Objective-This study used a longitudinal design to investigate the buffering role of resilience on worsening HbA 1c and self-care behaviours in the face of rising diabetes-related distress.Method-A total of 111 patients with diabetes completed surveys and had their glycosylated hemoglobin (HbA 1c ) assessed at baseline and 1-year follow-up. Resilience was defined by a factor score of self-esteem, self-efficacy, self-mastery, and optimism. Diabetes-related distress and selfcare behaviours were also assessed.Results-Baseline resilience, diabetes-related distress, and their interaction predicted physical health (HbA 1c ) at 1-year. Patients with low, moderate, and high resilience were identified. Those with low or moderate resilience levels showed a strong association between rising distress and worsening HbA 1c across time (r=.57, .56, respectively). However, those with high resilience scores did not show the same associations (r=.08). Low resilience was also associated with fewer self-care behaviours when faced with increasing distress (r= −.55). These correlation coefficients remained significant after controlling for starting points.Conclusion-In patients with diabetes, resilience resources predicted future HbA 1c and buffered worsening HbA 1c and self-care behaviours in the face of rising distress levels.Healthcare providers benefit from the knowledge and understanding of associations between psychosocial and physiological variables in patients with chronic illness. These associations can further inform treatment, prevention, and intervention protocols through a biopsychosocial perspective. In diabetes patients, a holistic view of disease can aid the prevention of a variety of debilitating physical complications that can result from consistently poor self-care behaviors and high glycosylated hemoglobin levels.One well-known correlate of poor glycemic control and self-care is diabetes-related psychological distress (Polonsky, Anderson, Lohrer, Welch, & Jacobson, 1995Weinger & Jacobson, 2001). Reducing diabetes-related distress has been successful through intensive, educational, or cognitive behavioral interventions (see Welch, Weinger, Anderson, & Polonsky, 2003, for review). Less is known about the personal factors that encourage successfully coping with rising levels of diabetes-related distress. Rising distress levels may accompany a diabetes patient at any stage of disease. For example, Shaban, Fosbury, Kerr, and Cavan (2006) report significant prevalence rates for moderate to severe depression and anxiety in type 1 patients living with diabetes for many years. Due to the extensive, daily nature of * Requests for reprints should be addressed to Joyce P. Yi, Ph.D., University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195 USA. jyi@u.washington.edu. NIH Public Access Author ManuscriptBr J Health Psychol. Author manuscript; available in PMC 2010 July 8. diabetes self-care, feeling "burned out" or overwhelmed is a risk for patients at any stage of their disease. However, psycho...

OBJECTIVE—Given limited reports on diabetes among U.S. Asian and Pacific Islander youth, we describe the clinical characteristics, incidence, and prevalence of diabetes among Asian, Pacific Islander, and mixed Asian–Pacific Islander youth.RESEARCH DESIGN AND METHODS—Data were collected from 245 Asian, Pacific Islander, and Asian–Pacific Islander participants in the SEARCH for Diabetes in Youth Study, a population-based study of diabetes in youth (aged <20 years). Additionally, we estimated the incidence and prevalence of type 1 and type 2 diabetes for Asian, Pacific Islander, and Asian–Pacific Islander youth combined.RESULTS—Most participants with type 2 diabetes were obese (range Asian 71% to Pacific Islander 100%) with mean BMI >33 kg/m2. In those with type 1 diabetes, Pacific Islanders were more likely to be obese, with a mean BMI of 26 vs. 20 kg/m2 for Asian and Asian–Pacific Islander youth (P < 0.0001). The incidence of type 1 diabetes for youth aged 0–9 years was 6.4 per 100,000 person-years and 7.4 per 100,000 person-years for youth aged 10–19 years. The incidence of type 2 diabetes was 12.1 per 100,000 person-years for youth aged 10–19 years.CONCLUSIONS—While Asian and Asian–Pacific Islanders with type 1 and type 2 diabetes had lower mean BMIs than Pacific Islanders, all Asian, Pacific Islander, and Asian–Pacific Islanders with type 2 diabetes had mean BMIs above adult ethnicity-specific definitions of obesity. While the majority of Asian, Pacific Islander, and Asian–Pacific Islander youth had type 1 diabetes, older Asian, Pacific Islander, and Asian–Pacific Islander youth (aged 10–19 years) have an incidence of type 2 diabetes almost double that of type 1 diabetes. Public health efforts to prevent type 2 diabetes and obesity in Asian, Pacific Islander, and Asian–Pacific Islander adolescents are needed.

