Predictors of collaborative coping in couples managing type 2 diabetes: Illness factors,relationship factors,and interdependent personality traits

Abstract

Past work has revealed benefits for both persons with diabetes (PWD) and their partners (e.g., spouses) when engaging in collaborative coping to manage a chronic illness, yet little is known about predictors of this type of dyadic coping. Based on conceptual frameworks on communal and dyadic coping, we sought to examine how illness factors, relationship factors, and interdependent personality traits predicted the frequency of collaborative coping among couples managing type 2 diabetes, and whether role (PWD vs. partner) moderated the associations. Cross-sectional survey data from 296 older adults (N = 148 different-sex couples) were analyzed. Multilevel models examined both linear and nonlinear associations between each factor and collaborative coping, controlling for race/ethnicity. Linear associations were found for positive relationship quality, and nonlinear associations were found for diagnostic length and relationship length. No significant associations emerged between interdependent personality traits and collaborative coping. Although PWD reported more frequent engagement in collaborative coping than partners, role only moderated the associations between diagnostic length and relationship length with collaborative coping. Findings contribute to an understanding of potential correlates of collaborative coping and may have implications for health promotion and interventions for older couples managing type 2 diabetes.

Keywords

Diabetes collaborative coping marriage relationship quality personality

Introduction

Diabetes is a prevalent chronic health condition that increases with age, with nearly 1.5 million new cases being diagnosed annually, approximately 90-95% of which are type 2 diabetes (American Diabetes Association [ADA], 2023; Centers for Disease Control and Prevention [CDC], 2024). Due to the lifestyle changes required for successful management, as well as the many sources of stress associated with the condition, diabetes has been classified as a chronic stressor and may result in disease-specific and overall distress (August, Kelly, & Abbamonte, 2014; Polonsky et al., 2005). Among individuals in a committed romantic relationship, diabetes has the potential to be appraised as a couple’s (or “we”) – versus individual – stressor (Helgeson et al., 2018), with research showing that both partners’ stress levels are linked to poor diabetes treatment adherence (Anderson et al., 2016). There exist many opportunities for the partners of persons with diabetes (PWD) to engage with PWD in managing the daily tasks and coping with stress associated with the disease (Berg & Upchurch, 2007; Helgeson et al., 2018). One specific way partners are involved in PWDs’ diabetes management is by engaging in a type of dyadic coping known as collaborative coping (Berg & Upchurch, 2007; Falconier & Kuhn, 2019). Collaborative coping imparts benefits to both the PWD (Helgeson et al., 2017; Zajdel et al., 2022), and the partner (Berg et al., 2008; Helgeson et al., 2017). Little is known, however, about predictors of engagement in collaborative coping. In this study, we explore these predictors in couples managing type 2 diabetes.

Collaborative coping

Dyadic coping is theorized to occur when stress experienced by an individual is also experienced as stress by a close other (Bodenmann, 1997). Much of the research surrounding dyadic coping examines stress among couples (Bodenmann et al., 2019; Falconier & Kuhn, 2019), especially those in which one member has a chronic health condition (Berg & Upchurch, 2007; Rentscher, 2019), including type 2 diabetes (Helgeson et al., 2018). One such type, communal coping, consists of two distinct processes: (1) a cognitive component, which includes appraising the stressor as shared and (2) a behavioral component, which includes partners collaborating to manage the stressor (Lyons et al., 1998). The current study focuses on the behavioral component of communal coping; specifically, collaboration, referred to here as collaborative coping.

Although these concepts overlap, each form of coping is distinct in its theoretical underpinnings. Dyadic coping emphasizes how one partner’s stress affects the other partner, leading to joint coping efforts (Bodenmann et al., 2016, 2019). Communal coping involves viewing a stressor as shared and engaging in joint efforts to cope with it together (Helgeson et al., 2018; Lyons et al., 1998). Collaborative coping focuses specifically on joint efforts to cope with a stressor, whether it impacts both partners individually or is appraised as shared by both partners (Falconier & Kuhn, 2019).

