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Sex, race, and the role of relationships in diabetes health: intersectionality matters

  • Jeanean B. NaqviEmail author
  • Vicki S. HelgesonEmail author
  • Tiffany L. Gary-Webb
  • Mary T. Korytkowski
  • Howard J. Seltman
Article
  • 28 Downloads

Abstract

Previous research has seldom used an intersectionality framework to consider how sex and race affect diabetes health, nor has it examined the role of sex and race in the well-established link between romantic relationship quality and health. This study targeted 200 adults with type 2 diabetes (46% Black; 45% female) and examined whether sex, race, and the interaction between sex and race predicted behavioral and psychological health, or moderated the link between relationship quality and health outcomes. Black women reported poorer diabetes self-care and lower self-efficacy compared to other groups. Relationship quality was associated with better self-care, increased self-efficacy, and lower depressive symptoms. The association between relationship quality and medication adherence was stronger for Black women, and the association between relationship quality and self-efficacy was stronger for both Black women and White men. Results suggest that Black women with diabetes experience more health disadvantages than other groups, but some of these disadvantages might be attenuated by supportive romantic relationships.

Keywords

Race Sex Gender Relationship quality Marital quality Type 2 diabetes 

Notes

Acknowledgements

This research was supported by the National Institutes of Health Grant R01 DK095780, and received recruiting assistance from the University of Pittsburgh Clinical and Translational Science Institute, which is supported by the National Institutes of Health Grant UL1TR000005. The authors are grateful to Tiona Jones, Gianna Davis, Jennifer Melynk, Shaquille Charles, Katilyn Mascatelli, Melissa Zajdel, and Charis Vanderpuye for interviewing the study participants, and to Phuong (Phoebe) Ngoc Dinh for her invaluable comments.

Compliance with ethical standards

Conflict of interest

Jeanean B. Naqvi, Vicki S. Helgeson, Tiffany L. Gary-Webb, Mary T. Korytkowski, and Howard J. Seltman declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Supplementary material

10865_2019_57_MOESM1_ESM.docx (202 kb)
Supplementary material 1 (DOCX 201 kb)

