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Diabetes stress and health: Is aging a strength or a vulnerability?


The purpose of this work was to examine (1) relations of diabetes stress to psychological well-being and health, (2) links of age to such outcomes and (3) the extent to which age moderated relations from diabetes stress to outcomes. These aims were addressed in a diverse community sample of 207 individuals recently diagnosed with type 2 diabetes, employing survey and daily diary methods. Participants reported age, diabetes distress, and psychological distress at baseline and 6 months later. Glycemic control also was assessed. Participants completed a 14-day daily diary protocol in which they reported daily diabetes stressors, mood, and self-care. Both cross-sectional and longitudinal results showed diabetes distress was associated with poorer outcomes. Daily diary data showed that individuals who reported more daily diabetes stressors reported poorer outcomes. Older age was linked to less psychological distress, but was unrelated to daily diabetes stressors. Older age attenuated relations of diabetes distress to outcomes.

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  • Berg, C. A., & Upchurch, R. (2007). A developmental-contextual model of couples coping with chronic illness across the adult life span. Psychological Bulletin,133, 920–954.

    Article  Google Scholar 

  • Bolger, N., & Laurenceau, J.-P. (2013). Intensive longitudinal methods: An introduction to diary and experience sampling research. New York: Guilford Press.

    Google Scholar 

  • Carstensen, L. L., Turan, B., Scheibe, S., Ram, N., Ersner-Hershfield, H., Samanez-Larkin, G. R., et al. (2011). Emotional experience improves with age: Evidence based on over 10 years of experience sampling. Psychology and Aging,26, 21–33.

    Article  PubMed  PubMed Central  Google Scholar 

  • Centers for Disease Control and Prevention. (2017a). National Diabetes Statistics Report, 2017. Atlanta, GA: Center for Disease Control and Prevention, US Department of Health and Human Services.

  • Centers for Disease Control and Prevention. (2017b). Long-term Trends in Diabetes. Centers for Disease Control and Prevention’s Division of Diabetes Translation.

  • Charles, S. T. (2010). Strength and vulnerability integration: A model of emotional well-being across adulthood. Psychological Bulletin,136, 1068–1091.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior,24, 385–396.

    Article  CAS  Google Scholar 

  • Diener, E., Emmons, R., Larsen, R., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment,49, 71–75.

    Article  CAS  Google Scholar 

  • English, T., & Carstensen, L. (2016). Socioemotional selectivity theory. In N. Pachana (Ed.), Encyclopedia of geropsychology. Singapore: Springer.

    Google Scholar 

  • Fisher, L., Mullan, J. T., Arean, P., Glasgow, R. E., Hessler, D., & Masharani, U. (2010). Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care,33, 23–28.

    Article  Google Scholar 

  • Fisher, L., Polonsky, W. H., Hessler, D. M., Masharani, U., Blumer, I., Peters, A. L., et al. (2015). Understanding the sources of diabetes distress in adults with type 1 diabetes. Journal of Diabetes and Its Complications,29, 572–577.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gonzalez, J. S., Shreck, E., Psaros, C., & Safren, S. A. (2015). Distress and type 2 diabetes-treatment adherence: A mediating role for perceived control. Health Psychology,34, 505–513.

    Article  PubMed  Google Scholar 

  • Helgeson, V. S., Jakubiak, B., Van Vleet, M., & Zajdel, M. (2018). Communal coping and adjustment to chronic illness: Theory update and evidence. Personality and Social Psychology Review,22, 170–195.

    Article  Google Scholar 

  • Helgeson, V. S., Naqvi, J. B., Seltman, H., Vaughn, A. K., Korytkowski, M., Hausmann, L.R.M., & Gary-Webb, T. L. (in press). Links of communal coping to relationship and psychological health in type 2 diabetes: Actor-partner interdependence models involving role, sex, and race Annals of Behavioral Medicine.

  • Hessler, D. M., Fisher, L., Mullan, J. T., Glasgow, R. E., & Masharani, U. (2011). Patient age: A neglected factor when considering disease management in adults with type 2 diabetes. Patient Education and Counseling,85, 154–159.

    Article  PubMed  Google Scholar 

  • Hilliard, M. E., Yi-Frazier, J. P., Hessler, D. M., Butler, A. M., Anderson, B. J., & Jaser, S. (2016). Stress and a1c among people with diabetes across the lifespan. Current Diabetes Reports,16, 67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Morisky, D. E., Green, L. W., & Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care,24, 67–74.

    Article  CAS  Google Scholar 

  • Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J. T., et al. (2005). Assessing psychosocial distress in diabetes. Diabetes Care,28, 626–631.

    Article  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement,1, 385–401.

    Article  Google Scholar 

  • Schilling, O. K., & Diehl, M. (2014). Reactivity to stressor pile-up in adulthood: Effects on daily negative and positive affect. Psychology and Aging,29, 72–83.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stawski, R. S., Scott, S. B., Zawadzki, M. J., Sliwinski, M. J., Marcusson-Clavertz, D., Kim, J., et al. (2019). Age differences in everyday stressor-related negative affect: A coordinated analysis. Psychology and Aging,34, 91–105.

    Article  PubMed  Google Scholar 

  • Talbot, F., Nouwen, A., Gingras, J., Gosselin, M., & Audet, J. (1997). The assessment of diabetes-related cognitive and social factors: The multidimensional diabetes questionnaire. Journal of Behavioral Medicine,20, 291–311.

    Article  CAS  Google Scholar 

  • Tanenbaum, M. L., Ritholz, M. D., Binko, D. H., Baek, R. N., Shreck, M. S. E., & Gonzalez, J. S. (2013). Probing for depression and finding diabetes: A mixed-methods analysis of depression interviews with adults treated for type 2 diabetes. Journal of Affective Disorders,150, 533–539.

    Article  PubMed  PubMed Central  Google Scholar 

  • Toobert, D. J., & Glasgow, R. E. (1994). Assessing diabetes self-management: The summary of diabetes self-care activities questionnaire (Unpublished doctoral dissertation). Eugene, Oregon.

  • Usala, P. D., & Hertzog, C. (1989). Measurement of affective states in adults. Evaluation of an adjective rating scale instrument. Research on Aging,11, 403–426.

    Article  CAS  Google Scholar 

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We are grateful to Pamela Snyder for her overall management of the project and the data to Courtney Armstrong, Emma Bright, Shaquille Charles, Gianna Davis, Aarohee Fulay, Tiona Jones, Katilyn Mascatelli, Jennifer Melynk, Jeanean Naqvi, and Charis Vanderpuye for interviewing the participants and to the participants who so graciously gave their time to this study. Portions of these data were presented at the 2019 Society of Behavioral Medicine conference.


This research was supported by National Institutes of Health R01 DK095780 and received assistance from the University of Pittsburgh Clinical and Translational Science Institute, which is supported by the National Institutes of Health Grant UL1TR000005.

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Correspondence to Vicki S. Helgeson.

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Vicki S. Helgeson, Meredith Van Vleet, Melissa Zajdel declare that they have no conflict of interest.

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Helgeson, V.S., Van Vleet, M. & Zajdel, M. Diabetes stress and health: Is aging a strength or a vulnerability?. J Behav Med 43, 426–436 (2020).

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