While we draw from literature on all three overlapping yet distinct concepts, we primarily use a conceptual framework proposed by Helgeson and colleagues (2018) that delineates predictors of communal coping to examine potential predictors of collaborative coping to guide this research, while also integrating Berg and Upchurch’s (2007) Developmental-Contextual Model (DCM) of dyadic coping (see Figure 1).

Figure 1.

Conceptual Model of Predictors of Collaborative Coping. Note: Model based on framework proposed by Helgeson and colleagues (2018) and Berg and Upchurch’s (2007) Developmental-Contextual Model.

Helgeson and colleagues’ (2018) framework posits predictors of communal coping that may include the nature of the illness, relationship quality, and interdependent self-construals. These factors are considered within the DCM as the proximal context that influence couples’ coping with chronic illness. This study aims to test factors identified by Helgeson and colleagues (2018), including illness factors that represent the “nature of the illness” and relationship quality (both positive and negative), as well as expanding on the framework by testing additional factors that may be associated with collaborative coping – relationship length and interdependent personality traits (meant to serve as a proxy for interdependent-self-construal).

Illness factors

Type 2 diabetes is characterized by a variety of symptoms, which develop over time and, if left untreated, can lead to serious complications (NCCDPHP, 2022). Despite various frameworks proposing a connection between illness factors and collaborative coping (Berg & Upchurch, 2007; Helgeson et al., 2018), little research has empirically examined their role in couples’ efforts to cope. Instead, illness factors are often examined as covariates in studies of communal coping (e.g., Helgeson et al., 2021), and those that report an association have shown conflicting results. For example, some research has found no significant association between diagnostic length and communal coping (Helgeson et al., 2017), whereas other research has found a positive association (Helgeson et al., 2017). Past studies have yet to provide evidence of whether the association exists for couples’ collaborative coping efforts.

Another illness factor – illness severity – has been examined in relation to the appraisal component of communal coping. For example, Basinger (2018) found that when a PWD’s illness was perceived as more severe, both PWD and family members described taking more ownership of the illness, suggesting that they also may engage in collaborative coping more frequently. Other research, however, points toward an inverse association between symptom severity and collaborative coping, due in part to instances wherein illness factors work in tandem to influence other factors (e.g., relationship quality) and thus partners’ decisions to cope together. In one study of couples coping with type 2 diabetes, spouses found daily interactions more enjoyable when diagnostic length was longer, if PWD’s symptom severity was held constant. However, spouses found daily interactions less enjoyable when diagnostic length was longer and symptom severity was greater than usual (Iida et al., 2013). It can thus be reasoned that illness factors, such as diabetes complications and symptoms, are important to consider in understanding the frequency of engagement in collaborative coping, as collaborative coping is strongly associated with greater positive relationship quality (Helgeson et al., 2017).

These seemingly contradictory findings may be due to the possibility that the association between illness severity and collaborative coping is curvilinear in nature (Afifi et al., 2020). That is, when PWD experience less frequent symptoms or complications, partners may engage in less frequent collaborative coping, whereas when PWD experience more frequent symptoms or complications, partners may engage in more frequent collaborative coping. Yet, the coping ability of both the PWD and partner may be compromised when symptoms and complications are experienced in excess and lead to less frequent engagement in collaborative coping (Afifi et al., 2020).

