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The literature on the role of peer support for psychological well-being and disease management among youth with type 1 diabetes (T1D) is mixed. In this topical review, we use self-determination theory (SDT) as a framework to understand the conditions under which peer support is helpful or unhelpful regarding psychological well-being and diabetes management. We briefly review the literature to support our claim that existing research on peer support is inconsistent. A primary reason for the inconsistency is that previous work largely focuses on diabetes instrumental and informational support from peers, which have the potential to threaten SDT needs for autonomy, competence, and relatedness. Instrumental and informational support may set youth with T1D apart from peers at a time when fitting in with peers is crucial. Instead, we argue that emotional support from and companionship with peers best meet the SDT need of relatedness while not posing direct threats to autonomy or competence. We also note that some youth have extremely high needs for relatedness such that they prioritize connecting with peers over diabetes management. We conclude by calling for more research to adopt a SDT theory approach to examine the role of peer support in the lives of youth with T1D and for health care professionals to expand their focus from the specifics of diabetes to the broader social context.

Managing type 1 diabetes involves coordinating complex daily behaviors that may rely on the cognitive abilities of people with diabetes (PWD) and spouses, especially as couples collaborate surrounding diabetes care. The aims of the study were to examine whether 1) the cognitive abilities of PWD and their spouses predicted lower A1C, 2) collaborating with a spouse with higher cognitive abilities was especially beneficial for PWD with lower cognitive abilities, and 3) the benefit of the cognitive abilities of PWD and their spouse occurred through better self-care. Couples (n = 199) were recruited with one member diagnosed with type 1 diabetes (PWD 52% female sex, average age 46.81 years, average duration of diabetes 27 years; spouses 48% female sex; average age 46.40 years). PWD and spouses completed fluid (trail making tests from the Delis-Kaplan Executive Function System) and crystallized (information subtest from the Wechsler Adult Intelligence Scale—4th Edition) ability tests. PWD rated their spouse’s collaboration in diabetes and reported self-care behaviors through surveys. A1C was assessed as a measure of blood glucose through a blood assay. Multiple regressions revealed that spouses’ crystallized ability was the only statistically significant predictor, with higher values associated with lower A1C (t = −2.17, P

Positive affect (PA) has been shown to facilitate the accrual of social resources which, in turn, reduces stress and improves health. These social resources may encourage interpersonal coping strategies, but this effect has been understudied. The present research examined if PA facilitates the interpersonal coping style of communal coping, defined as the perception of a stressor as shared (shared appraisal) and collaborative action to manage the stressor (collaboration). We assessed whether trait and state PA predicted increased collaboration and shared appraisal on the same day, and whether state PA predicted increased collaboration and shared appraisal the following day. Participants were romantic partners in which one person had recently been diagnosed with type 2 diabetes. Patients ( n = 198, 45% female, 44.9% Black, 72% married) and their significant others completed daily diary surveys that assessed PA, negative affect, and diabetes-specific shared appraisal and collaboration for 14 days. Multilevel modeling was used to differentiate the effects of within-person (state) and between-person (trait) PA. Actor Partner Interdependence Modeling was used to assess the effects of both couple member’s mood on one person’s coping. Results showed partner state PA was cross-sectionally linked to shared appraisal, but the link of actor PA to shared appraisal was accounted for by the inclusion of actor NA. Both actor and partner state and trait PA were cross-sectionally linked to collaboration. Importantly, actor state PA predicted next-day shared appraisal. Findings provide initial support for the role of affect in predicting communal coping.

Previous research linking collaboration to relationship and health outcomes has relied almost exclusively on individual self-report and failed to take into consideration the dyadic nature of collaboration. We enrolled couples (n = 193) in which one person had Type 1 diabetes (52% female; 91% non-Hispanic white) into the study and asked them to discuss a diabetes-related issue of high concern for 8 min. These videotaped interactions were coded for dyadic collaboration. Mood was measured before and after the discussion. After the discussion, patients and partners reported support provided and received during the discussion. Results showed that observed dyadic collaboration was related to improvements in mood and greater support exchanges for both patients and partners when self-reported collaboration was statistically controlled. Gender moderated the effects on partners, such that benefits of dyadic collaboration were stronger for women than men. Future research may benefit from including collaborative elements into couple-focused interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

While affect is linked to a number of diabetes outcomes, the specific role of positive affect (PA) in HbA1c remains unclear. The present study examined whether PA prospectively predicted lower HbA1c among adults with type 2 diabetes and whether this relation was moderated by stress. Participants were 123 adults (44.7% female; 60.2% White, 39.8% Black) recently diagnosed with type 2 diabetes. Perceived stress, diabetes-specific distress, and PA were assessed at baseline; HbA1c was assessed at baseline (T1), six months (T2), and five years (T3). PA was cross-sectionally associated with lower HbA1c at T1 and prospectively predicted lower HbA1c at T3. PA interacted with both measures of T1 stress to predict T1 HbA1c, and PA interacted with T3 perceived stress to predict T3 HbA1c. Interactions were consistent with stress buffering. Sensitivity analyses attentuated findings, but robust evidence remained for PA as a protective factor for blood glucose five years later and for a stress-buffering effect of PA on diabetes-specific distress. Findings suggest PA may be a clinically useful indicator among adults with type 2 diabetes and may be particularly important for those experiencing the greatest stress from their disease.

