Psychological Reporfs, 1991, 68, 623-632. O Psychological Reports 1991
ASSESSMENT O F COPING STRATEGIES, SOCIAL SUPPORT, AND GENERAL HEALTH STATUS IN INDIVIDUALS WITH DIABETES MELLITUS ' SHARON HANCHER KVAM
JOHN S. LYONS
Northwestern Memorial Hospital Diabetes Center
Northwestern University Medical School
Summary.-This study examined 5 1 individuals (30 men, 21 women) who participated in an outpatient diabetes education program. Participants with higher perceived support by friends and problem-solving coping strategies were healthier, while chose exhibiting a wish-fdillrnent coping style were less healthy. Perceived family social support was much greater for Type I1 (noninsulin.dependent) individuals than for Type I (insulrn-dependent) individuals. Men perceived grearer family support, were more likely to use problem-solving coping, and were healther than women; however, both wish fulfillment and detachment coping were more prevalent in women. Perceived support from family and friends increased with education. Implications for diabetes education programs are also introduced.
Coping is generally viewed as a process, not an isolated set of independent actions (Weisman, 1979). Under Lazarus' cognitive-phenomenological definition a reciprocal relationshp between the person and the environment is acknowledged, in which each affects and in turn is affected by the other (Lazarus, 1966; Lazarus & Launier, 1978; Lazarus & Folkman, 1984). In groups other than diabetics, coping, social support, and life stress have been important aspects of well-being (Doerfler & Richards, 1981). Coyne, Aldwin, and Lazarus (1981) reported that depressed persons tended to require more information before acting on situations and were more likely to seek informational or emotional suppbrt and to exhibit wishful thinking. The relationship between coping and responsiveness to life stress has also been studied in normal populations (Andrews, Tennant, Hewson, & Schonell, 1978; Billings & Moos, 1982; Folkman & Lazarus, 1980), persons with cancer (Maury, 1982; Weisman & Worden, 1975), elderly individuals (Aldrich & Mendkoff, 1963), and those with hypertension (Weiner, Singer, & Reiser, 1962; Harburg, Blakelock, & Roeper, 1979; Sapira, Scheib, Moriarty, & Shapiro, 1971). Much of the diabetes literature focuses on the psychological aspects of diabetes, looking at the disease's effect on marriage and family (Ahlfield, Soler, & Marcus, 1985; Newbrough, Simpkins, & Maurer, 1985; Pond, 1979), possible psychological precipitants (Hauser & PoIIets, 1979), and how the psychosocial environment may affect the course of the dness (Grant, Kyle, Teichman, & Mendels, 1974; Hinkle & Wolf, 1952; Holmes & 'We gratefully acknowledge the assistance of Dr. Mark Molitch and staff of the Diabetes Center. Correspondence concerning this article should be addressed to Sharon Hancher Kvam, 3308 Noyes Street, Evanston, IL 60201.
624
S. H. KVAM & J. S. LYONS
Masuda, 1974). Several studies have addressed coping with diabetes, but these involve children or measurements different from this study's tools. For example, Gross and Johnson (1981) developed the Diabetes Assertiveness Test to measure social coping skills in preadolescent diabetics, finding that the diabetic youths in their study showed deficiencies on a number of components of social skills. Linn, Skyler, Linn, Edelstein, and Sandifer (1985) studied insulin-dependent diabetics with regard to styles of coping with stress and metabolic control. Their findings suggested that self-controlling behaviors might be enhanced, and angerlflight stress reactions to stress be reduced, through self-management programs that reinforce and model successful coping styles. Another study was designed to assess children's psychological adjustment and coping strategies during their first year of insulin-dependent diabetes meltitus (Kovacs, Brent, Steinberg, Paulauskas, & Reid, 1986). Research also exists that stresses the importance of social relationships in mediation of health outcomes. There are a number of empirical studies in which low social support is implicated in negative health outcomes for complications of pregnancy (Nuckolls, Cassel, & Kaplan, 1972), neurosis (Henderson, Byrne, Duncan-Jones, Adcock, Scott, & Steele, 1978), and mortality from all causes (Berkman & Magnusson, 1979). The goal of this study was to analyze how diabetics' coping strategies and perceptions of social support influence their general health status. If patterns can be identified, then implications for future interventions can be realized.
