bolstering of resilience in women in particular, as clinicians may benefit further understanding of sex differences in this area on therapy and intervention.
Of the adaptive coping patterns, older and more educated patients tended to use more acceptance coping. Perhaps these characteristics are signs of more “coping maturity” in these patients. Interestingly, those with longer duration of diabetes were less likely to use instrumental support and planning. It may be that these particular strategies of coping only have benefit to those who have been diagnosed more recently. One study investigating patients with breast cancer found that younger women had poorer psychological adjustment near the time of initial diagnosis, but this association was no longer significant at follow-up visits (Compas et al., 1999
). As newly diagnosed patients with diabetes are more prone to being overwhelmed by the rigid self-management and lifestyle requirements, our results similarly seem to indicate that coping strategies influential to this adjustment (such as instrumental support and planning) were of more benefit to those newly diagnosed patients. Further research is needed to elucidate these findings.
Previous research has shown that high levels of resilience resources buffer, or protect, diabetes patients from worsening HbA1c
or self-care behaviors in the face of rising distress (Yi et al., 2008
). To explore coping patterns as a potential mechanism of this finding, we first investigated the association between coping and resilience. Interestingly, every maladaptive coping subscale from both the COPE and Coping Styles Questionnaires was negatively associated with levels of resilience resources. Clearly, the use of maladaptive coping strategies was exacerbated by low levels of resilience, although directionality is still unclear. In fact, we found that the coping profiles of these groups differed, and this difference was primarily driven by the vast differences in use of maladaptive coping. The high resilience group seemed to adopt maladaptive coping strategies extremely infrequently as compared to adaptive strategies. The use of self-blame, anxiety, impatience and behavioral disengagement were the most notable differences between the resilience groups. While prior research has shown relations among these maladaptive strategies and poor glycemic control, quality of life, and psychological adjustment (Coelho et al., 2003
; Graue et al., 2004
; Peyrot, McMurry, & Kruger, 1999
), no study to our knowledge has linked maladaptive coping strategies to fewer personal resources, such as resilience. Given the mixed results in the effectiveness of coping interventions in chronic illness patients (de Ridder & Schreurs, 2001
), our finding may help target the specific patients who would benefit from an intervention with a coping modification component.
Adaptive coping strategies were not as strongly related to resilience as maladaptive strategies, such that those with the lowest resilience resources used adaptive coping patterns the least. Literature in chronic pain and illness have reported adaptive coping to be associated with better outcomes (McCracken & Eccleston, 2003
) (Zalewska, Miniszewska, Chodkiewicz, & Narbutt, 2007
). We did not find a particularly strong link for those with high levels of resilience to use adaptive coping strategies significantly more than those with lower resilience resources. It may be the case that having ample resilience resources is sufficient for managing the ups and downs of living with diabetes, and the choice and use of coping strategies is not as critical for these patients as it is for those who have low levels of personal resources.
We did not find an association between resilience and HbA1c
in our study, nor did we find strong associations between coping strategies and glycemic control. However, in our previous study, we found that resilience predicted change
in glycemic control over time (Yi et al., 2008
). Thus, future research should continue to investigate changes over time in these critical variables, and should be explored in relation to both resilience and coping. We did find that anger coping style associated with glycemic control, such that more use of anger coping associated with higher HbA1c
levels. This finding corroborates previous reports on the detrimental effects of anger coping (Yi, Yi, Vitaliano, & Weinger, 2008
). Other research has reported active coping patterns to be linked with lower HbA1c
levels (Graue et al., 2004
; Hartemann-Heurtier et al., 2001
; Rose et al., 2002
). As this study is cross-sectional, further research is needed to understand the long-term effects of coping on resilience on diabetes-specific outcomes such as HbA1c
, and how resilience may protect individuals from worsening levels.
Taken together, these results may suggest a “double whammy” effect for persons undergoing chronic illness. In analyses of the planned univariate contrast tests, differences were truly driven by the high levels of maladaptive coping used by the low resilience groups. Thus, it may be the case that maladaptive coping is exacerbated by the lack of resilience resources, although causality is not determined in this study. Interventions targeting those patients with poor glycemic control can benefit from understanding the resources and mechanisms involved with diabetes outcomes. Our work suggests that identifying those with low resilience resources may inform a psychoeducational coping skills intervention designed specifically to reduce maladaptive coping strategies and instead teach patients how to choose and effectively execute coping strategies which may in turn improve long-term glycemic outcomes. Given the mixed results in the effectiveness of coping interventions in chronic illness patients (de Ridder & Schreurs, 2001
), our findings may help target the specific low-resilience patients who would benefit from an intervention with a coping modification component. In sum, our study expands on existing work by highlighting the importance of coping in diabetes patients and informs tailored-interventions by identifying the specific individuals that may benefit most from the improvement of coping skills.