The majority of observed couple communication research has focused on physically healthy couples and those who are White, educated, and affluent. In the present study, we observed persons with Type 2 diabetes and their romantic partners discuss how to improve diabetes management; afterward, we measured positive affect, negative affect, and discussion evaluations. We also measured mood and self-care behavior over the next 2 weeks. Couples (n = 207) were recruited from the community and varied in education, income, and race. Half of patients were White (53%), and half were Black (47%). Results showed that observed patient warmth was related to a more positive evaluation of the discussion, more postdiscussion positive affect, less postdiscussion negative affect, and better 2-week daily happy mood; observed patient negativity was related to less postdiscussion progress, a more negative evaluation of the discussion, less postdiscussion positive affect, and poorer 2-week dietary adherence; and observed patient distress was related to a more negative discussion evaluation, more postdiscussion negative affect, and worse mood over the next 2 weeks. Two of the findings were moderated by race, in the direction of links being stronger for Black than White patients. Partner warmth was rarely related to outcomes, but partner negativity was related to patients' poorer discussion evaluation, patient's lower happy mood and higher angry mood over the next 2 weeks, and patient's poorer 2-week dietary adherence. Future research on couple interactions should attend to important contextual variables such as race, ethnicity, income, and social status. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Communal coping consists of a shared appraisal of a stressor and collaborative efforts to manage it. There has been a wealth of literature linking communal coping to relationship and health outcomes, but there is little research on the context in which communal coping occurs or how communal coping is manifested in daily life. The first and second study goals were to examine the implications of gender for the components of communal coping (shared appraisal, collaboration) and for potential manifestations of communal coping in daily life (e.g., shared meals). Our third study goal was to examine whether shared appraisal and collaboration in the context of diabetes generalized to another domain—household chore distribution—and whether these relations were moderated by gender. As an exploratory goal, we examined intersections of gender with race. Participants were 203 couples in which one person had been recently diagnosed with type 2 diabetes. Shared appraisal and collaboration were assessed with multiple methods. Results showed greater shared appraisal and collaboration when patients were male than when they were female. This finding extended to some, but not all, of the daily life behaviors. Actor–partner interdependence models showed that the relations of actor and partner shared appraisal to household labor depended on both role (patient, spouse) and gender; relations of actor and partner collaboration depended only on role. Findings were not moderated by race. These results highlight the need to consider gender in the context of communal coping.

OBJECTIVE Approximately 34 million people in the U.S. have diabetes. With this illness come substantial changes to psychological and physical health. However, type 2 diabetes disproportionately affects non-Hispanic Black compared with non-Hispanic White populations. The purpose of this study was to examine racial differences in psychological, behavioral, and physical health over time among individuals recently diagnosed with type 2 diabetes. RESEARCH DESIGN AND METHODS Data were collected from a community sample of 193 adults recently diagnosed with type 2 diabetes (44% female; 45% Black). Measures of distress, self-care behaviors, and HbA1c were taken at an initial interview (time 1) and 6 months later (time 2). Individuals wore an Actical accelerometer to assess physical activity and participated in three 24-h dietary recall interviews to assess dietary intake within 2 weeks of the initial interview. RESULTS From time 1 to time 2, Black women showed the highest increase in depressive symptoms. There was a greater increase in regimen and physician distress among White compared with Black participants. White men and Black women reported a decline in medication adherence over time. There were no racial differences in changes in physical activity across 6 months. However, Black individuals had higher overall calorie consumption with greater protein, saturated fat, and cholesterol intake than White individuals. There were no race or sex differences in changes in glycemic stability. CONCLUSIONS Initial adjustment to a diagnosis of type 2 diabetes differentially influences Black and White men and women in terms of depressive symptoms, diabetes distress, and self-care.

Negative social interactions have been linked to worse psychological health. However, individuals’ perceptions of negative interactions may depend on relational interdependent self-construal or how much they define the self in terms of their close relationships. The current analysis examined whether the effect of three different stressors on daily mood is moderated by having a relational self-construal. Participants ( N = 833) from a national, community-based study reported relational self-construal, the experience of three types of stressors, negative affect, and positive affect on 8 consecutive days. Compared to less relationally interdependent individuals, more relationally interdependent individuals experienced a greater increase in negative affect from the prior day when an interpersonal conflict occurred but a lesser increase in negative affect from the prior day when an interpersonal conflict was avoided. These results suggest that the type of interpersonal stressor determines whether self-construal is a risk factor or protective factor for psychological health.