References

  1. American Diabetes Association. (2018). 6. Glycemic targets: Standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement 1), S55–S64.CrossRefGoogle Scholar
  2. Banks, R. R. (2011). Is marriage for White people? How the African American marriage decline affects everyone. New York, NY: Dutton.Google Scholar
  3. Barnes, D. M., & Bates, L. M. (2017). Do racial patterns in psychological distress shed light on the Black–White depression paradox? A systematic review. Social Psychiatry and Psychiatric Epidemiology, 52, 913–928.CrossRefGoogle Scholar
  4. Bauer, G. R. (2014). Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social Science and Medicine, 110, 10–17.CrossRefGoogle Scholar
  5. Boyle, J. P., Thompson, T. J., Gregg, E. W., Barker, L. E., & Williamson, D. F. (2010). Projection of the year 2050 burden of diabetes in the US adult population: Dynamic modeling of incidence, mortality, and prediabetes prevalence. Population Health Metrics, 8, 29.CrossRefGoogle Scholar
  6. Brody, D. J., Pratt, L. A., & Hughes, J. P. (2018). Prevalence of depression among adults aged 20 and over: United States, 2013–2016. NCHS Data Brief, 303, 1–8.Google Scholar
  7. Brown, D. L. (2008). African American resiliency: Examining racial socialization and social support as protective factors. Journal of Black Psychology, 34, 32–48.CrossRefGoogle Scholar
  8. Centers for Disease Control and Prevention. (2017). National diabetes statistics report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services.Google Scholar
  9. Cherrington, A., Wallston, K. A., & Rothman, R. L. (2010). Exploring the relationship between diabetes self-efficacy, depressive symptoms, and glycemic control among men and women with type 2 diabetes. Journal of Behavioral Medicine, 33, 81–89.CrossRefGoogle Scholar
  10. Chiu, C. J., & Wray, L. A. (2010). Gender differences in functional limitations in adults living with type 2 diabetes: Biobehavioral and psychosocial mediators. Annals of Behavioral Medicine, 41, 71–82.CrossRefGoogle Scholar
  11. Cole, E. R. (2009). Intersectionality and research in psychology. American Psychologist, 64, 170–180.CrossRefGoogle Scholar
  12. Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 140, 139–167.Google Scholar
  13. Fisher, L., Skaff, M. M., Mullan, J. T., Arean, P., Glasgow, R., & Masharani, U. (2008). A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with type 2 diabetes. Diabetic Medicine, 25, 1096–1101.CrossRefGoogle Scholar
  14. Geiss, L. S., Wang, J., Cheng, Y. J., Thompson, T. J., Barker, L., Li, Y., et al. (2014). Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980–2012. JAMA, 312, 1218–1226.CrossRefGoogle Scholar
  15. Geronimus, A. T. (2001). Understanding and eliminating racial inequalities in women’s health in the United States: The role of the weathering conceptual framework. Journal of the American Medical Women’s Association, 56, 133–136.Google Scholar
  16. Goldzweig, G., Andritsch, E., Hubert, A., Walach, N., Perry, S., Brenner, B., et al. (2009). How relevant is marital status and gender variables in coping with colorectal cancer? A sample of middle-aged and older cancer survivors. Psycho-Oncology, 18, 866–874.CrossRefGoogle Scholar
  17. Hausmann, L. R., Ren, D., & Sevick, M. A. (2010). Racial differences in diabetes-related psychosocial factors and glycemic control in patients with type 2 diabetes. Patient Preference and Adherence, 4, 291–299.CrossRefGoogle Scholar
  18. Hunter, C. M. (2016). Understanding diabetes and the role of psychology in its prevention and treatment. American Psychologist, 71, 515–525.CrossRefGoogle Scholar
  19. Kim, G., Shim, R., Ford, K. L., & Baker, T. A. (2015). The relation between diabetes self-efficacy and psychological distress among older adults: Do racial and ethnic differences exist? Journal of Aging and Health, 27, 320–333.CrossRefGoogle Scholar
  20. Leeman, J., Skelly, A. H., Burns, D., Carlson, J., & Soward, A. (2008). Tailoring a diabetes self-care intervention for use with older, rural African American women. The Diabetes Educator, 34, 310–317.CrossRefGoogle Scholar
  21. Li, C., Ford, E. S., Strine, T. W., & Mokdad, A. H. (2008). Prevalence of depression among US adults with diabetes: Findings from the 2006 Behavioral Risk Factor Surveillance System. Diabetes Care, 31, 105–107.CrossRefGoogle Scholar
  22. Lincoln, K. D., & Chae, D. H. (2010). Stress, marital satisfaction, and psychological distress among African Americans. Journal of Family Issues, 31, 1081–1105.CrossRefGoogle Scholar
