Journal of Behavioral Medicine

, Volume 31, Issue 4, pp 291–300 | Cite as

Coping with diabetes in adulthood: a meta-analysis




A meta-analysis was performed to summarize the relations between coping dimensions (i.e., avoidance, approach, emotion-focused, and problem-focused) and indices of adjustment (i.e., overall, depression, anxiety, glycemic control) in individuals with diabetes.


Relevant methodological and statistical information was culled from 21 primary studies consisting of 3,381 people with diabetes. The correlation coefficient was used as the target effect size.


Use of approach and problem-focused coping was associated with better overall adjustment (small-to-medium effect sizes). Avoidance and emotion-focused coping were not significantly related to overall adjustment. However, negative effect sizes medium-to-large in magnitude were found between emotion-focused coping and specific indices of adjustment (anxiety, depression).


These findings suggest that coping methods aimed at assuaging both the concomitant negative feelings and specific stressors, such as meeting with doctors and engaging in a new treatment regimen commonly associated with diabetes management, largely improve psychological health. However, these relations are dependent upon both the specific coping method used and the index of adjustment assessed.


Coping Diabetes Meta-analysis Adjustment Depression Anxiety 


Note: *indicates articles used in the meta-analysis.

  1. American Diabetes Association. (2002). Fact sheet: Diabetes [On-line]. Available
  2. Amirkhan, J. H. (1998). Attributions as predictors of coping and distress. Personality and Social Psychology Bulletin, 24, 1006–1018. doi:10.1177/0146167298249008.CrossRefGoogle Scholar
  3. Anderson, R. M., Funnel, M. M., Butler, P. M., Arnold, M. S., Fitzgerald, J. T., & Feste, C. C. (1995). Patient empowerment. Results of a randomized controlled trial. Diabetes Care, 18, 943–949. doi:10.2337/diacare.18.7.943.PubMedCrossRefGoogle Scholar
  4. Anderson, R. J., Freeland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes. Diabetes Care, 24, 1069–1078. doi:10.2337/diacare.24.6.1069.PubMedCrossRefGoogle Scholar
  5. *Auslander, W. F., Bubb, J., Rogge, M., & Santiago, J. V. (1993). Family stress and resources: Potential areas of intervention in children recently diagnosed with diabetes. Health and Social Work, 18(2), 101–113.Google Scholar
  6. Averill, J. R., & Rosenn, M. (1972). Vigilant and nonvigilant coping strategies and psychophysiological stress reaction during anticipation of electric shock. Journal of Personality and Social Psychology, 23, 128–141. doi:10.1037/h0032758.PubMedCrossRefGoogle Scholar
  7. Ayres, A., Hoon, P. W., Franzoni, J. B., Matheny, K. B., Cotanch, P. H., & Takayanagi, S. (1994). Influence of mood and adjustment to cancer on compliance with chemotherapy among breast cancer patients. Journal of Psychosomatic Research, 38, 393–402.PubMedCrossRefGoogle Scholar
  8. Bandura, A. (1986). Social foundations of thoughts and action: A social cognitive theory. Englewood Cliffs: Prentice-Hall.Google Scholar
  9. Bombardier, C. H., D’Amico, C., & Jordan, J. S. (1990). The relationship of appraisal and coping to chronic illness adjustment. Behavioral and Research Therapy, 28, 297–304.CrossRefGoogle Scholar
  10. Cameron, R., & Meichenbaum, D. (1982). The nature of effective coping and the treatment of stress related problems: A cognitive-behavioral perspective. New York (NY): Free Press.Google Scholar
  11. Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283.PubMedCrossRefGoogle Scholar
  12. *Cheng, T., & Boey, K. M. (2002). Coping, social support, and depressive symptoms of older adults with Type II diabetes mellitus. Clinical Gerontologist, 22, 15–30.CrossRefGoogle Scholar
