Diabetes Distress and Depressive Symptoms: A Dyadic Investigation of Older Patients and Their Spouses

In this dyadic study, we examined diabetes distress experienced by male and female patients and their spouses (N = 185 couples), and its association with depressive symptoms using the Actor-Partner Interdependence Model. Diabetes-related distress reported by both patients and spouses was associated with each partner's own depressive symptoms (actor effects) but generally was not associated with the other's depressive symptoms (partner effects). Moreover, diabetes distress was associated with depressive symptoms more strongly for male than for female patients, but this association did not differ between female and male spouses. Findings underscore the dyadic nature of managing chronic illness in that disease-related distress was experienced by patients and by their spouses and consistently was associated with poorer affective well-being. Key Words: chronic illness management, diabetes, dyadic analysis, marriage and health. A growing literature affirms that marital partners often face chronic illness together, and yet studies often emphasize the health and well-being of patients and give less attention to the experiences of their spouses (Berg & Upchurch, 2007). Spouses often are actively involved in the day-to-day management of their partners' illness. Moreover, involvement of spouses is associated not only with their partners' diseaserelated outcomes (Franks et al., 2006), but also with their own emotional well-being (Coyne & Smith, 1991). Our dyadic study of married partners' responses to chronic illness was guided by the developmental-contextual model of couples coping with chronic illness put forth by Berg and colleagues (Berg & Upchurch). Drawing from this model, we investigated patients' and spouses' concerns associated with managing diabetes, referred to as diabetes distress (Polonsky et al., 1995), and the association of their diabetes distress with their own and their partners' depressive symptoms. We further explored potential gender differences in the association between diabetes distress and depressive symptoms of married patients and their spouses in light of potential differences in the way that women and men respond to the health needs and emotional distress of their ill partners (Berg & Upchurch; Kiecolt-Glaser, & Newton, 2001). DAILY MANAGEMENT OF DIABETES Diabetes affects approximately one in five Americans over the age of 60 and is among the leading causes of death in the United States (Centers for Disease Control and Prevention, 2008). Type 2 diabetes is a chronic disorder of the endocrine system involving insufficient secretion of insulin and resistance to insulin that lessens the ability of cells to absorb glucose from the bloodstream. This type of diabetes accounts for the vast majority of cases of diabetes (only 5-10% of individuals with diabetes have Type 1 diabetes, which involves insulin deficiency resulting from autoimmune destruction of jo-cells of the pancreas; American Diabetes Association, 2010). The management of diabetes requires vigilant and sustained adherence to a complex and coordinated treatment regimen comprising multiple health behaviors, including diet, exercise, and use of prescribed medications (Halter, 1999). Proper daily management of diabetes reduces patients' risk of serious complications such as heart disease and stroke, neuropathy and nephropathy (Gonder-Frederick, Cox, & Ritterband, 2002; Halter). Despite encouragement from healthcare providers and warnings about the harmful consequences of treatment nonadherence, many patients are unsuccessful in sustaining recommended lifestyle behaviors. For instance, although individualized nutrition education often is emphasized in diabetes education, some patients do not recall receiving nutrition recommendations from their healthcare provider, and many patients who receive nutrition recommendations do not closely adhere to them (Rubin, Peyrot, & Saudek, 1991). Notably, the importance of family support for sustaining patients' treatment adherence is recognized in that national standards for diabetes self-management education specifically address education of patients' families and caregivers to promote effective self-management of diabetes (Funnell et al. …