Relationship factors

While a review of the literature revealed how one relationship factor – relationship length – has been identified as a predictor of dyadic coping among those in close personal relationships (Staff et al., 2017), the literature examining this link in the context of chronic illness has yet to produce a clear association (see Falconier & Kuhn, 2019). Some studies have found no association (Van Vleet et al., 2019; Zajdel et al., 2018), while others suggest a positive association (Feldman & Broussard, 2006; Helgeson et al., 2017). More research is therefore needed to understand this association, which could potentially be curvilinear in nature. For instance, couples in early-stage marriages may engage in more frequent collaborative coping, as positive marital quality (a strong predictor of collaborative coping) tends to be highest in the early years of marriage (Orbuch et al., 1996). It is also possible, however, that couples in late-stage marriages may report more frequent engagement in collaborative coping, as couples in long-term marriages tend to possess skills indicative of collaboration (Berg & Upchurch, 2007).

As the above findings suggest, relationship quality plays a key role in dyadic coping and has been theorized to be both a predictor as well as an outcome of dyadic coping, suggesting a cyclical association between the two (Berg & Upchurch, 2007). Some dyadic coping types, such as collaborative coping, have been thought to occur in couples in high quality relationships in response to both general and health-related stressors (Falconier & Kuhn, 2019). Previous work supports these claims, as studies have shown a positive association between marital quality and communal coping for both PWD (Helgeson et al., 2017; Zajdel & Helgeson, 2022) and partners (Berg et al., 2008; Zajdel & Helgeson, 2022).

As couples in low quality marriages often have more arguments and tension in the relationship, it has been suggested that couples in relationships characterized by lower levels of marital quality may also engage in less frequent collaborative coping (Berg & Upchurch, 2007). This idea is supported by evidence that dyadic coping is positively associated with conflict resolution in both partners (Falconier et al., 2013a). Thus, it would be plausible to expect that more negative relationship quality would be linked to less collaborative coping.

Past studies that have examined associations between various coping strategies and relationship quality have revealed significant nonlinear associations (Bouchard et al., 1998). These findings, coupled with recent calls for a more thorough examination of nonlinear methodology in close relationships research (Girme, 2020), suggest that testing potential nonlinear associations between relationship quality and collaborative coping is warranted.

Interdependent personality traits

As proposed by Helgeson et al. (2018), individuals who interpret stressors as shared may be more likely to have interdependent self-construals, or the propensity to define the self in relation to others (American Psychological Association [APA], 2023; Cross & Madson, 1997), and thus engage more frequently in collaborative coping. Chronic illness management is often interpersonal in nature, providing opportunities for collaboration among partners (Berg & Upchurch, 2007; Helgeson et al., 2018). A related individual difference factor that assesses interdependence in close relationships - the communal factor of the Interpersonal Circumplex (Soldz et al., 1995) - has never been directly examined in this context but may be useful in understanding how individual differences in interdependence are associated with collaborative coping.

The Inventory of Interpersonal Problems – Short Circumplex Form (IIP-SC; Soldz et al., 1995) categorizes an individual into one of eight octants and assesses the degree to which an individual is both agentic (domineering vs. non-assertive) and communal (cold vs. overly-nurturant; Soldz et al., 1995). The degree to which an individual is communal (measure of interdependent personality traits) may be of particular importance in understanding collaborative coping, as it assesses interpersonal behaviors and qualities linked to warmth and cooperation in social interactions. Berg and Upchurch (2007) posit that hallmarks of optimal relationship interactions involve warmth and working to encourage behaviors characteristic of collaborative coping (such as joint problem solving). It can thus be reasoned that these more communal behaviors and qualities may relate to how often couples cope collaboratively. This association may not be linear, however, as PWD who are highly interpersonal may have an increased awareness of how they impact their partners and may behave in ways to decrease partner burden and distress by engaging in less collaborative coping (Afifi et al., 2020; Helgeson et al., 2018; Lyons et al., 1998).