OBJECTIVE Diabetes technology has improved the lives of people with diabetes (PWD), but there is little research on how insulin pumps and continuous glucose monitoring (CGM) affect couples’ relationships. The purpose of this study was to examine how the use of diabetes technology affects couple interactions. METHODS In a secondary data analysis, we used a multiple-method qualitative analysis, including a constant-comparison approach, to examine similarities and differences in couple interactions related to diabetes technology. PWD and their spouses were interviewed separately, using a semi-structured interview guide; the interviews primarily focused on how couples coped with type 1 diabetes. RESULTS Participants (n = 134 couples) were using an insulin pump or CGM system. Average age was 44 ± 12.05 years for PWD and 44 ± 12.62 years for spouses. Couples’ average length of relationship was 18 ± 12.50 years. Among the PWD, 54 used a pump only, 12 used CGM only, and 68 used both. Four main themes emerged: 1) diabetes technology facilitates shared diabetes management for couples, 2) diabetes technology facilitates spousal involvement in diabetes care, 3) diabetes technology is a source of relationship tension, and 4) diabetes technology causes positive/negative responses to sleep and alarms. CONCLUSION Overall, couples perceived diabetes technology as having a positive effect on their relationship by increasing collaboration, promoting communication, and reducing diabetes burden and vigilance. Technology also was perceived to increase relationship tension, lifestyle inconveniences, and positive/negative responses regarding sleep and alarms. Involvement of spouses in diabetes technology education should be considered.

Youth with type 1 diabetes (T1D) must adhere to a complex treatment regimen to prevent health complications. Friends may provide diabetes-specific support to help youth manage diabetes, but evidence on whether youth benefit from diabetes-specific friend support is inconclusive. The present study first investigated whether satisfaction with friend support was linked to psychological distress and diabetes management. Second, it was investigated whether self-esteem mediated these relations. To this end, 324 Dutch-speaking emerging adults (17-28 years) with T1D completed questionnaires on diabetes-specific friend support, self-esteem, diabetes-specific distress, depressive symptoms, and self-care. HbA1c values were obtained from patients' physicians. Receiving diabetes-specific support from friends was associated with more diabetes-specific distress, but not for youth who were satisfied with the received support. Diabetes-specific friend support was not associated with other outcomes. Self-esteem did not mediate these relations. These results suggest that associations between diabetes-specific friend support and diabetes management are limited and that support satisfaction should be taken into consideration when examining the role of friend support for youth with T1D. ispartof: Journal Of Behavioral Medicine vol:44 issue:3 pages:1-10 ispartof: location:United States status: Published online

Communal coping has been linked to better psychological and physical health across a variety of stressful contexts. However, there has been no experimental work causally linking communal coping to relationship and health outcomes. In addition, research has emphasized the collaboration over the shared appraisal component of communal coping. The present study sought to isolate the role of appraisal by manipulating whether dyads viewed a stressor as shared or individual. Friend dyads (n = 64 dyads; 128 participants) were randomly assigned to view a stressor as either a shared or an individual problem, but both groups were allowed to work together. Across self-report and observational measures dyads reported more collaboration and support, better relationship outcomes, and more positive mood after the stressor in the shared than the individual appraisal group. This is the first laboratory evidence to establish causal links of communal coping—specifically shared appraisal—to positive relationship and health outcomes.

Feeling overwhelmed, exhausted, and frustrated by the daily demands of diabetes management has been referred to as diabetes burnout. The goal of the study was to develop a measure of diabetes burnout and to link this measure to psychological health and diabetes outcomes. Emerging adults with type 1 diabetes (n = 88, average age 27) completed an online questionnaire and an HbA1c assessment; a subset was interviewed by phone to obtain a more in-depth understanding of burnout. Exploratory factor analysis revealed three burnout domains: exhaustion, detachment, and powerlessness. Burnout was related to higher psychological distress, higher diabetes distress, and poorer diabetes outcomes. Burnout independently predicted higher HbA1c, independent of diabetes distress. Qualitative interviews revealed that participants defined burnout in terms of exhaustion and powerlessness and resolved burnout by acceptance and utilization of social resources. Prevention and intervention efforts might target resilience as a way to mitigate burnout.

Objective There is evidence that youth with type 1 diabetes are at risk for depression, and depression is a significant risk factor for subsequent psychological and physical health problems. However, it is not clear if/when this depression risk emerges. The goal of this study was to determine if there are differences in levels of depressive symptoms between youth with and without type 1 diabetes that develop over the course of emerging adulthood. We also examined whether adolescent psychosocial variables predicted depressive symptoms during emerging adulthood. Methods Youth with (n = 132) and without (n = 131) type 1 diabetes were enrolled in the study at average age 12 and followed for 14 years. Depressive symptoms were measured throughout the study. Psychosocial variables of interest were measured during adolescence. Results Group differences in depressive symptoms emerged by study end at average age 26. Depressive symptoms appeared to decline over time for youth without diabetes and to increase over time for youth with diabetes. Parent relationship difficulties increased over adolescence as did peer conflict for the entire cohort. Supportive relationships with parent and peers predicted fewer end of study depressive symptoms (controlling for baseline depressive symptoms)—equally so for both groups. Conclusions This study provides evidence that those with type 1 diabetes may be at risk for depressive symptoms many years after diagnosis and after adolescence. Although relational difficulties with parents and peers increase during adolescence, supportive relationships over the course of adolescence may help to mitigate depressive symptoms during young adulthood.

