Diabetes and the couple dyad: Expressed emotion, diabetes control and management

Expressed emotion, a construct defined by the level of criticism, emotional over-involvement, and warmth in a relationship has been consistently shown to be a significant predictor of relapse and poor disease management across numerous physical and mental health conditions. This study presents an investigation on how expressed emotion may influence diabetes control and management. Diabetes control was measured by the frequency of hypoglycemic and hyperglycemic episodes. Diabetes management was measured through, dietary practices, exercise frequency and intensity, and perceptions of ability to effectively manage illness. This study also sought to understand how attributions made about how the illness developed and is managed from the spouse without diabetes, may influence levels of expressed emotion. One hundred and six heterosexual couples between the ages of 18 and 79 where one spouse was diagnosed with type 2 diabetes completed questionnaires about living with the illness and relationship quality. Study hypotheses were tested using structural equation modeling. Emerging data revealed that when the partner without diabetes had attributions that suggested the their partner had little control over the development and management of the illness, the partner without diabetes reported lower levels of expressed emotion that is, lower criticism of partner and higher relationship warmth. Results also suggest that when a partner without diabetes had low expressed emotion it had a direct impact on the self-management behaviors of their spouse. Specifically, spouses tended to eat healthier, exercise more, and have a better outlook on their overall diabetes management. Outcomes from this study illustrate the significant influence spouse's can have on their partner's disease management behaviors, expand our current understanding of how the construct expressed emotion operates in relationships where chronic illness is present, and highlight the importance of a relational approach to diabetes care, research, education, and intervention.