Role in couple as PWD versus partner

Researchers have suggested that when partners engage in collaborative coping, lines may blur with regard to who is the “patient” as both members of the couple attempt to cope with the stressor (Helgeson et al., 2018; Van Vleet et al., 2019). Despite this overlap in coping, there are still unique experiences of PWD and partners, suggesting that role may be an influential factor in understanding collaborative coping experiences (Helgeson et al., 2018). For example, in a study of couples managing type 2 diabetes, role (PWD vs. partner) did not significantly moderate the association between communal coping and mood outcomes (Zajdel et al., 2018). Yet other research has found differing results in who benefits from dyadic coping, with some studies indicating more benefits for PWD (Van Vleet et al., 2019) and others for partners (Berg et al., 2008). In light of these conflicting findings, more research is needed to examine whether role is important in understanding collaborative coping experiences, including potential predictors.

The current study

The current study was guided by Helgeson’s framework (2018), along with Berg and Upchurch’s (2007) DCM of dyadic coping, by examining potential predictors of collaborative coping, while considering role (PWD vs. partner). As a first step in attempting to test this theoretical framework, we examined these aims using cross-sectional data. The first aim (Aim 1) of this study was to examine whether illness factors were related to collaborative coping. Specifically, it was expected that when PWD reported longer diagnostic length, more diabetes symptoms, and more diabetes complications, both PWD and partners would report more frequent engagement in collaborative coping. The second aim (Aim 2) of this study was to examine whether relationship factors were associated with collaborative coping. It was expected that when PWD reported longer relationship length, and PWD and partners reported greater positive and less negative relationship quality, both PWD and partners would report more frequent engagement in collaborative coping. The third aim (Aim 3) of this study was to examine whether interdependent personality traits were associated with collaborative coping. It was expected that when PWD and partners were more communal, they would report more frequent engagement in collaborative coping. The fourth aim (Aim 4) of this study was to examine role (PWD vs. partner) moderated the above associations. This aim was exploratory. Given the reasoning noted above, coupled with recommendations from other researchers (e.g., Afifi et al., 2020; Helgeson et al., 2018) about potential nonlinear effects in understanding the links between some of these factors and collaborative coping, both linear and nonlinear associations were examined for all predictors. Nonlinear aims were exploratory.

Method

Procedure and participants

The sample for the current study was drawn from a larger study of N = 156 couples managing type 2 diabetes, which was reviewed and approved by the Institutional Review Board at Rutgers University (Pro2018001819). All participants resided in the United States and were recruited through Qualtrics Panels (Qualtrics, Provo, Utah). Specifically, Qualtrics’ partner companies distributed emails to targeted individuals containing an anonymous survey link, and interested individuals completed an online eligibility screening questionnaire. Inclusion criteria were that at least one member of the couple was diagnosed with type 2 diabetes by a health care professional, was being seen by a health care provider annually for diabetes management, was at least 55 years old¹, and that the couple was married or in a marital-like relationship². Quota sampling was used to allow for a relatively equal number of men and women in each role (PWD or partner), as well as to ensure that at least 25% of the sample consisted of racial/ethnic minority participants.

Participants who met inclusion criteria were instructed to complete the survey on their own without the help of their partner. Immediately after, partners were instructed to complete their own survey (with partners being unable to see the responses of the PWD). Consent forms were included at the beginning of each survey for both partners. Participants worked with Qualtrics partners in selecting the type of compensation they preferred, such as cash and airline miles. The type and amount of compensation participants received varied across providers and was based on panelist profile (e.g., sociodemographic characteristics), difficulty in acquiring participants, and survey length.

The sample for the current study consisted of 296 individuals (N = 148 couples). Given work highlighting the strong gendered expectations toward caregiving and health management that exist in long-term different-sex couples, as well as evidence suggesting same-sex couples may have different experiences with dyadic coping than different-sex couples (Meuwly et al., 2013; Umberson et al., 2016; Umberson & Kroeger, 2015; Wang & Umberson, 2023), seven couples who indicated they were in same-sex relationships were excluded from the present analyses. Given the limited number of same-sex couples, we were unable to examine sexual orientation as a control variable or moderator.