Older adults often report less exposure to and less affective reactions to daily stressors. However, older adults with a chronic illness such as Type 1 diabetes may experience more daily stressors due to the complications of diabetes and may be more affected by those stressors. The study examined (a) age differences in reported exposure to general and diabetes stressors, (b) whether daily general and diabetes stressors relate to daily positive and negative affect, self-care, and blood glucose, and (c) whether these daily associations are moderated by age and comorbidity. Individuals with Type 1 diabetes (n = 199; 52.3% female, average age 46.81 years) completed a checklist for 14 days reporting general and diabetes stressors. General diabetes distress was assessed with the Diabetes Distress Scale. Daily positive and negative affect and daily self-care behaviors were rated each day. Blood glucose was assessed via glucometers. Older adults reported fewer daily general and diabetes stressors and less diabetes distress compared to younger adults. Multilevel models indicated that both daily general and diabetes stressors (between- and within-person) were associated with lower positive and higher negative affect. Fewer diabetes stressors were associated with better self-care and lower (better) mean blood glucose. Neither age nor comorbidity interacted with general or diabetes stressors to predict any outcome (except one effect for comorbidity), indicating that older adults and those experiencing more comorbid conditions were similarly affected by stressors. Results suggest that older adults experience fewer stressors than younger adults but are similarly affected when stressors do occur. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Whether visible and invisible social support are beneficial depends on contextual factors, such as relationship satisfaction. The purpose of the present study was to examine whether differences in support provision are impactful in type 1 diabetes (T1D), which involves frequent opportunities for partners to provide support. We hypothesized that invisible support may be beneficial only when relationship satisfaction is high and also that relationship satisfaction may relate to greater visibility of provided support. We tested these hypotheses in a sample of 199 adult persons with T1D (PWD) and their spouses. Using a 14-day diary, PWD reported diabetes support from partners. Partners reported support provided. Invisible support was coded when PWD reported receiving no support, but partners reported providing it. If both PWD and their partner indicated support received/provided, the day was coded as visible support. Glucometers measured daily blood glucose. Participants reported baseline relationship satisfaction and daily positive and negative affect. Results indicated there were no main effects of support visibility on blood glucose or affect. Analyses showed invisible support was associated with lower mean blood glucose, smaller standard deviation of mean blood glucose, and lower average daily risk only when partner relationship satisfaction was high. Both spouses’ greater relationship satisfaction was associated with more visible and less invisible support. The results contribute to the literature on invisible support, by indicating that it may yield beneficial outcomes primarily when partners are more satisfied. Overall, however, invisible support might occur more in less satisfied relationships.

Dyadic coping theories posit that spousal involvement may benefit illness management through collaborative and supportive (CS) strategies and shared illness appraisals. Illness appraisals have only been examined as individual differences rather than fluctuating daily as individuals manage the difficult Type 1 diabetes regimen. The study examined how daily illness appraisals of individuals with Type 1 diabetes and their spouses were linked to spouses' daily CS strategies and whether CS strategies were most beneficial for daily diabetes outcomes when they occurred in the context of shared illness appraisals.Couples (Multilevel models indicated both within-person and between-person effects of patients' and spouses' illness appraisals on CS strategies with higher shared illness appraisals associated with greater CS strategies. Greater shared illness appraisals were associated with fewer self-regulation failures and better self-care. CS strategies were associated with lower self-care and higher blood glucose levels. Appraisal interacted with CS strategies such that CS strategies were associated with more self-regulation failures, lower self-care, and lower perceived coping effectiveness when patients reported lower shared appraisals.Results suggest that CS strategies may be more detrimental for diabetes management when individuals view diabetes as less shared. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Communal coping is defined as the appraisal of a problem as shared and collaboration to address the problem. The goals of the present study were to apply a multi-method approach to (1) disentangle appraisal and collaboration, (2) establish links to relationships and health outcomes, and (3) demonstrate that collaboration mediates the relations of shared appraisal to outcomes. Self-report measures, an observational measure, and we-language were assessed in patients with type 2 diabetes and their spouses ( n = 207). A confirmatory factor analysis distinguished the two components of communal coping; each component was linked to greater relationship quality and less psychological distress for patients and spouses as well as better diabetes self-care behaviors for patients. Mediation analyses suggested that the links of shared appraisal to these outcomes were largely accounted for by collaboration.

In the context of coping with chronic illness, shared appraisal refers to one person’s perception that the illness is a shared issue. Despite increasing research linking shared appraisal to positive relationship and health outcomes, whether it is static or fluctuates across time has not yet been investigated. Fluctuations in shared appraisal may affect patient and spouse well-being and influence disease management. We investigated the association of daily shared appraisal fluctuations (operationalized as intraindividual standard deviations) to relationship satisfaction, psychological well-being, and diabetes-specific well-being over 2 weeks among 199 couples in which one person had type 1 diabetes. In addition, we examined attachment insecurity as a correlate of shared appraisal fluctuations. Individuals higher in anxiety or avoidance may more frequently reevaluate their relationship. Thus, their shared appraisal may be more reactive to daily events. Actor–partner interdependence models showed greater fluctuations in spouse appraisal were associated with lower patient relationship satisfaction (partner effect) but not with spouse relationship satisfaction and with greater spouse psychological distress (actor effect) but not patient psychological distress. There were no actor or partner effects of patient appraisal fluctuations on these outcomes. In terms of diabetes outcomes, regression analyses showed that greater fluctuations in patient and spouse appraisal were each associated with higher patient diabetes distress, and greater fluctuations in spouse appraisal were associated with lower patient self-care. Higher attachment anxiety was related to greater appraisal fluctuations in the spouse but not the patient. These findings highlight the importance of spouse appraisal stability for spouse relationships and well-being and for patient diabetes outcomes and suggest that attachment insecurity may be implicated in the instability of shared appraisal.