Subjects
Subjects with both Type I (insulin-dependent) and Type I1 (noninsulin-dependent) classifications of Diabetes Mellitus were represented. Table 1 presents demographic characteristics of the subjects. The sample of 51 consisted of 30 men (59%) and 21 women (41%). The age range of the subjects was 17 to 78 years, with a mean age of 49.0 (SD= 16). The sample was composed of white (63%), black (21%), Hispanic (4%), Oriental (2%), and unknown (10%). While 18% ((n = 9) of the group earned less than $10,000 per year, over half of the part~cipantsearned more than $25,000 annually. Over half of the sample (n = 27) were married, with a majority of subjects having at least earned a high school diploma. Fifty-seven percent (n = 29) were insulin-dependent, while 29% (n = 15) were noninsdn-dependent, controlling their diabetes through oral hypoglycemic agents. The remaining 14% (n = 7), neither insulin or noninsulin dependent, utilized diet to control diabetes. Average age of dlabetes onset was 41.1, with the average subject having been diagnosed with diabetes for approximately eight years. Nearly two-thirds of the subjects had family members with diabetes.
625
COPING, SUPPORT, HEALTH STATUS IN DIABETES TABLE 1 DEMOGRAPHIC CHARACTEIUSTICS OF SAMPLE Variable
%
n
Sex Men Women Race White Black Hispanic Oriental Unknown Marital Status Single Married Divorced Unknown (not furnished)
Variable
n
%
9 2 5 3 14 14
18
Annual Income 30 21
59 41
32 11 2 1 5
63 21 4 2 10
16 27 7 1
32 54 14 2
Variable
< $10,000 $10,001-$15,000 $15,001-$20,000 $20,001-$25,000 $25,001-$50,000 $50,000 +
n
4 10 6 27 27
%
Education Graduate School College Graduate Associate/Technical Degree High School Graduate Some Hlgh School Unknown Diabetes Classification Type I (insulin-dependent) Type I1 (noninsulin-dependent) Neither (diet controlled) Diabetes Familial Relationship Diabetic Family Member(s) No Diabetic Family Member(s) Unknown
Procedure Subjects were participants in an outpatient diabetes education program at The Diabetes Center of Northwestern Memorial Hospital. An endocrinologist, nurse practitioner, dietician, physical therapist, occupational therapist, and social worker formed the multidisciplinary staff. The two-day educational program first consisted of an assessment of the patient's diabetes, utilizing a medical history, physical examinations, and appropriate laboratory tests. An assessment of educational needs then was conducted. These needs were then addressed through group discussions, lectures, and individual instruction. The staff provided a final set of recommendations to participants and their physicians for further follow-up. Family members and/or friends
626
S. H. KVAM & J. S. LYONS
were encouraged to attend with the participant to foster greater understanding of diabetes and support for the diabetic participant. Upon completion of the education program, one of the principal staff members (physician, nurse practitioner, or dietician) administered the questionnaires used in this study. No time limit was imposed on the participants. Participants who did not fully complete the questionnaires were excluded from the study. All participants were informed of this study and were assured that data would remain confidential. Measures Ways of Coping.-Participants completed the Folkman-Lazarus Ways of Coping Checklist-Revised (Folkman & Lazarus, 1980). Participants were asked to answer the checklist with respect to their diabetes so the thoughts and behaviors uthzed to deal with diabetes could be assessed. Items on the checklist represent seven scales: Problem-focus ("made a plan of action and followed it"), Wishful Thinking ("wished you could change the situation"), Detachment ("refused to believe it happened"), Seeks Social Support ("talked to others and accepted their sympathy"), Positive/Growth ("changed or grew as a person in a good way"), Blamed Self ("felt responsible for the problem"), TenseIMinimize Threat ("making light of the situation"). Perceived Social Support.