The association between regulatory focus and distress in patients with a chronic disease: the moderating role of partner support.

OBJECTIVES: To determine the association between two regulatory foci (i.e. promotion and prevention focus) and distress in patients with chronic disease requiring self-management, and to determine whether these associations were moderated by partner support. DESIGN AND METHOD: Four hundred and seventy-seven patients with diabetes, asthma, or heart disease completed a postal survey consisting of the Regulatory Focus Questionnaire, questionnaires measuring active engagement (i.e. supportive behaviour) and protective buffering and overprotection (i.e. unsupportive behaviour) by the partner as perceived by the patient, and the General Health Questionnaire-12 to measure distress. RESULTS: A promotion focus was negatively associated with distress. This association was only found when patients reported that their partner engaged in relatively low levels of active engagement or relatively high levels of protective buffering and overprotection. The positive association between prevention focus and distress was not consistently found to be moderated by partner support. CONCLUSION: Active engagement appears to buffer against high distress in patients with a weak promotion focus, while protective buffering and overprotection appear to aggravate distress in these patients.

Spousal support and changes in distress over time in couples coping with cancer: the role of personal control.

This longitudinal study has examined the associations between perceived supportive and unsupportive spousal behavior and changes in distress in couples coping with cancer. We tested whether people relatively low in their sense of personal control were more responsive to spousal supportive and unsupportive behavior than were people relatively high in personal control. Patients with colorectal cancer and their partners (n = 70) completed questionnaires at two assessment points: 3 (at baseline) and 9 months (at follow-up) after the diagnosis. We assessed perceived spousal supportive (SSL) and unsupportive (SSL-N) behavior, sense of personal control (Pearlin & Schooler's Mastery), and depressive symptoms (CES-D) in both patients and partners. Multilevel analysis (MLwiN) was used to examine changes in distress over time in a dyadic context. Patients and partners who perceived more spousal support reported less distress over time, but this only applied to those relatively low in personal control. Moreover, partners who perceived more unsupportive spousal behavior reported more distress, again only if they were relatively low in personal control. Patients and partners relatively high in personal control reported relatively low levels of distress, regardless of spousal behavior. In conclusion, people relatively low in personal control may be more adversely affected by unsupportive behavior and benefit more from supportive behavior than people relatively high in personal control.

The role of overprotection by the partner in coping with diabetes: a moderated mediation model.

This study examined whether diabetes-specific self-efficacy mediates the association between overprotection and distress and whether this mediation depends on glycemic control and gender. The research sample of 215 individuals with diabetes and their partners completed a measure of partners' overprotective behaviours towards the patient. Patients also completed measures of diabetes-specific self-efficacy and diabetes-related distress. Further, HbA1c values were obtained as an indication of glycemic control. Diabetes-specific self-efficacy mediated the association between overprotection by the partner and diabetes-related distress especially when glycemic control was relatively poor. Furthermore, diabetes-specific self-efficacy mediated the association between overprotection and diabetes-related distress more strongly in female than in male patients. The findings underscore the importance of studying both moderators and mediators in the association between partner behaviour and distress in patients.

The impact of social comparison information on motivation in patients with diabetes as a function of regulatory focus and self-efficacy.

OBJECTIVE: Our aim was to determine whether the impact of upward and downward social comparison information on individuals' motivation to manage their diabetes is dependent on their regulatory focus (promotion or prevention focus) and self-efficacy. DESIGN: The hypotheses were examined in a cross-sectional study. Patients with diabetes (N = 234) read a fictitious interview with a fellow patient, either an upward or a downward target, and they filled out questionnaires. MAIN OUTCOME MEASURES: Motivation to work on diabetes regulation. RESULTS: High promotion-focused patients reported more motivation than low promotion-focused patients when confronted with the upward target (positive role model). High prevention-focused patients reported more motivation than low prevention-focused patients when confronted with the downward target (negative role model). This latter finding was qualified by patients' self-efficacy, as it applied only to patients with relatively high levels of self-efficacy. CONCLUSION: The current study highlights the importance of considering individual differences when using role models to encourage self-care activities in persons with diabetes.

Support behavior and relationship satisfaction in couples dealing with diabetes: main and moderating effects.

This study examined associations between support behavior, i.e. active engagement and protective buffering, and relationship satisfaction in both patients with diabetes and their partners. Active engagement refers to supportive behavior characterized by involving one's partner in discussions, asking how the other feels, and problem solving strategies. Protective buffering refers to less supportive behavior characterized by denying fears and worries, and by pretending everything is fine. Furthermore, we examined whether there were interactive effects of these two support behaviors on patients' and partners' relationship satisfaction. At baseline (T1), 205 couples rated to which degree they received active engagement and protective buffering from their partners, and completed a measure of relationship satisfaction. At three follow-up assessments, couples were asked to fill out the same measures. Using dyadic data analytic approaches, we found relationship satisfaction to be positively associated with active engagement, and negatively with protective buffering, in both patients and partners. Moreover, we found a moderating effect, in that the negative association between protective buffering and relationship satisfaction was only present when levels of active engagement were relatively low. Again, these results were found for patients as well as their partners. We were able to replicate the T1 results at the other three assessment points. Our findings illustrate the need to consider adequate and less adequate support behaviors simultaneously, and to study the effects on both patients and partners.