The stress of diabetes management not only affects persons with type 1 diabetes (PWD) but also their social network. We examined the extent to which romantic partners of PWD (n = 199) identified their most significant daily stressor as diabetes-related (i.e., partner diabetes stress) using a 14-day daily diary design. Utilizing a communal coping framework, we examined appraisal and communication as predictors of partner diabetes stress and examined links of partner diabetes stress to supportive/unsupportive behavior and mood by assessing each construct daily. We also examined whether a survey measure of partner anxious attachment moderated these links. Results showed that viewing diabetes as a shared problem and greater diabetes communication were associated with greater partner diabetes stress. Partner diabetes stress was linked to partner provision of greater supportive and unsupportive behavior-especially so for anxiously attached partners. Importantly, partner diabetes stress was not linked to mood for PWDs or partners.

Researchers have recognized the role of social environment in diabetes management, with substantial attention directed toward spouses or romantic partners of people with diabetes. However, the specific ways in which partners are involved have not been articulated. This study, which included 207 couples in which one person was recently diagnosed with type 2 diabetes, used a mixed-methods approach to assess types of partner involvement in diabetes management. First, different types of partner involvement were qualitatively identified from audio-recorded interviews, and links between qualitative findings and demographics were examined. Next, qualitative codes were compared with quantitative measures of partner involvement. Finally, relations of qualitative codes to relationship quality and diabetes outcomes were assessed. Qualitative analyses identified three ways in which partners were involved in diabetes management (support provision, collaboration, and controlling behavior) and two ways in which they were not involved (independent coping and disengagement on the part of the person with diabetes). Participants with diabetes perceived less partner involvement than their partners. Comparisons with quantitative measures revealed that collaboration was distinct from partner support. Reports from participants with diabetes of collaboration, but not partner support, were connected to higher relationship quality and lower A1C, whereas partner reports of collaboration were related to better self-care. Diabetes disengagement was associated with poorer relationship and behavioral outcomes. These findings underscore the varied ways in which partners are and are not involved in diabetes management and suggest that collaboration is more beneficial than social support in terms of relationship quality and diabetes outcomes.

Objective Friendships and romantic relationships are important sources of support that contribute to well-being for youth across adolescence and emerging adulthood and may be especially important for those with a chronic illness. We examined gender differences in trajectories of peer relationships among those with type 1 diabetes (T1D) and how they differ from those without. Methods Individuals with T1D (N = 132) and controls (N = 131) completed questionnaires across 11 years (M age = 12 years at baseline). Trajectories of friend support, conflict, and companionship were estimated from ages 11 to 23. Romantic support and conflict trajectories were estimated from ages 17 to 23. Results Females experienced more friend support than males, especially in comparison to males with T1D. Control females experienced highest levels of romantic support and lowest levels of romantic conflict. In comparison to control males, males with T1D experienced less friend support in early adolescence and less companionship in late adolescence and emerging adulthood. In comparison to control females, females with T1D experienced less friend support in late adolescence and more romantic conflict in emerging adulthood. Conclusions Findings that males with T1D report less friend support and companionship compared to control males, and females with T1D report less friend support and more romantic conflict than control females are of concern as these results suggest those with T1D may be missing out on important aspects of peer relationships. Understanding the broader social network of peer relationships may be useful to clinicians as they assist individuals in garnering support in general and for their diabetes.

Anxious and avoidant attachment may be detrimental for diabetes distress and management. Additionally, individuals’ perceptions of their partner’s involvement may affect these associations. The study explored cross-sectionally and at the daily level whether anxious and avoidant attachment associated with diabetes distress or stressors and diabetes management, and whether higher perceived collaboration and support (C&S) moderated associations between attachment and diabetes management. Individuals with type 1 diabetes (N = 199; M age = 46.82; 52.3% women) completed measures of diabetes distress, diabetes-related C&S, self-care, average blood glucose (hemoglobin A1c), and attachment insecurity, and daily diary measures of diabetes-related C&S, diabetes stressors, mean blood glucose, and self-care. Higher anxious and avoidant attachment associated with higher diabetes distress. Higher anxious attachment associated with more daily stressors. Anxious attachment associated with lower self-care. C&S did not moderate any associations. Findings highlight the need to consider attachment when designing interventions to reduce diabetes-related distress.

Background Sleep, a process that restores the body’s ability to self-regulate, may be one important factor affecting self-care behaviors and blood glucose (BG) levels. The link between sleep quality, self-care behaviors, and BG levels may occur by sleep-altering daily self-regulatory failures. Purpose This study examined whether the relation between sleep quality and self-care behaviors occurred through self-regulation failures and whether the relation between sleep quality and BG levels occurred through self-regulation failures and self-care behaviors sequentially. Methods One hundred and ninety-nine adults with type 1 diabetes (T1D) completed an online questionnaire for 14 days in which they reported sleep quality, self-regulation failures, and self-care behaviors. BG levels were gathered from glucometers. Analyses involved multilevel mediation models and focused on daily within-person and between-person variability of sleep quality. Results Better daily sleep quality was associated with higher self-care behaviors at both within-person and between-person levels, and self-regulation failures mediated the association between daily sleep quality and daily self-care behaviors at both within-person and between-person levels. Better daily sleep quality was associated with better BG levels at the within-person level and self-regulation behaviors and self-care behaviors sequentially mediated the association between daily sleep quality and daily BG levels at the within-person level. Conclusion This study provides a process account of the importance of daily sleep quality of adults with T1D, as well as one potential mechanism—self-regulation—that may explain the effect of sleep quality on diabetes outcomes.