  13. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York, NY: Academic Press.Google Scholar
  14. Cohen, F., & Lazarus, R. S. (1973). Active coping processes, coping dispositions, and recovery from surgery. Psychosomatic Medicine, 35, 375–389.PubMedGoogle Scholar
  15. DeRidder, D., & Schreurs, K. (2001). Developing interventions for chronically ill patients: Is coping a helpful concept? Clinical Psychology Review, 2, 205–240.CrossRefGoogle Scholar
  16. Eisenberg, L. (1992). Treating depression and anxiety in primary care. Closing the gap between knowledge and practice. New England Journal of Medicine, 326, 1080–1084.PubMedGoogle Scholar
  17. Endler, N. S., & Parker, J. D. A. (1999). Coping inventory for stressful situations (CISS): Manual (2nd ed). Toronto, Ontario, Canada: Multi-Health Systems.Google Scholar
  18. *Enzlin, P., Mathieu, C., & Demyttenaere, K. (2002). Gender differences in the psychological adjustment to Type 1 diabetes mellitus: An explorative study. Patient Education and Counseling, 48, 139–145.PubMedCrossRefGoogle Scholar
  19. Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior, 21, 219–239.PubMedCrossRefGoogle Scholar
  20. Folkman, S., & Lazarus, R. S. (1985). If it changes it must be a process: Study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology, 48, 150–170.PubMedCrossRefGoogle Scholar
  21. Folkman, S., & Lazarus, R. S. (1988). Manual for the ways of coping questionnaire. Palo Alto (CA): Consulting Psychologist Press.Google Scholar
  22. *Fournier, M., de Ridder, D., & Bensing, J. (2002). Optimism and adaptation to chronic disease: The role of optimism in relation to self-care options of Type 1 diabetes mellitus, rheumatoid arthritis and multiple sclerosis. British Journal of Health Psychology, 7, 409–432.PubMedCrossRefGoogle Scholar
  23. *Frenzel, M. P., McCaul, K. D., Glasgow, R. E., & Schafer, L. C. (1988). The relationship of stress and coping to regimen adherence and glycemic control of diabetes. Journal of Social & Clinical Psychology, 6, 77–87.Google Scholar
  24. Gilbar, O., & De-Nour, A. K. (1989). Adjustment to illness and dropout of chemotherapy. Journal of Psychosomatic Research, 33, 1–5.PubMedCrossRefGoogle Scholar
  25. Grey, M., & Berry, D. (2004). Coping skills training and problem solving in diabetes. Current Diabetes Reports, 4, 126–131.PubMedCrossRefGoogle Scholar
  26. *Grey, M., Davidson, M., Boland, E., & Tamborlane, W. V. (2001). Clinical and psychosocial factors associated with achievement of treatment goals in adolescents with diabetes mellitus. Journal of Adolescent Health, 28, 377–385.PubMedCrossRefGoogle Scholar
  27. *Grier, J. B. (1999). The relationship of stage of change, self-efficacy, and coping style to health status in adults with non-insulin dependent diabetes. (Doctoral Dissertation, Auburn University, 1999). Dissertation Abstracts International: Section B: The Sciences and Engineering, 60(5-B), 2340. Abstract retrieved September 7, 2004 from PsychInfo Database.Google Scholar
  28. Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando (FL): Academic Press.Google Scholar
  29. Heitzmann, C. A., & Kaplan, R. M. (1984). Interaction between sex and social support in the control of Type II diabetes mellitus. Journal of Consulting and Clinical Psychology, 52, 1087–1089.PubMedCrossRefGoogle Scholar
  30. *Hoff, A. L., Mullins, L. L., Chaney, J. M., Hartman, V. L., & Domek, D. (2002). Illness uncertainty, perceived control, and psychological distress among adolescents with Type I diabetes. Research and Theory for Nursing Practice: An International Journal, 16, 223–236.Google Scholar
  31. Holahan, C. J., & Moos, R. H. (1987). Personal and contextual determinants of coping strategies. Journal of Personality and Social Psychology, 52, 946–955.PubMedCrossRefGoogle Scholar
