Abstract
Anxious and avoidant attachment may be detrimental for diabetes distress and management. Additionally, individuals’ perceptions of their partner’s involvement may affect these associations. The study explored cross-sectionally and at the daily level whether anxious and avoidant attachment associated with diabetes distress or stressors and diabetes management, and whether higher perceived collaboration and support (C&S) moderated associations between attachment and diabetes management. Individuals with type 1 diabetes (N = 199; M age = 46.82; 52.3% women) completed measures of diabetes distress, diabetes-related C&S, self-care, average blood glucose (hemoglobin A1c), and attachment insecurity, and daily diary measures of diabetes-related C&S, diabetes stressors, mean blood glucose, and self-care. Higher anxious and avoidant attachment associated with higher diabetes distress. Higher anxious attachment associated with more daily stressors. Anxious attachment associated with lower self-care. C&S did not moderate any associations. Findings highlight the need to consider attachment when designing interventions to reduce diabetes-related distress.
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Notes
Speaking English as a primary language was necessary for cognitive testing that was part of the larger study protocol.
Supplemental analyses of the interpersonal distress subscale were conducted post hoc but for clarity the results are not presented. In general, interpersonal distress did not have as strong associations with attachment insecurity or diabetes management compared to the originally used total score of diabetes distress. However, the pattern of results was largely the same.
In addition to the a priori covariates we tested, we also examined low blood glucose episodes in a typical week and comorbidities as covariates post-hoc. Our results were the same with the addition of these post-hoc covariates. However, as the variables themselves were less interpretable than our a priori covariates, we chose to not include them in the main text.
As C&S was conceptualized as the moderator, we included the interaction on Level 2, despite the data being daily diary. Additional analysis examined cross-level interactions between attachment and C&S, and found similar results.
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Acknowledgements
This work was supported by a grant from the NIDDK at NIH (Grant Number DP3DK10399, MPIs Berg and Helgeson).
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C. S. Kelly, C. A. Berg, and V. S. Helgeson declare that they have no conflict of interest to disclose.
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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.
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Kelly, C.S., Berg, C.A. & Helgeson, V.S. Adult attachment insecurity and associations with diabetes distress, daily stressful events and self-management in type 1 diabetes. J Behav Med 43, 695–706 (2020). https://doi.org/10.1007/s10865-019-00111-7
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DOI: https://doi.org/10.1007/s10865-019-00111-7