Objective. The purpose of this study was to understand perceptions of diabetes management responsibilities and the impact of diabetes on day-to-day activities in older adulthood for individuals with type 1 diabetes and their spouses. Design and methods. This qualitative content analysis used a constant-compare approach to analyze individual interviews conducted with older adults and their spouses. People with type 1 diabetes (PWD) and their spouses were interviewed regarding how they coped or dealt with diabetes, what activities they carried out or avoided because of diabetes, and how they appraised diabetes as an individual or shared problem. Results. Participants (n = 52) included 26 older adults with diabetes (mean age 69 years, SD 2.56 years; 38.5% female) and their spouses (mean age 68 years, SD 5.11 years; 61.5% female). Half of the PWD (50%) and the majority of spouses (76.9%) appraised diabetes as a shared issue. Five themes emerged from the interview data: 1) Perceptions pf PWD of spouse involvement in diabetes care, 2) PWD underestimated the impact of diabetes on their spouse’s daily lives, 3) gendered nature of spouses supporting diabetes management, 4) evolution of diabetes and the relationship across developmental time, and 5) differences in diabetes management among couples. Conclusion. Older adults with type 1 diabetes and their spouses have different perspectives regarding diabetes support and responsibility and may not always realize what support is being provided or needed to optimize effective diabetes management. Advancing age with or without diabetes complications may necessitate that spouses provide diabetes support. Diabetes management training for spouses would likely be helpful.

Purpose Significant cancer-related distress affects 30–60% of women diagnosed with breast cancer. Fewer than 30% of distressed patients receive psychosocial care. Unaddressed distress is associated with poor treatment adherence, reduced quality of life, and increased healthcare costs. This study aimed to evaluate the preliminary efficacy of a new web-based, psychoeducational distress self-management program, CaringGuidance™ After Breast Cancer Diagnosis, on newly diagnosed women’s reported distress. Methods One-hundred women, in five states, diagnosed with breast cancer within the prior 3 months, were randomized to 12 weeks of independent use of CaringGuidance™ plus usual care or usual care alone. The primary multidimensional outcome, distress, was measured with the Distress Thermometer (DT), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Impact of Events Scale (IES) at baseline and months 1, 2, and 3. Intervention usage was continually monitored by the data analytic system imbedded within CaringGuidance™. Results Although multilevel models showed no significant overall effects, post hoc analysis showed significant group differences in slopes occurring between study months 2 and 3 on distress (F(1,70) = 4.91, p = .03, η2 = .065) measured by the DT, and depressive symptoms (F(1, 76) = 4.25, p = .043, η2 = .053) favoring the intervention. Conclusions Results provide preliminary support for the potential efficacy of CaringGuidance™ plus usual care over usual care alone on distress in women newly diagnosed with breast cancer. This analysis supports and informs future study of this self-management program aimed at filling gaps in clinical distress management.

We-talk (first-person plural pronoun usage) is frequently used to represent the degree to which a person views an illness as shared within a couple. There is evidence that we-talk is related to good relationship and health. However, research has failed to examine the implications of we-talk for spouses and the interpersonal mechanisms that underlie relational and health benefits. To address these limitations, we investigated the association of we-talk to relationship and health among 199 couples in which one person had type 1 diabetes. We-talk was assessed in the context of a brief coping interview with patients and spouses separately. Patients reported their perceptions of their spouse’s behavior over the past month. Actor–partner interdependence, regression, and bootstrap models showed that patient we-talk was unrelated to patient and spouse well-being, but greater spouse we-talk was associated with higher patient relationship satisfaction, higher patient self-efficacy, and better patient self-care behavior. For spouses, greater spouse we-talk also was associated with higher relationship satisfaction, lower stress, and fewer depressive symptoms. Mediational analyses showed that patients’ perceptions of spouses’ greater emotional support and fewer critical behaviors partially accounted for these associations. Spouse we-talk may be more important than patient we-talk because it signifies that spouses are involved in helping with diabetes management, namely by providing emotional support and refraining from criticizing the patient.

We adapted the widely-used measure of relationship closeness, the Inclusion of Other in Self Scale (IOS; Aron, Aron, & Smollan, 1992), to assess communal coping (IOS-CC). Communal coping is a construct that reflects a shared appraisal of a stressor (‘our problem’ instead of ‘my problem’) and collaborative action to manage the stressor. We administered the IOS and the IOS-CC to a racially and economically diverse sample of persons with type 2 diabetes and their partners (n = 207 couples) and examined how a subset (n = 85 couples) interpreted the IOS-CC as well as the IOS. The IOS-CC was largely interpreted as intended. The IOS reflected interpersonal connection, as expected, but also a number of other relationship constructs. The IOS-CC and IOS were positively related, but empirically distinguished by stronger connections of the IOS-CC to communal coping and stronger connections of the IOS to relationship quality. Future researchers should consider using the IOS-CC to measure communal coping when a simple, visual, and less time-intensive measure is needed and consider the different ways the IOS is conceptualized by diverse populations.

