Associations between Economic Pressure and Diabetes Efficacy in Couples with Type 2 Diabetes

By Novak, Joshua R.; Anderson, Jared R. et al. | Family Relations, April 2017 | Go to article overview

Associations between Economic Pressure and Diabetes Efficacy in Couples with Type 2 Diabetes


Novak, Joshua R., Anderson, Jared R., Johnson, Matthew D., Walker, Ann, Wilcox, Allison, Lewis, Virginia L., Robbins, David C., Family Relations


Type 2 diabetes is a major health concern that is increasingly prevalent in high- and low-income countries (Seuring, Archangelidi, & Suhrcke, 2015), affecting approximately 387 million people worldwide (International Diabetes Federation, 2014). This chronic health problem comes at a considerable cost, with recent estimates of the direct health-care costs totaling $282,973 over one's lifetime in the United States (Seuring et al., 2015). These substantial health-care costs do not include the indirect costs of living with diabetes, such as lost productivity (Seuring et al., 2015) and increased mental health problems (Ho, Dobb, Knuiman, Finn, & Webb, 2008; Lynch, Kaplan, & Shema, 1997). As such, investigation into how one's financial standing might be linked with type 2 diabetes outcomes is a crucial direction for research. Although economic pressure is common in couples with a partner battling cancer (Sharp & Timmons, 2010), little is known about the consequences of economic pressure for couples with type 2 diabetes. Perceptions of economic pressure may be associated with increased emotional distress for both partners and, ultimately, how confident both partners are in the patient's ability to manage his or her diabetes.

Drawing on survey data from 117 married couples in which one partner has been diagnosed with type 2 diabetes (referred to as patients), the purpose of this study is to examine associations between patient and spouse perceived economic pressure (e.g., inability to pay bills), and patient (self-efficacy) and spouse confidence in the patient's ability to successfully manage the diabetes. In addition, we examine both partners' emotional distress (symptoms of depression, negative affect, and stress) as a potential mediator of the economic pressure-diabetes efficacy association, and problem-solving communication was tested as a moderator to understand how relationship dynamics might buffer associations between economic pressure and emotional distress.

LITERATURE REVIEW

Economic Pressure and Couples with Chronic Illnesses

Economic pressure represents the degree to which a couple's financial resources do not meet their financial obligations or material needs and is often accompanied by a constant need to reduce expenditures. This construct encompasses recurring events, such as inability to pay monthly bills or not having money left over after paying bills, and larger circumstances, including income loss, debt, unemployment, unstable work conditions, and medical emergencies (Conger & Elder, 1994; Conger, Rueter, & Elder, 1999). The present study focuses on economic pressure as it relates to the daily irritations and difficulties to pay one's bills or fund economic necessities. Economic pressure differs from financial stress or distress, as the latter refers to the subjective worry about one's financial situation-regardless of income level-and is a by-product of economic pressure (Wheaton, 1994). Economic pressure is a particularly important variable to study, as scholars have found that other indicators of socioeconomic status, such as income level, tend to exert their influence on emotional health by decreasing one's ability to meet financial needs (greater economic pressure leads to greater emotional distress according to the family stress model; Conger et al., 1999).

Understanding economic pressure in couples with type 2 diabetes is important for several reasons. First, research has shown that couples dealing with a chronic illness experience more economic pressure than couples without (Sharp & Timmons, 2010; Smith, 2004). This is increasingly true in the context of type 2 diabetes, as couples incur frequent expenses for hospital and physician visits, prescription drugs, and diagnostic and laboratory tests, as well as costs associated with adhering to diet and exercise guidelines (Seuring et al., 2015). Very little research has investigated the impact of economic pressure on couples challenged by chronic illnesses (see Skinner, Zautra, & Reich, 2004), and no studies, to our knowledge, have investigated the impact of economic pressure on couples with type 2 diabetes. …

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Associations between Economic Pressure and Diabetes Efficacy in Couples with Type 2 Diabetes
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