title: Social orientation and diabetes-related distress in Japanese and American patients with type 2 diabetes.
abstract: OBJECTIVE
  Recent evidence in cultural and social psychology suggests Eastern cultures' emphasis on harmony and connection with others and Western cultures' emphasis on self-direction and autonomy. In Eastern society, relational harmony is closely linked to people's well-being. The impact of this cultural and social orientation on diabetes-related distress was investigated.
  
  
  METHODS
  Japanese and American patients with type 2 diabetes were surveyed by well-established questionnaire in Japan and in the United States, respectively. The association of personal values for interdependence, perceived emotional support, and the Problem Areas in Diabetes scale (PAID) were analyzed.
  
  
  RESULTS
  A positive correlation between interdependence and PAID (r = 0.18; P = 0.025) and a negative correlation between perceived emotional support and PAID (r = - 0.24; P = 0.004) were observed after adjustments for other factors in Japanese data (n = 149), but not in American data (r = 0.00; P = 0.990, r = 0.02; P = 0.917, respectively, n = 50). In Japanese data, the three-factor structure of PAID (negative feelings about total life with diabetes, about living conditions with diabetes, and about treatment of diabetes) was identified, and interdependence showed significant positive correlations with the first and second factors and perceived emotional support showed significant negative correlations with all three factors of PAID.
  
  
  CONCLUSIONS
  These results suggest that personal values for interdependence may be linked to the level of diabetes-related distress and that the distress may be relieved by perception of emotional support, especially in an interdependent cultural context.
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Nankoku-shi Kochi, Japan.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Fujimoto
authors.affiliation: Department of Psychology, University of Delaware, Newark, DE, United States of America.
authors.forename: Beth
authors.initials: B
authors.lastname: Morling
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shiho
authors.initials: S
authors.lastname: Ayano-Takahara
authors.affiliation: Department of Psychology, University of Delaware, Newark, DE, United States of America.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Carroll
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Harashima
authors.affiliation: Kokoro Research Center, Kyoto University, Kyoto, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Uchida
authors.affiliation: Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Nobuya
authors.initials: N
authors.lastname: Inagaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D003431:Cross-Cultural Comparison; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States; D044465:White People