Objective Limited clinical resources create barriers to quality management of cancer-related distress. CaringGuidance After Breast Cancer Diagnosis is a web-based, patient-controlled, psychoeducational program of cognitive-behavioral, coping and problem-solving strategies aimed at early post-diagnosis distress reduction without clinical resources. This study evaluated the feasibility of recruiting and retaining newly diagnosed women to 12 weeks of CaringGuidance and program acceptance. Methods Women with stage 0 to II breast cancer diagnosed within the prior 3 months were recruited from clinics and communities in four states, from 2013 to 2015 and randomized to 12 weeks of CaringGuidance plus usual care (n = 57) or usual care alone (n = 43). Recruitment, retention, and program use were tracked. Using standard and study-derived measures, demographic and psychological variables were assessed at baseline and monthly and program satisfaction at 12 weeks. Results Of 139 women screened, 100 enrolled, five withdrew, and 12 were lost to follow-up (83% retention rate). Total program engagement was positively associated with greater baseline intrusive/avoidant thoughts. Intervention participants (92%) believed CaringGuidance would benefit future women and was easy to use. Sixty-six percent believed CaringGuidance helped them cope. Women used program content to change thoughts (49%) or behaviors (40%). Stress in the previous year was positively associated with reports that CaringGuidance was reassuring and helpful. Conclusions Feasibility and acceptance of CaringGuidance was demonstrated pointing to the program's potential as a cancer-distress self-management intervention. Future research will explore program feasibility and acceptability in other regions of the United States, leading to clinical implementation trials.

Research has increasingly recognized the links of communal coping—a shared appraisal of a stressor and collaborative action to manage it—to positive adjustment outcomes in chronic illness. However, past literature rarely examines if these two components have unique links to relationship and health outcomes, if one component is more strongly linked than the other component to these outcomes, or if the two components interact to influence outcomes. Additionally, the impact of shared appraisal and collaboration may depend on the source—the patient or the romantic partner. In a study of 200 patients with newly diagnosed type 2 diabetes and their spouses, daily reports of shared appraisal and collaboration, mood, support interactions, and patient self-care were collected over 14 consecutive days. Multi-level modeling showed that both patient and spouse reports of shared appraisal and collaboration were linked independently to support interactions and better mood for patients and spouses, while collaboration alone was linked to self-care. Further, collaboration was generally more strongly linked to behavioral outcomes—support and self-care—than shared appraisal, while links to mood were similar for shared appraisal and collaboration. Shared appraisal and collaboration also interacted such that shared appraisal was particularly beneficial for those who reported low collaboration. Finally, results suggested one’s own reports of shared appraisal and collaboration were more strongly linked to outcomes than partner reports. Overall, these findings demonstrate unique impacts of daily shared appraisal and collaboration on adjustment to chronic illness for patients and spouses.

Although play has been linked to psychological and physical well-being in childhood, little work has examined benefits of play in adulthood. Play may be especially important in the context of coping with a chronic illness such as type 1 diabetes as self-care involves a difficult daily process. We hypothesized that daily play with one’s romantic partner would be linked to better mood, greater diabetes disclosure, greater support receipt, greater perceived coping effectiveness with one’s most important daily stressors, and better self-care regarding type 1 diabetes. We examined these hypotheses in a sample of 199 adults with type 1 diabetes. Participants completed daily diary measures of play with their partner and proposed outcomes for 14 days. Daily play was linked to better mood, greater diabetes disclosure to one’s partner, greater support received from one’s partner, and greater perceived coping effectiveness with the day’s most important diabetes and general stressors. However, daily play was unrelated to self-care. Mediation analyses further indicated that positive mood explained links from daily play to perceived coping effectiveness, and diabetes disclosure explained links from daily play to support. These findings indicate that having fun with one’s partner may have important psychological and relationship benefits for individuals with chronic illness. More work needs to be conducted to examine links from daily play to self-care. Implications are discussed.

We examined links between sleep quality and psychological distress among couples dealing with type 1 diabetes (T1D) across cross-sectional and daily diary methods and investigated whether relationship satisfaction moderated these associations.199 persons with T1D and their spouses completed survey questionnaires reporting their own sleep quality, depressive symptoms, and relationship satisfaction. They also completed 14-day diaries reporting their own sleep quality and negative affect. Multi-level actor-partner interdependence models examined associations between sleep quality and psychological distress.Cross-sectional and daily diary data revealed an association between poorer sleep quality and higher psychological distress for both persons with T1D and their spouses (ie, actor effects). Some partner effects were found. For example, poorer sleep quality of persons with T1D was associated with greater negative affect for spouses (within persons). Relationship satisfaction moderated the effects of sleep quality on psychological distress. For example, participants' poorer overall daily sleep quality was associated with greater negative affect for those with lower relationship satisfaction but not for those with higher relationship satisfaction (ie, actor effects). In contrast, partners' poorer overall daily sleep quality was associated with participants' greater negative affect for those with higher relationship satisfaction but not for those with lower relationship satisfaction (ie, partner-effects).Links between sleep quality and psychological distress occur both within and between persons. Relationship satisfaction moderates the effect of poorer sleep quality on psychological distress in a nuanced way.

