A person-focused analysis of resilience resources and coping in patients with diabetes

Diabetes patients face adjustment to their disease at many stages over the course of their illness, and not simply at its onset. For example, fluctuations in daily life stress, changes in their physical health, or feelings of burnout, may cause disease management to become even more difficult and burdensome. However, some patients are better able than others to maintain their mental and physical health over the course of their disease. Positive psychosocial variables have been found to influence the psychological adjustment and physical health of diabetes patients (Fournier, De Ridder, & Bensing, 2002; Johnston-Brooks, Lewis, & Garg, 2002; Sousa, Zauszniewski, Musil, Price Lea, & Davis, 2005). One such construct, resilience, defined as an individual's capacity to maintain psychological and physical well-being in the face of adversity, has flourished across many disciplines of psychology and health because of the rising popularity of positive psychology in these areas. Although sparsely studied in the diabetes population, in other areas of chronic illness and stress such as HIV+ men, survivors of violent trauma, or battered women in shelters, resilience has been found to be associated with better emotional and physical health (Connor, Davidson, & Lee, 2003; Humphreys, 2003; Vedhara & Nott, 1996). In a previous study of diabetes patients (Yi, Vitaliano, Smith, Yi, & Weinger, 2008), resilience was defined by personality variables that have been shown to increase adaptive capacity in the face of stressful events. Using a factorial composite derived from measures of self-efficacy, self-esteem, self-mastery, and optimism, 111 diabetes patients were followed over a one-year period to assess changes in glycemic control. They found that baseline resilience predicted future glycosylated hemoglobin levels and buffered worsening glycemic control and self-care behaviors in the face of rising distress levels. Specifically, those with low resilience showed increases in HbA1c levels, while those with high resilience did not. It thus appears that resilience is linked to important changes in diabetes patients that have strong implications for their well-being. Despite this finding, the mechanisms involved in these salutary effects have not been explored in diabetes patients, and are, in fact, still understudied in much of the research involving resilience in general (Kinard, 1998; Rutter, 1987). As first put forth by leading resilience researcher Michael Rutter, the “why” and “how” of resilience is crucial in understanding processes involved in responding to circumstances of risk (Rutter, 1987). Despite this plea, resilience is still predominantly defined as a “constellation of traits” (Jacelon, 1997, p. 128). Understanding the processes of resilience in patients with chronic illness such as diabetes may be useful in aiding prevention and intervention work targeting satisfactory quality of life and physical health. Therefore, this study investigates coping as a potential mechanism of resilience in diabetes patients. Coping involves the cognitions and behaviors designed to master, tolerate, or reduce internal and external demands. Previous research has identified adaptive and maladaptive coping strategies and inspired the development of appropriate self-report measures to assess individual differences in coping strategies and skills (Carver, 1989; Folkman & Lazarus, 1980; Peyrot & McMurry, 1985). Adaptive and maladaptive coping strategies have, in turn, been found to differ in persons with varying levels of resilience in other populations, suggesting that coping may indeed contribute to resilience in the face of stress (Yi, Smith, & Vitaliano, 2005). Previous research on coping patterns in diabetes patients has found adaptive, or problem-focused, coping strategies such as planning and active coping to be linked with less depression and anxiety (Macrodimitris & Endler, 2001) and lower glycosylated hemoglobin levels (Graue, Wentzel-Larsen, Bru, Hanestad, & Ovisk, 2004; Hartemann-Heurtier, Sultan, Sachon, Bosquet, & Grimaldi, 2001; Rose, Fliege, Hildenbrandt, Schirop, & Klapp, 2002). Maladaptive, or emotion-focused, coping strategies such as avoidance and disengagement have been associated with poorer metabolic control, quality of life, and psychological adjustment, as well as increased anxiety and depression (Coelho, Amorim, & Prata, 2003; Graue et al., 2004; Macrodimitris & Endler, 2001). Linking coping to psychosocial resources can elucidate the “why” and “how” of resilience. Despite the passing of two decades since Rutter's original statement (1987), little progress has been made in the understanding of resilience mechanisms. Whether coping may contribute to positive psychosocial resources such as resilience is unclear, although Rose et al. (2002) did find that those with higher self-efficacy and optimism showed more active coping behavior. Our research aimed to expand on these findings by using a person-focused analysis to explore whether varying levels of resilience resources differentiated the coping profiles of diabetes patients.