  23. Mayberry, L. S., Bergner, E. M., Chakkalakal, R. J., Elasy, T. A., & Osborn, C. Y. (2016). Self-care disparities among adults with type 2 diabetes in the USA. Current Diabetes Reports, 16, 113.CrossRefGoogle Scholar
  24. McGuire, B. E., Morrison, T. G., Hermanns, N., Skovlund, S., Eldrup, E., Gagliardino, J., et al. (2010). Short-form measures of diabetes-related emotional distress: The Problem Areas in Diabetes Scale (PAID)-5 and PAID-1. Diabetologia, 53, 66–69.CrossRefGoogle Scholar
  25. Morisky, D. E., Green, L. W., & Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24, 67–74.CrossRefGoogle Scholar
  26. Norton, R. (1983). Measuring marital quality: A critical look at the dependent variable. Journal of Marriage and the Family, 45, 141–151.CrossRefGoogle Scholar
  27. Nouwen, A., Winkley, K., Twisk, J., Lloyd, C. E., Peyrot, M., Ismail, K., et al. (2010). Type 2 diabetes mellitus as a risk factor for the onset of depression: A systematic review and meta-analysis. Diabetologica, 53(12), 2480–2486.CrossRefGoogle Scholar
  28. Peyrot, M., Egede, L. E., Campos, C., Cannon, A. J., Funnell, M. M., Hsu, W. C., et al. (2014). Ethnic differences in psychological outcomes among people with diabetes: USA results from the second Diabetes Attitudes, Wishes, and Needs (DAWN2) study. Current Medical Research and Opinion, 30, 2241–2254.CrossRefGoogle Scholar
  29. Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J., et al. (2005). Assessing psychosocial distress in diabetes: Development of the Diabetes Distress Scale. Diabetes Care, 28, 626–631.CrossRefGoogle Scholar
  30. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  31. Rintala, T. M., Jaatinen, P., Paavilainen, E., & Åstedt-Kurki, P. (2013). Interrelation between adult persons with diabetes and their family: A systematic review of the literature. Journal of Family Nursing, 19, 3–28.CrossRefGoogle Scholar
  32. Robles, T. F., Slatcher, R. B., Trombello, J. M., & McGinn, M. M. (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin, 140, 140–187.CrossRefGoogle Scholar
  33. Rosland, A. M., Heisler, M., & Piette, J. D. (2012). The impact of family behaviors and communication patterns on chronic illness outcomes: A systematic review. Journal of Behavioral Medicine, 35, 221–239.CrossRefGoogle Scholar
  34. Roy, T., & Lloyd, C. E. (2012). Epidemiology of depression and diabetes: A systematic review. Journal of Affective Disorders, 142, S8–S21.CrossRefGoogle Scholar
  35. Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR inventory. Journal of Marital and Family Therapy, 7, 47–60.CrossRefGoogle Scholar
  36. Sesko, A. K., & Biernat, M. (2010). Prototypes of race and gender: The invisibility of Black women. Journal of Experimental Social Psychology, 46, 356–360.CrossRefGoogle Scholar
  37. Talbot, F., Nouwen, A., Gingras, J., Gosselin, M., & Audet, J. (1997). The assessment of diabetes-related cognitive and social factors: The multidimensional diabetes questionnaire. Journal of Behavioral Medicine, 20, 291–312.CrossRefGoogle Scholar
  38. Toobert, D. J., & Glasgow, R. E. (1994). Assessing diabetes self-management: The summary of diabetes self-care activities questionnaire. In C. Bradley (Ed.), Handbook of psychology and diabetes (pp. 351–375). Eugene, OR: Oregon Research Institute.Google Scholar
  39. Vancampfort, D., Mitchell, A. J., De Hert, M., Sienaert, P., Probst, M., Buys, R., et al. (2015). Type 2 diabetes in patients with major depressive disorder: A meta-analysis of prevalence estimates and predictors. Depression and Anxiety, 32, 763–773.CrossRefGoogle Scholar
  40. Wiebe, D. J., Helgeson, V., & Berg, C. A. (2016). The social context of managing diabetes across the life span. American Psychologist, 71, 526–538.CrossRefGoogle Scholar
  41. Williams, D. R., Mohammed, S. A., Leavell, J., & Collins, C. (2010). Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Annals of the New York Academy of Sciences, 1186, 69–101.CrossRefGoogle Scholar
  42. Yu, M. K., Lyles, C. R., Bent-Shaw, L. A., & Young, B. A. (2013). Sex disparities in diabetes process of care measures and self-care in high-risk patients. Journal of Diabetes Research, 2013, 575814.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyCarnegie Mellon UniversityPittsburghUSA
  2. 2.University of Pittsburgh Graduate School of Public HealthPittsburghUSA
  3. 3.University of Pittsburgh School of MedicinePittsburghUSA

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