title: A dyadic multiple mediation model of patient and spouse stressors predicting patient dietary and exercise adherence via depression symptoms and diabetes self-efficacy.
abstract: Using dyadic data from 117 married couples in which one partner was diagnosed with Type 2 diabetes, the purpose of this study was to determine whether a number of specific patient and spouse stressors (chronic life stress, diabetes-specific stress, and physical health stress in the form of the number of comorbidities) were associated with Type 2 diabetes patients' dietary and exercise adherence through two potentially modifiable patient and spouse factors-depression symptoms and diabetes self-efficacy. We found that patient and spouse stressors, particularly patient and spouse diabetes stress and the number of patient comorbidities, were related to patient dietary and exercise adherence through patient depression symptoms and both patient and spouse diabetes self-efficacy. These conclusions were strengthened by incorporating a number of relevant control variables in our models and by testing four alternative models which supported our proposed model. These results are important because they provide further evidence of the significant role spouses' play in managing diabetes and they provide diabetes educators and clinicians with specific targets for intervention programming.
authors.affiliation: School of Family Studies and Human Services, Kansas State University, 113 Campus Creek Complex, Manhattan, KS, 66506, USA. jra@ksu.edu.
authors.forename: Jared R
authors.initials: JR
authors.lastname: Anderson
authors.affiliation: Utah State University, Logan, UT, USA.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Novak
authors.affiliation: University of Alberta, Edmonton, Canada.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Johnson
authors.affiliation: School of Family Studies and Human Services, Kansas State University, 113 Campus Creek Complex, Manhattan, KS, 66506, USA.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Deitz
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Walker
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Wilcox
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Virginia L
authors.initials: VL
authors.lastname: Lewis
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Robbins
mesh_terms: D000328:Adult; D003863:Depression / Q000150:complications / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology*; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010349:Patient Compliance / Q000523:psychology*; D020377:Self Efficacy; D018454:Spouses / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology
keywords: Couples; Diabetes self-efficacy; Dietary and exercise adherence; Dyadic data; Stress; Type 2 diabetes