-The Perceived Social Support measure (Procidano & Heller, 1983) assessed participants' perceptions of support, information and feedback from both friends and family. The distinction between friends' support (PSS-Fr) and family support (PSS-Fa) is made with this measure and is important, given that individuals rely on friends and family to different extents (Procidano & Heller, 1983, p. 2). General Well-being Schedule.-The Rand Health Insurance Study-General Well-being Schedule was also administered (Brook, Ware, Davies-Avery, Stewart, Donald, Rogers, Williams, & Johnston, 1979). The schedule scores were correlated with scores from both the Ways of Coping Checklist and the Perceived Social Support scale to examine the association of diabetics' coping strategies and social support with their general health status. RESULTS Effects of Ways of Coping Checklist on General Well-being A multiple regression analysis (mean deviation = 24.9, df = 40, p = ,002) was performed to compare participants' Ways of Coping and Perceived Social Support measures to their General Well-being indexes. Tables 2 and 3 summarize the results. Of the eight factors, problem-solving coping had the most significant impact on general well-being (r = ,344). General well-being was higher in subjects utilizing problem-solving coping than in subjects who fantasized about their diabetes. A negative correlation between wish-fulfillment coping strategy and general well-being was confirmed (r = -.357).
COPING, SUPPORT, HEALTH STATUS IN DIABETES TABLE 2 CORRELATION WTRM: WAYSOF COPING, PERCENED FRIENDS' A N D FAMILY SUPPORT TO WELL-BEING Problem-focused \V~sh-fulfillment Detachment Social Support-seeking Positive Focus
0.34 -0.36 -0.14 0.05 0.22
Blames Self Tense/Minimize Threat Perceived Family Support Petceived Friends' Support
-0.004 -0.15 0.29 0.42
Self-blame and social support-seeking factors had virtually no effect on well-being: rs of -.004 and .046, respectively. The analysis also showed a slight correlation between positive-focus coping and well-being (r = .22) and a slight negative correlation between self-coping and well-being (r = -.272). TABLE 3 CORRUA~O MATRIX: N WAYSOP COPINGTO PERCEIVED FAMILY AND FRIENDSUPPORT Coping Strategy Problem-focused Wish-fulfillment Detachment Social Support-seeking Positive Focus Blames Self Tense/Minirnize Threat
Perceived Support Family Friend 0.18 -0.02 -0.36 0.17 0.16 0.06 -0.08
0.18 -0.12 -0.09 0.25 0.23 0.10 0.15
Effects of Coping on Perceived Family and Friends' Social Support There was no relationship between problem-solving coping strategies and perceived social support by family and friends. However, subjects who used a detached coping style were less likely to perceive support from their families. No significant association was found between self-blame coping methods and perceived farnily or friends' support. This was consistent throughout the research, as self-blame had no over-all effect on perceived family or friend social support or general well-being.
Effects of Perceived Social Support on Well-being There were no differences between perceived support from family
(M = 14.0, SD = 5.1) and friends (M = 13.6, SD = 4.4). However, there was a significantly higher correlation with general well-being from perceived friends' support (r = .422) than from perceived family support (r = .288). The correlation between friend support and family support was relatively low (r = .20). Participants believed they received support from either friends or family but not necessarily from both.
628
S. H. KVAM & J. S. LYONS
Effect of Type I and Type I1 Diabetes on Perceived Social Support and General Well-being Perceived family social support was much greater for Type I1 (noninsulin-dependent) participants (M = 17, SD = 3.5) than for Type I (insulin-dependent) participants (M = 12.4, SD = 4.5). Diabetics who controlled their diabetes through diet only fell in the middle (M = 14 and SD = 7.6). I and Type I1 diabetics perceived the same amount of Both friends' social support (M = 13.1, SD = 4.2 and M = 13.1, SD = 5.1, respectively), while diet-controlled diabetics perceived greater support from their friends (M = 16.7, SD = 2.3). Type I1 diabetics scored much higher on wellbeing (M = 171.3, SD = 24.4) than did Type I diabetics (M = 156.4, SD = 29.2).