  32. Horowitz, M. (1976). Stress response syndrome. New York, NY: Aronson.Google Scholar
  33. Janis, I. L. (1977). Decision making. New York, NY: The Free Press.Google Scholar
  34. Kahnemann, D. (1973). Attention and effort. Princeton, NJ: Prentice Hall.Google Scholar
  35. Kaplan, R. M., & Hartwell, S. L. (1987). Differential effects of social support and social network in psychological and social outcomes in men and women with Type II diabetes mellitus. Health Psychology, 6, 387–398.PubMedCrossRefGoogle Scholar
  36. Karlsen, B., & Bru, E. (2002). Coping styles among adults with Type 1 and Type 2 diabetes. Health and Medicine, 7, 245–259.CrossRefGoogle Scholar
  37. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York, NY: Springer Publishing.Google Scholar
  38. Lipsey, M. W., & Wilson, D. B. (2001) Practical Meta-Analysis. Sage Press.Google Scholar
  39. Lundman, B., & Norberg, A. (1993). Coping strategies in people with insulin-dependent diabetes mellitus. Diabetic Education, 19, 198–204.CrossRefGoogle Scholar
  40. Lustman, P. J., Clouse, R. E., Griffith, L. S., & Carney, R. M. (1997). Screening for depression in diabetes using the Beck Depression Inventory. Psychosomatic Medicine, 59, 24–31.PubMedGoogle Scholar
  41. *Macrodimitris, S. D., & Endler, N. S. (2001). Coping, control, and adjustment in Type 2 diabetes. Health Psychology, 20, 208–216.PubMedCrossRefGoogle Scholar
  42. Maes, S., Leventhal, H., & DeRidder, D. T. D. (1996). Coping with chronic diseases. Handbook of coping. New York: Wiley.Google Scholar
  43. Moos, R. H., & Billings, A. G. (1982). Conceptualizing and measuring coping resources and processes. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress: Theoretical and clinical aspects. New York (NY): Free Press.Google Scholar
  44. Moos, R. H., & Schaefer, J. A. (1993). Coping resources and processes: Current concepts and measures. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress: Theoretical and clinical aspects (pp. 234–257). New York, NY: The Free Press.Google Scholar
  45. Mullins, L. L, Chaney, J. M., Pace, T. M., & Hartman, V. L. (1997). Illness uncertainty, attributional style, and psychological adjustment in older adolescents and young adults with asthma. Journal of Pediatric Psychology, 22, 871–880.PubMedCrossRefGoogle Scholar
  46. *Palmer, D. L., Berg, C. A., Wiebe, D. J., Beveridge, R. M., Korbel, C. D., Upchurch, R., Swinyard, M. T., Lindsay, R., & Donaldson, D. L. (2004). The role of autonomy and pubertal status in understanding age differences in maternal involvement in diabetes responsibility across adolescence. Journal of Pediatric Psychology, 29, 35–46.PubMedCrossRefGoogle Scholar
  47. *Peyrot, M., McMurry, J. F. Jr., Kruger, D. F. (1999). A biopsychosocial model of glycemic control in diabetes: Stress, coping and regimen adherence. Journal of Health and Social Behavior, 40, 141–158.PubMedCrossRefGoogle Scholar
  48. Roesch, S. C., & Weiner, B. (2001). A meta-analytic review of coping with illness: Do causal attributions matter? Journal of Psychosomatic Research, 50, 205–219.PubMedCrossRefGoogle Scholar
  49. Roesch, S. C., Weiner, B., & Vaughn, A. A. (2002). Cognitive approaches to stress and coping. Current Opinions in Psychiatry, 15, 627–632.CrossRefGoogle Scholar
  50. Roesch, S. C., Adams, L., Hines, A., Palmores, A., Vyas, P., Tran, C., Pekin, S., & Vaughn, A. A. (2005). Coping with prostate cancer: A meta-analytic review. Journal of Behavioral Medicine, 28, 281–293.PubMedCrossRefGoogle Scholar
  51. Roth, S., & Cohen, L. J. (1986). Approach, avoidance, and coping with stress. American Psychologist, 41, 813–819.PubMedCrossRefGoogle Scholar