The authors examined relationships between chronic stress and cognitive decline and whether such relationships were mediated by psychophysiological factors. Ninety-six caregivers of spouses with Alzheimer's disease (AD) were compared with 95 similar noncaregiver spouses. All were free of diabetes. Although the groups started similarly, over 2 years caregivers declined by a small but significant amount (1 raw score point and 4 percentile points, each p<.05) on Shipley Vocabulary. In contrast, noncaregivers did not change. Higher hostile attribution (beta=-.09; p<.05) and metabolic risk (beta=-.10; p<.05) in caregivers mediated the cognitive decline. This is the first study of cognitive decline and mediators in caregivers. This work has implications for caregiver and care-recipient health and for research on cognition, psychophysiology, diabetes, and AD.

OBJECTIVE -To examine psychometric properties of the Confidence in Diabetes Self-Care (CIDS) scale, a newly developed instrument assessing diabetes-specific self-efficacy in Dutch and U.S. patients with type 1 diabetes.RESEARCH DESIGN AND METHODS -Reliability and validity of the CIDS scale were evaluated in Dutch (n ϭ 151) and U.S. (n ϭ 190) outpatients with type 1 diabetes. In addition to the CIDS scale, assessment included HbA 1c , emotional distress, fear of hypoglycemia, self-esteem, anxiety, depression, and self-care behavior. The Dutch sample completed additional measures on perceived burden and importance of self-care. Test-retest reliability was established in a second Dutch sample (n ϭ 62).RESULTS -Internal consistency (Cronbach's ␣ ϭ 0.86 for Dutch patients and 0.90 U.S. patients) and test-retest reliability (Spearman's r ϭ 0.85, P Ͻ 0.0001) of the CIDS scale were high. Exploratory factor analysis showed one strong general factor. Spearman's correlations between the CIDS scale and other measures were moderate and in the expected directions, and high HbA 1c levels were associated with low CIDS scores in the U.S. sample only. Low CIDS scores were positively associated with self-care but not with glycemic control in the original samples. CIDS scores in the U.S. and Dutch samples did not show any statistically significant differences. U.S. men had higher CIDS scores than U.S. women.CONCLUSIONS -The CIDS scale is a reliable and valid measure of diabetes-specific selfefficacy for use in patients with type 1 diabetes. High psychometric similarity allows for crosscultural comparisons. Diabetes Care 26:713-718, 2003E ffective self-regulation of diabetes is not just based on simple adherence to a prescribed regimen but requires active behavioral involvement of patients on a day-to-day basis. A key factor in attaining behavioral goals is self-efficacythe individual's confidence in his or her own ability to perform specific tasks required to reach a desired goal (1). To cope effectively with the complex demands of the diabetes treatment regimen, a sufficient sense of self-efficacy is required.

Coping correlates of resilience, defined as resistance to illness in the face of exposure to high numbers of negative life events, were studied in a sample of 404 young women high school athletes. Negative life events and coping strategies were assessed preseason, and daily illness data were collected during the course of the season. Among athletes with high levels of exposure to negative life events, resilient (no illness time loss) and nonresilient (upper third of time loss distribution) groups were compared on 6 scales of the Ways of Coping Checklist. Coping profiles of the groups differed significantly, with resilient athletes favoring Problem-focused Coping and Seeking Social Support, and nonresilient athletes reporting greater use of Avoidance and Blaming Others. Correlations among Problem-focused Coping, Seeking Social Support, and Minimize Threat were higher in the resilient group. Results suggest that certain coping strategies may contribute to illness-resistance in the face of high life stress.