~~~e
Gender Table 4 summarizes these results. Men perceived greater support from family (M = 14.9, SD = 4.8), while women reported more support from friends (M= 16.8, SD = 3.2). Men reported being healthier than the women, with the men's well-being mean at 166.2 (SD = 27.4) and the women's at 156.8 (SD = 35.2). TABLE 4
PERCEIVED FAMILY AND FRIENDS' SOCIALSUPWRTA N D GENERAL WELL-BEING Measure n Perceived Family Support M SD Perceived Friends' Support M SD General Well-being M SD
Men
Women
Total Group
30
21
51
15.0 4.8
13.0 5.4
14.0 5.1
11.3 5.1
16.8 3.2
13.6 4.4
166.2 27.4
156.8 35.2
162.3 27.4
Men were slightly more likely to utilize problem-focused coping (M = 18.4, SD=6.4) than the women (M= 17.6, SD=5.2). However, women scored higher on wish fulfillment (M = 6.3, SD = 4.0) and detachment (M = 6.0, SD = 3.8) coping strategies than men (M = 4.6, SD = 3.2 and M = 4.8, SD = 3.2, respectively). There were no significant differences between men and women on the remaining factors. Education Education was categorized into three groups to make possible use of larger cells (Table 5). Analysis of perceived social support scores indicated no
629
COPING, SUPPORT, HEALTH STATLJS IN DIABETES
significant difference between perceived family and friends' support and education. However, college-educated subjects yielded a higher well-being score (M = 172.6, SD = 27.6) than those who graduated from high school and/or technical school (M = 153, SD = 32.1) or who did not graduate from high school at all (M = 163.6, SD = 27.9). Perceived family and friends' social support scores increased with education. The better educated the person, the more social support perceived from family and friends. TABLE 5 RELATIONSHIP OF FAMUYINCOME AND EDUCATION T O PERCEIVED SUPPORTAND WELL-BEING Measure
Perceived Suooort Friend Social M SD M SD L a
General well-being M
SD
Family Income
ASSESSMENT O F COPING STRATEGIES, SOCIAL SUPPORT, AND GENERAL HEALTH STATUS IN INDIVIDUALS WITH DIABETES MELLITUS ' SHARON HANCHER KVAM
JOHN S. LYONS
Northwestern Memorial Hospital Diabetes Center
Northwestern University Medical School
Summary.-This study examined 5 1 individuals (30 men, 21 women) who participated in an outpatient diabetes education program. Participants with higher perceived support by friends and problem-solving coping strategies were healthier, while chose exhibiting a wish-fdillrnent coping style were less healthy. Perceived family social support was much greater for Type I1 (noninsulin.dependent) individuals than for Type I (insulrn-dependent) individuals. Men perceived grearer family support, were more likely to use problem-solving coping, and were healther than women; however, both wish fulfillment and detachment coping were more prevalent in women. Perceived support from family and friends increased with education. Implications for diabetes education programs are also introduced.
Coping is generally viewed as a process, not an isolated set of independent actions (Weisman, 1979). Under Lazarus' cognitive-phenomenological definition a reciprocal relationshp between the person and the environment is acknowledged, in which each affects and in turn is affected by the other (Lazarus, 1966; Lazarus & Launier, 1978; Lazarus & Folkman, 1984). In groups other than diabetics, coping, social support, and life stress have been important aspects of well-being (Doerfler & Richards, 1981). Coyne, Aldwin, and Lazarus (1981) reported that depressed persons tended to require more information before acting on situations and were more likely to seek informational or emotional suppbrt and to exhibit wishful thinking. The relationship between coping and responsiveness to life stress has also been studied in normal populations (Andrews, Tennant, Hewson, & Schonell, 1978; Billings & Moos, 1982; Folkman & Lazarus, 1980), persons with cancer (Maury, 1982; Weisman & Worden, 1975), elderly individuals (Aldrich & Mendkoff, 1963), and those with hypertension (Weiner, Singer, & Reiser, 1962; Harburg, Blakelock, & Roeper, 1979; Sapira, Scheib, Moriarty, & Shapiro, 1971). Much of the diabetes literature focuses on the psychological aspects of diabetes, looking at the disease's effect on marriage and family (Ahlfield, Soler, & Marcus, 1985; Newbrough, Simpkins, & Maurer, 1985; Pond, 1979), possible psychological precipitants (Hauser & PoIIets, 1979), and how the psychosocial environment may affect the course of the dness (Grant, Kyle, Teichman, & Mendels, 1974; Hinkle & Wolf, 1952; Holmes & 'We gratefully acknowledge the assistance of Dr. Mark Molitch and staff of the Diabetes Center. Correspondence concerning this article should be addressed to Sharon Hancher Kvam, 3308 Noyes Street, Evanston, IL 60201.