  52. *Senecal, C., Nouwen, A., & White, D. (2000). Motivation and dietary self-care in adults with diabetes: Are self-efficacy and autonomous self-regulation complementary or competing constructs? Health Psychology, 19, 452–457.PubMedCrossRefGoogle Scholar
  53. *Skaff, M. M., Mullan, J. T., Fisher, L., & Chesla, C. A. (2003). A contextual model of control beliefs, behavior, and health: Latino and European Americans with Type 2 diabetes. Psychology & Health, 18, 295–312.CrossRefGoogle Scholar
  54. *Smari, J., & Valtysdottir, H. (1997). Dispositional coping, psychological distress, and disease-control in diabetes. Personality and Individual Differences, 22, 151–156.CrossRefGoogle Scholar
  55. *Spirito, A., Ruggiero, L., Bowen, A., McGarvey, S., Bond, A., & Coustan, D. (1991). Stress, coping, and social support as mediators of the emotional status of women with gestational diabetes. Psychology and Health, 5, 111–120.CrossRefGoogle Scholar
  56. Standley, K., Soule, B., & Copans, S. A. (1979). Dimensions of prenatal anxiety and range of influence on pregnancy outcome. American Journal of Obstetrics and Gynecology, 135, 22–26.PubMedGoogle Scholar
  57. Stanton, A. L, Collins, C. A., & Sworowski, L. A. (2001). Adjustment to chronic illness: Theory and research In A. Baum, T. A. Revenon, & J. S. Singer (Eds.), Handbook of health psychology (pp. 387–403). Mahway, NJ: Erlbaum.Google Scholar
  58. Suls, J, & Fletcher, B. (1985). The relative efficacy of avoidant and nonavoidant coping strategies: A meta-analysis. Health Psychology, 4, 249–288.PubMedCrossRefGoogle Scholar
  59. Taylor, S. E. (1999). Health psychology. Boston: McGraw-Hill.Google Scholar
  60. *Thiagarajan, K. D. (1998). Stress, social support, problem-solving coping, acceptance of diabetes and self-management as predictors of metabolic control and quality of life among adults with insulin-dependent diabetes mellitus. (Doctoral Dissertation, University of Washington, 1998). Dissertation Abstracts International: Section B: The Sciences and Engineering, 59(6-B), pp. 2688. Abstract retrieved September 9, 2004 from PsychInfo Database.Google Scholar
  61. *Townsend, C. O. (2002). Perceived stress, coping and dietary fat intake in rural adolescents: Gender and ethnic differences. (Doctoral Dissertation, Virginia Commonwealth University, 2002). Dissertation Abstracts International: Section B: The Sciences and Engineering, 63(2-B), pp. 1052. Abstract retrieved September 15, 2004 from PsychInfo Database.Google Scholar
  62. *Van Tilburg, M. L., McCaskill, C. C., Lane, J. D., Edwards, C. L., Bethel, A., Feinglos, M. N., Surwit, R. S. (2001). Depressed mood is a factor in glycemic control in Type 1 diabetes. Psychosomatic Medicine, 63, 551–555.Google Scholar
  63. *Wiebe, D. J., Alderfer, M. A., Palmer, S. C., Lindsay, R., & Jarret, L. (1994). Behavioral self-regulation in adolescents with Type I diabetes: Negative affectivity and blood glucose symptom perception. Journal of Consulting and Clinical Psychology, 62, 1204–1212.PubMedCrossRefGoogle Scholar
  64. White, N.E., Richter, J.M., & Fry, C. (1992). Coping, social support and adaptation to chronic illness. Western Journal of Nursing Research, 14, 211–224.PubMedCrossRefGoogle Scholar
  65. *Wright, W. S. (1997). Predicting adolescent adjustment to diabetes mellitus from locus of control and optimism. (Doctoral Dissertation, University of Utah, 1998). Dissertation Abstracts International: Section B: The Sciences and Engineering, 57(10-B), 6609. Abstract retrieved September 7, 2004 from PsychoInfo database.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of NebraskaLincolnUSA
  2. 2.Department of Psychology, College of SciencesSan Diego State UniversitySan DiegoUSA

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