A Dyadic Multiple Mediation Model of Patient and Spouse Stressors Predicting Patient Dietary Adherence Via Depression Symptoms and Diabetes Self-Efficacy

Introduction/Method

Type 2 diabetes (T2D) is becoming a global epidemic, with roughly 500 million people around the world expected to be living with the disease by 2035. Despite the significant increase in health risks associated with T2D, the disease can often be successfully managed through strict adherence to a dietary and exercise regimen (Wing et al., 2001). Unfortunately, such adherence has proven a very difficult task for many patients (August & Sorkin, 2010).

Patient stress is one factor found to impact metabolic control via engagement (or not) in diabetes self-care behaviors (i.e., diet and exercise; Viner et al., 1996). Yet, it is unclear whether different types of stressors have similar associations with patient diabetes self-care behaviors and we know little about the pathways through which these stressors are related to diabetes self-care behaviors. Research also suggests that spouses play an integral role in patient dietary adherence (August & Sorkin, 2010; August et al., 2013), thus any models linking contextual factors, such as stress, to patient self-care behaviors are likely to be stronger when incorporating spouse perceptions.

Thus, the purpose of this study is to identify potentially modifiable patient and spouse factors related to patient dietary adherence. This study specifically examines associations between several distinct stressors (i.e., diabetes-related distress, physical health stress, relationship stress, and general life stress) and patient dietary adherence via patient and spouse depression symptoms and patient and spouse diabetes self-efficacy. The dyadic multiple mediation model was tested using data from 117 married couples in which one partner was diagnosed with Type 2 diabetes. The indirect effects were tested using bootstrapping procedures.

Results/Conclusion

We found patient and spouse stressors, particularly diabetes distress reported by both partners and patient physical health stress, operationalized as the number of comorbid health conditions, were related to patient dietary adherence through patient depression symptoms and both patient and spouse diabetes efficacy. These conclusions were strengthened by empirically comparing our proposed model to three plausible alternatives, with support for our hypothesized model. These results are important because they provide further evidence for the importance of healthy spouses in the management of type 2 diabetes. These results also provide diabetes educators and clinicians with specific factors to target in intervention programming and suggest that education and intervention programs that focus solely on the patient are targeting only part of the solution.