Setbacks in diet adherence and emotional distress: A study of older patients with type 2 diabetes and their spouses

Abstract

Objectives We investigated patients’ difficulties in managing their diet (i.e., diet setbacks) and associations with change in disease-specific and general emotional distress (diabetes distress and depressive symptoms) among patients with type 2 diabetes and their spouses. Method Data for this study were collected in couples’ homes (N = 115 couples) using structured interviews and self-administered questionnaires at three time points: baseline (T1), six months after baseline (T2), and twelve months after baseline (T3). Results Patients’ diet setbacks were associated with an increase in their diabetes distress in the shorter-term (over six months). Patients’ diet setbacks were not associated with longer-term change in diabetes distress or with change in depressive symptoms at either time point (six months or one year). In contrast, spouses’ perceptions of patients’ diet setbacks were associated with increases in their own diabetes distress at both time points (over six months and one year), and also with an increase in their depressive symptoms in the longer-term (over one year). Conclusion Findings reveal detrimental consequences of patients’ diet nonadherence for emotional well-being that extend to the well-being of their spouses.

Distress and its association with self-care in people with type 2 diabetes

“…Studies carried out in the United States (Gonzalez, Shreck, Psaros & Safren, 2015;Hessler et al, 2014;Franks et al, 2012) and Nigeria (Ogbera & Adeyemi-Doro, 2011) have found that people suffering diabetes and distress have a greater risk of presenting low adherence to self-care in comparison with patients who do not.…”

Spousal overprotection is indirectly associated with poorer dietary adherence for patients with type 2 diabetes via diabetes distress when active engagement is low

“…In a study examining change in diabetes distress following a diabetes education course, having a spouse exhibit more overprotective coping at the outset of education predicted smaller declines in diabetes distress at the end of the course (Hagedoorn et al ., ), and an association between higher spousal overprotection and higher patient diabetes distress was found in another sample of patients with type 2 diabetes and spouses (Schokker et al ., ). A daily diary study revealed on days when spouses engaged in higher than normal levels of diet‐related pressure, which is operationally similar to overprotection, diabetes distress was higher (Stephens et al ., ), and a separate study found a greater shared meal routine, which is conceptually linked with active engagement, predicted reduced diabetes distress for patients (Franks et al ., ; Franks, Sahin et al ., ). Collectively, these studies provide evidence that overprotection from spouses is associated with higher diabetes distress, while active engagement might reduce diabetes distress.…”

“…While the developmental‐contextual model of couples coping with chronic illness (Berg & Upchurch, ) supports exploration of this possibility, there has not been extensive exploration of the association between diabetes distress and dietary adherence. One study found that higher patient diabetes distress was correlated with poorer patient dietary adherence and greater dietary setbacks and no evidence was found to suggest dietary adherence predicted later diabetes distress in patients (Franks et al ., ; Franks, Sahin et al ., ), but the longitudinal predictive power of dietary adherence on diabetes distress was not explored. Another study evaluating the impact of diabetes education on glycaemic control in patients with type 2 diabetes found that those patients who experienced steeper declines in diabetes distress also experienced greater improvements in glycaemic control (Zagarins, Allen, Garb, & Welch, ).…”

“…Because there is evidence that spousal coping efforts may have a direct effect on patient dietary adherence (e.g., Stephens et al ., ), the proposed fully mediated model will be compared to a model in which the direct effect from spouse active engagement, overprotection, and the interaction term to dietary adherence will be included. Additionally, other research has conceptualized dietary adherence as leading to diabetes distress (Franks et al ., ; Franks, Sahin et al ., ), so this alternative causal sequence will also be compared to our proposed model. In terms of control variables, comorbid medical conditions, amount of time the patient has been diagnosed with type 2 diabetes, age, patient gender, and relationship satisfaction will be included on the basis of theoretical (e.g., Berg & Upchurch, ) and empirical evidence (e.g., Henry et al ., ; Schokker et al ., ) suggesting linkages with the central variables of interest.…”

Self-management as a mediator of the relationship between social support and health outcomes of African American adults with type 2 diabetes.

“…Conversely, pressure and persuasion aimed to negatively control spousal behavior leads to increased distress and decreased dietary adherence . Distress and depressive symptoms both increased as patients faced more difficulties in managing their diet (Franks et al, 2012). Spouses' attempts to help their partners regain control and manage their diet as the challenges increased (Franks et al, 2012).…”