November 2011 - Genetics play a critical role in developing diabetes. So do eating properly, exercising and not smoking. According to a new study by an Ithaca College psychology professor and her two colleagues, people with diabetes who see themselves as responsible for their disease onset blame themselves for making poor lifestyle choices and are significantly less likely to monitor their glucose levels, properly inject themselves and make lifestyle choices that would benefit their condition.
The new findings have added relevance now, since the American Diabetes Association has designated November as American Diabetes Month.
"A great deal of research targets the biological interventions for diabetes," said Mary Turner DePalma, professor of psychology at Ithaca College. "But far fewer studies examine the psychological factors related to managing the disease. Our study investigated the relationship between judgments of responsibility for disease onset and subsequent health behavior.
We hypothesized that increased anger regarding the development of diabetes would be associated with increased self-blame and negative social support and, when coupled with decreased positive social support, would ultimately be associated with the self-report of poorer disease management."
DePalma and her colleagues-Julia Rollison, senior analyst at Arlington's MANILA Consulting Group, and Matthew Camporese, clinical psychology doctoral candidate at Adelphi University-began the study by placing postcards in a medical and a fitness center to recruit individuals over 18 who had been diagnosed with either type 1 or type 2 diabetes to take an Internet survey.
The 46 participants, (18 males, 27 females and one who failed specify sex, ranging from 18 to 92 years of age) answered questions about perceptions of responsibility for disease onset, trait anger (anxiety that is chronic not temporary), self-blame, positive and negative social support and disease management.
"We used the word ‘perceptions' of responsibility in a very deliberate way," DePalma said. "The accuracy of a person's judgment was not at issue. Rather, we were primarily concerned with an individual's perceptions, which may be true, or they may be false and unfair, but the consequences can be real nonetheless.
- Responsibility was measured by asking, "How responsible to you perceive yourself to be for the onset of your diabetes?" and then asking the participants to respond on a scale of 0 to 10. (Zero=not at all responsible; ten=entirely responsible).
- Self-blame was measured by asking, "How do you generally react when you experience diabetes-related stressful events?" and then responding, on a scale of 1 to 4. (One=I usually don't do this at all; four=I usually do this a lot).
- Anger was measured by using a subscale of the State-Trait Anger Expression Inventory-2.
- Social support was measured by the Diabetes Family Behavior Checklist.
The data was analyzed through structural equation modeling, a statistical technique used to test causal models.
"As perceptions of responsibility for disease onset increased, so did trait anger," said DePalma. "Increases in trait anger were associated with increases in self-blame and negative social support, which were associated with the self-report of poorer disease management."
The data showed no relationship between trait anger and positive social support.
"That perceptions of responsibility for diseases onset are associated with health behavior illustrates their importance in the specific context of diabetes," DePalma said. "Our study shows that interventions designed to improve anger management and increase disease acceptance may offer additional mechanisms to improve diet, exercise and perform appropriate blood glucose testing in individuals with diabetes."
Although the investigation was limited to the self-report of health behaviors associated with diabetes, DePalma added that this model could generalize to other diseases in which lifestyle risk factors play a commanding role. Also, since the study participants were male and female Caucasians, additional research is currently being conducted to determine if cultural backgrounds may influence the link between attitudes and disease management.
The study was published in the "American Journal of Health Behavior."
Source: Ithaca College