624
S. H. KVAM & J. S. LYONS
Masuda, 1974). Several studies have addressed coping with diabetes, but these involve children or measurements different from this study's tools. For example, Gross and Johnson (1981) developed the Diabetes Assertiveness Test to measure social coping skills in preadolescent diabetics, finding that the diabetic youths in their study showed deficiencies on a number of components of social skills. Linn, Skyler, Linn, Edelstein, and Sandifer (1985) studied insulin-dependent diabetics with regard to styles of coping with stress and metabolic control. Their findings suggested that self-controlling behaviors might be enhanced, and angerlflight stress reactions to stress be reduced, through self-management programs that reinforce and model successful coping styles. Another study was designed to assess children's psychological adjustment and coping strategies during their first year of insulin-dependent diabetes meltitus (Kovacs, Brent, Steinberg, Paulauskas, & Reid, 1986). Research also exists that stresses the importance of social relationships in mediation of health outcomes. There are a number of empirical studies in which low social support is implicated in negative health outcomes for complications of pregnancy (Nuckolls, Cassel, & Kaplan, 1972), neurosis (Henderson, Byrne, Duncan-Jones, Adcock, Scott, & Steele, 1978), and mortality from all causes (Berkman & Magnusson, 1979). The goal of this study was to analyze how diabetics' coping strategies and perceptions of social support influence their general health status. If patterns can be identified, then implications for future interventions can be realized.
Subjects
Subjects with both Type I (insulin-dependent) and Type I1 (noninsulin-dependent) classifications of Diabetes Mellitus were represented. Table 1 presents demographic characteristics of the subjects. The sample of 51 consisted of 30 men (59%) and 21 women (41%). The age range of the subjects was 17 to 78 years, with a mean age of 49.0 (SD= 16). The sample was composed of white (63%), black (21%), Hispanic (4%), Oriental (2%), and unknown (10%). While 18% ((n = 9) of the group earned less than $10,000 per year, over half of the part~cipantsearned more than $25,000 annually. Over half of the sample (n = 27) were married, with a majority of subjects having at least earned a high school diploma. Fifty-seven percent (n = 29) were insulin-dependent, while 29% (n = 15) were noninsdn-dependent, controlling their diabetes through oral hypoglycemic agents. The remaining 14% (n = 7), neither insulin or noninsulin dependent, utilized diet to control diabetes. Average age of dlabetes onset was 41.1, with the average subject having been diagnosed with diabetes for approximately eight years. Nearly two-thirds of the subjects had family members with diabetes.