In the context of a chronic illness such as Type 1 diabetes (T1D), managing general stressors may be linked to diabetes-specific stressors for persons with T1D, an intraindividual contagion phenomenon (i.e., spillover). Among those with romantic partners, stress may also be associated with the partner's stress (i.e., crossover). These intraindividual and interpersonal processes may be further strengthened or weakened in the presence of individual (e.g., sleep satisfaction) and interpersonal (e.g., relationship satisfaction) factors. This study examined spillover and crossover effects between daily general and diabetes-specific stressors and whether sleep satisfaction and relationship satisfaction moderated spillover and crossover effects among couples in which one person had T1D. Persons with T1D (n = 199; Mage = 46.82, 52.3% female) and their romantic partners (n = 199; Mage = 46.41, 47.2% female) reported general stressors and sleep satisfaction, and persons with T1D reported diabetes-specific stressors on 14 consecutive days. Both couple members completed a survey that assessed relationship satisfaction. Multilevel models revealed significant within-person and between-person stress spillover and crossover effects. When examining the moderating role of sleep satisfaction, however, persons with T1D with better sleep satisfaction did not experience spillover between one domain and the other. Furthermore, partners with higher relationship satisfaction did not experience crossover between the persons with T1D-specific stressors and their general stressors. These findings support the conceptualization of the link between general and diabetes-specific stressors as both an intraindividual and a dyadic process among couples coping with T1D. In addition, better sleep satisfaction can prevent spillover effects, and relationship satisfaction can prevent stress crossover effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Purpose The purpose of this study was to examine parents’ perceptions of the role children play in their type 1 diabetes (T1DM) care. Family members are a resource to support T1DM self-management, but how children are involved in their parents’ diabetes has not been well explored. Methods Parents with T1DM (n = 85) and a subset of their romantic partners (n = 55) participated in interviews during which they described their children’s knowledge of and involvement in diabetes care. Interviews were transcribed, responses coded/tallied, and themes identified. Results All parents reported that children knew of their diabetes, which they learned about progressively from a young age. Most parents reported children to be accepting and understanding of the ways that diabetes affected their family experiences (eg, pause to treat low blood glucose). When asked about specific support, parents rated “making parent feel better about diabetes” as the most frequently occurring behavior. Some parents felt that children, particularly younger ones, occasionally detracted from T1DM management, but this was usually expected and considered transient. Regardless of child age, many parents did not want diabetes to burden children and limited their involvement. Both parents with T1DM and partners requested resources to enhance child awareness and preparedness to support diabetes. Respondents, particularly partners, were also interested in learning how to communicate better as a family and share perspectives on how diabetes affects individual family members. Conclusions Diabetes care and education specialists should consider developmentally and relationally appropriate ways to engage children of parents with T1DM in education and self-management.

Aims Daily diabetes stressful events take a toll on individuals with type 1 diabetes, and these experiences may look different across adulthood. The aims of the current study were to understand the nature of daily diabetes stress across adulthood and explore whether these experiences differed by age. Methods In this qualitative study, adults with T1D (N = 199, Mage = 46.81 years) described the most stressful event related to their diabetes each evening as part of a 14-day diary. Using a grounded theory approach, diabetes stressful events were coded for where they occurred, the source of stress (i.e. interpersonal or not), and content (e.g. sleep; blood glucose checking; frustration). Results Participants reported having a diabetes-related stressful event on 58% (M = 0.58, SD = (0.25)) of days. Daily stressful events included issues of diabetes management, diabetes-related interference to or from other areas of life, and negative impact on psychological well-being, but rarely included a social component. Older adults were less likely to report having a diabetes-related stressful event, but were more likely to report that stressful events occurred at home, compared to younger adults. Conclusion The lived experience of diabetes-related stress appears similar across ages, with individuals continuing to experience generally the same types of diabetes-related events in similar frequencies. Interventions to help improve diabetes outcomes or well-being may benefit from targeting the most commonly experienced areas of stress, which includes reducing the interference of daily activities to and by diabetes management.

Feeling overwhelmed, exhausted, and frustrated by the daily demands of diabetes management has been referred to as diabetes burnout. The goal of the study was to develop a measure of diabetes burnout and to link this measure to psychological health and diabetes outcomes. Emerging adults with type 1 diabetes (n = 88, average age 27) completed an online questionnaire and an HbA1c assessment; a subset was interviewed by phone to obtain a more in-depth understanding of burnout. Exploratory factor analysis revealed three burnout domains: exhaustion, detachment, and powerlessness. Burnout was related to higher psychological distress, higher diabetes distress, and poorer diabetes outcomes. Burnout independently predicted higher HbA1c, independent of diabetes distress. Qualitative interviews revealed that participants defined burnout in terms of exhaustion and powerlessness and resolved burnout by acceptance and utilization of social resources. Prevention and intervention efforts might target resilience as a way to mitigate burnout.