The Role of Affect and Coping in Diabetes Self-Management in Rural Adults with Uncontrolled Diabetes and Depressive Symptoms

  • Shannon R. MilesEmail author
  • Tasneem Khambaty
  • Nancy J. Petersen
  • Aanand D. Naik
  • Jeffrey A. Cully


Many patients with diabetes have poorly controlled blood sugar levels and remain at risk for serious diabetes complications, despite access to effective diabetes treatments and services. Using the transactional model of stress and coping framework, the study investigated the contributions of affect (Positive and Negative Affect Schedule) and coping (maladaptive and adaptive coping from the Brief Cope) on diabetes self-management behaviors, namely diet and exercise. One hundred seventy-eight rural adults with uncontrolled diabetes and moderate depressive symptoms completed the measures. Multiple regression analyses demonstrated that positive affect and negative affect were significantly associated with diet and exercise, even after adjusting for diabetes severity, illness intrusiveness, and diabetes knowledge. However, two path analyses clarified that adaptive coping mediated the relationships between affect (positive and negative) and self-management behaviors (diet and exercise). Comprehensive diabetes treatments that include self-management support can assist patients in recognition and use of adaptive emotion-focused coping skills.


Rural Diabetes Affect Coping 



The authors would like to thank Sonora Hudson, medical writer, for her thoughtful editing of the manuscript. The Healthy Outcomes through Patient Empowerment (HOPE) study is supported by an Investigator-Initiated Research Grant from the VA Health Services Research and Development Research Service Line (IIR 10-135). This research is partial supported by resources and facilities of the Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413), Office of Academic Affiliations VA Advanced Fellowship Program in Mental Illness Research and Treatment, and the Department of Veterans Affairs South Central Mental Illness Research Education and Clinical Center (MIRECC). The views expressed reflect those of the authors and not necessarily the policy or position of the Department of Veterans Affairs, the US government, or Baylor College of Medicine. None of these bodies played a role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Compliance with Ethical Standards

Conflict of interest

Dr. Shannon R. Miles, Tasneem Khambaty, and Nancy J. Petersen declare that they have no conflicts of interest. Drs. Aanand D. Naik and Jeffrey A. Cully jointly received an Investigator-Initiated Research Grant from the VA Health Services Research and Development Research Service Line (IIR 10–135).

Research Involving with Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments, or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply  2018

Authors and Affiliations

  • Shannon R. Miles
    • 1
    • 2
    • 3
    Email author
  • Tasneem Khambaty
    • 4
    • 5
  • Nancy J. Petersen
    • 4
    • 6
  • Aanand D. Naik
    • 4
    • 6
  • Jeffrey A. Cully
    • 3
    • 4
    • 7
  1. 1.Health Service Research and Development Center of Innovation on Disability and Rehabilitation Research (CINDRR)James A. Haley Veterans’ HospitalTampaUSA
  2. 2.Department of Psychiatry & Behavioral Neurosciences, Morsani College of MedicineUniversity of South FloridaTampaUSA
  3. 3.VA South Central Mental Illness Research, Education and Clinical CenterMichael E DeBakey VA Medical Center (MEDVAMC 152)HoustonUSA
  4. 4.VA HSR&D Houston Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical Center (MEDVAMC 152)HoustonUSA
  5. 5.Department of PsychologyIndiana University-Purdue University Indianapolis (IUPUI)IndianapolisUSA
  6. 6.Department of MedicineBaylor College of MedicineHoustonUSA
  7. 7.Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonUSA

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