625
COPING, SUPPORT, HEALTH STATUS IN DIABETES TABLE 1 DEMOGRAPHIC CHARACTEIUSTICS OF SAMPLE Variable
%
n
Sex Men Women Race White Black Hispanic Oriental Unknown Marital Status Single Married Divorced Unknown (not furnished)
Variable
n
%
9 2 5 3 14 14
18
Annual Income 30 21
59 41
32 11 2 1 5
63 21 4 2 10
16 27 7 1
32 54 14 2
Variable
< $10,000 $10,001-$15,000 $15,001-$20,000 $20,001-$25,000 $25,001-$50,000 $50,000 +
n
4 10 6 27 27
%
Education Graduate School College Graduate Associate/Technical Degree High School Graduate Some Hlgh School Unknown Diabetes Classification Type I (insulin-dependent) Type I1 (noninsulin-dependent) Neither (diet controlled) Diabetes Familial Relationship Diabetic Family Member(s) No Diabetic Family Member(s) Unknown
Procedure Subjects were participants in an outpatient diabetes education program at The Diabetes Center of Northwestern Memorial Hospital. An endocrinologist, nurse practitioner, dietician, physical therapist, occupational therapist, and social worker formed the multidisciplinary staff. The two-day educational program first consisted of an assessment of the patient's diabetes, utilizing a medical history, physical examinations, and appropriate laboratory tests. An assessment of educational needs then was conducted. These needs were then addressed through group discussions, lectures, and individual instruction. The staff provided a final set of recommendations to participants and their physicians for further follow-up. Family members and/or friends
626
S. H. KVAM & J. S. LYONS
were encouraged to attend with the participant to foster greater understanding of diabetes and support for the diabetic participant. Upon completion of the education program, one of the principal staff members (physician, nurse practitioner, or dietician) administered the questionnaires used in this study. No time limit was imposed on the participants. Participants who did not fully complete the questionnaires were excluded from the study. All participants were informed of this study and were assured that data would remain confidential. Measures Ways of Coping.-Participants completed the Folkman-Lazarus Ways of Coping Checklist-Revised (Folkman & Lazarus, 1980). Participants were asked to answer the checklist with respect to their diabetes so the thoughts and behaviors uthzed to deal with diabetes could be assessed. Items on the checklist represent seven scales: Problem-focus ("made a plan of action and followed it"), Wishful Thinking ("wished you could change the situation"), Detachment ("refused to believe it happened"), Seeks Social Support ("talked to others and accepted their sympathy"), Positive/Growth ("changed or grew as a person in a good way"), Blamed Self ("felt responsible for the problem"), TenseIMinimize Threat ("making light of the situation"). Perceived Social Support.-The Perceived Social Support measure (Procidano & Heller, 1983) assessed participants' perceptions of support, information and feedback from both friends and family. The distinction between friends' support (PSS-Fr) and family support (PSS-Fa) is made with this measure and is important, given that individuals rely on friends and family to different extents (Procidano & Heller, 1983, p. 2). General Well-being Schedule.-The Rand Health Insurance Study-General Well-being Schedule was also administered (Brook, Ware, Davies-Avery, Stewart, Donald, Rogers, Williams, & Johnston, 1979). The schedule scores were correlated with scores from both the Ways of Coping Checklist and the Perceived Social Support scale to examine the association of diabetics' coping strategies and social support with their general health status. RESULTS Effects of Ways of Coping Checklist on General Well-being A multiple regression analysis (mean deviation = 24.9, df = 40, p = ,002) was performed to compare participants' Ways of Coping and Perceived Social Support measures to their General Well-being indexes. Tables 2 and 3 summarize the results. Of the eight factors, problem-solving coping had the most significant impact on general well-being (r = ,344). General well-being was higher in subjects utilizing problem-solving coping than in subjects who fantasized about their diabetes. A negative correlation between wish-fulfillment coping strategy and general well-being was confirmed (r = -.357).
COPING, SUPPORT, HEALTH STATUS IN DIABETES TABLE 2 CORRELATION WTRM: WAYSOF COPING, PERCENED FRIENDS' A N D FAMILY SUPPORT TO WELL-BEING Problem-focused \V~sh-fulfillment Detachment Social Support-seeking Positive Focus
0.34 -0.36 -0.14 0.05 0.22
Blames Self Tense/Minimize Threat Perceived Family Support Petceived Friends' Support
-0.004 -0.15 0.29 0.42
Self-blame and social support-seeking factors had virtually no effect on well-being: rs of -.004 and .046, respectively. The analysis also showed a slight correlation between positive-focus coping and well-being (r = .22) and a slight negative correlation between self-coping and well-being (r = -.272). TABLE 3 CORRUA~O MATRIX: N WAYSOP COPINGTO PERCEIVED FAMILY AND FRIENDSUPPORT Coping Strategy Problem-focused Wish-fulfillment Detachment Social Support-seeking Positive Focus Blames Self Tense/Minirnize Threat
Perceived Support Family Friend 0.18 -0.02 -0.36 0.17 0.16 0.06 -0.08
0.18 -0.12 -0.09 0.25 0.23 0.10 0.15
Effects of Coping on Perceived Family and Friends' Social Support There was no relationship between problem-solving coping strategies and perceived social support by family and friends. However, subjects who used a detached coping style were less likely to perceive support from their families. No significant association was found between self-blame coping methods and perceived farnily or friends' support. This was consistent throughout the research, as self-blame had no over-all effect on perceived family or friend social support or general well-being.
Effects of Perceived Social Support on Well-being There were no differences between perceived support from family
(M = 14.0, SD = 5.1) and friends (M = 13.6, SD = 4.4). However, there was a significantly higher correlation with general well-being from perceived friends' support (r = .422) than from perceived family support (r = .288). The correlation between friend support and family support was relatively low (r = .20). Participants believed they received support from either friends or family but not necessarily from both.
628
S. H. KVAM & J. S. LYONS
Effect of Type I and Type I1 Diabetes on Perceived Social Support and General Well-being Perceived family social support was much greater for Type I1 (noninsulin-dependent) participants (M = 17, SD = 3.5) than for Type I (insulin-dependent) participants (M = 12.4, SD = 4.5). Diabetics who controlled their diabetes through diet only fell in the middle (M = 14 and SD = 7.6). I and Type I1 diabetics perceived the same amount of Both friends' social support (M = 13.1, SD = 4.2 and M = 13.1, SD = 5.1, respectively), while diet-controlled diabetics perceived greater support from their friends (M = 16.7, SD = 2.3). Type I1 diabetics scored much higher on wellbeing (M = 171.3, SD = 24.4) than did Type I diabetics (M = 156.4, SD = 29.2).
~~~e
Gender Table 4 summarizes these results. Men perceived greater support from family (M = 14.9, SD = 4.8), while women reported more support from friends (M= 16.8, SD = 3.2). Men reported being healthier than the women, with the men's well-being mean at 166.2 (SD = 27.4) and the women's at 156.8 (SD = 35.2). TABLE 4
PERCEIVED FAMILY AND FRIENDS' SOCIALSUPWRTA N D GENERAL WELL-BEING Measure n Perceived Family Support M SD Perceived Friends' Support M SD General Well-being M SD
Men
Women
Total Group
30
21
51
15.0 4.8
13.0 5.4
14.0 5.1
11.3 5.1
16.8 3.2
13.6 4.4
166.2 27.4
156.8 35.2
162.3 27.4
Men were slightly more likely to utilize problem-focused coping (M = 18.4, SD=6.4) than the women (M= 17.6, SD=5.2). However, women scored higher on wish fulfillment (M = 6.3, SD = 4.0) and detachment (M = 6.0, SD = 3.8) coping strategies than men (M = 4.6, SD = 3.2 and M = 4.8, SD = 3.2, respectively). There were no significant differences between men and women on the remaining factors. Education Education was categorized into three groups to make possible use of larger cells (Table 5). Analysis of perceived social support scores indicated no
629
COPING, SUPPORT, HEALTH STATLJS IN DIABETES
significant difference between perceived family and friends' support and education. However, college-educated subjects yielded a higher well-being score (M = 172.6, SD = 27.6) than those who graduated from high school and/or technical school (M = 153, SD = 32.1) or who did not graduate from high school at all (M = 163.6, SD = 27.9). Perceived family and friends' social support scores increased with education. The better educated the person, the more social support perceived from family and friends. TABLE 5 RELATIONSHIP OF FAMUYINCOME AND EDUCATION T O PERCEIVED SUPPORTAND WELL-BEING Measure
Perceived Suooort Friend Social M SD M SD L a
General well-being M
SD
Family Income