Participant characteristics are reported in Table 1. The sample consisted of older adults, as diabetes prevalence increases in later life, with research considering those aged 50 and older as representing this period of the lifespan (Zhang et al., 2023). PWD were 66.36 years old, on average, reported an average of 1.36 chronic health conditions other than diabetes, and a majority were Non-Hispanic White (68.2%) and had a bachelor’s degree or higher (52%). Partners were 65.54 years old, on average, reported an average of 1.1 chronic health condition, and a majority were Non-Hispanic White (69.6%) and had less than a bachelor’s degree (62.2%). Almost 1/5 (18.2%) of partners also had diabetes and more than 2/3 (67.5%) had another chronic condition requiring dietary changes as part of their regimen. The household income range with the largest percentage of couples reporting was between $55–100K (36.4%). Finally, couples reported an average relationship length of 33.34 years.

Table 1.

Participant characteristics and key variables by role (N = 296).

	PWD (n = 148)	Partner (n = 148)	Difference (Partner-PWD)	Test of Significance for Difference^a
Individual level characteristics
				OR (95% CI)
Gender, %	50% women	50% women	0%	0.97 (0.61, 1.54)
Gender, %	50% men	50% men	0%	0.97 (0.61, 1.54)
Race/ethnicity, %				1.09 (0.61,1.94)
Non-Hispanic White	68.2%	69.6%	1.4%
Non-White	31.8%	30.4%	1.4%
Education level, %				2.23 (1.28, 3.89)**
Less than a bachelor’s degree	48.0%	62.2%	14.2%
Bachelor’s degree or higher	52.0%	37.8%	14.2%
				B(SE)	pr
Age, years M(SD), median	66.36 (6.83), 67.09	65.54 (7.71), 66.64	−0.82 (0.88), 0.45	0.82 (0.44)	.15
Number of chronic conditions (not including diabetes), M(SD)	1.36 (0.93)	1.01 (0.97)	−0.35 (0.04)	0.35 (0.10)***	.27
Positive relationship quality	5.35 (0.94)	5.43 (0.96)	0.08 (0.02)	−0.08 (0.05)	−.13
Negative relationship quality	2.13 (0.67)	2.08 (0.69)	−0.05 (0.02)	0.05 (0.05)	.08
Communal IP	0 (0.60)	0 (0.68)	0 (0.08)	−0.07 (0.07)	−.08
Collaborative coping	2.65 (1.26)	2.36 (1.14)	−0.29 (-0.12)	0.30 (0.07)***	.34
Couple level characteristics
Partner had own condition requiring dietary changes^b (not including diabetes), %	67.5%		-----------	-----------	-------
Partner also had type 2 diabetes, %	18.2%		-----------	-----------	-------
Household income^c			-----------	-----------	-------
< $25K	7.9%		-----------
$25–55K	26.4%		-----------
$55–100K	36.4%
>$100K	29.3%
Diagnostic length	12.13 (7.44)		-----------
Diabetes symptoms	28.91 (10.68)		-----------
Diabetes complications	0.89 (0.66)		-----------
Relationship length	33.34 (14.91)		-----------

Note. PWD = 1, partner = 0. SE = standard error; pr = partial correlation; IP = interpersonal problems. Differences by role (PWD) were examined in multilevel models with PWD as a predictor of each variable. Unstandardized coefficients and standard error (SE) are presented from these models. Partial correlations (pr) are provided as a measure of effect size. Significant findings are bolded.

To test differences between PWD and partners, we estimated multilevel models for each variable with PWD as the sole predictor. For binary variables, odds ratios with 95% confidence intervals are reported. For continuous variables, unstandardized coefficients with standard errors are reported, along with the partial correlations (pr). See text for additional details.

^bE.g., Kidney disease, high blood pressure.

^cPWD reports. Eight participants reported that they preferred not to answer.

*p < .05. **p < .01.

Measures

Dependent variable

Collaborative Coping

All participants completed a 5-item Collaborative Coping Questionnaire (adapted by Hemphill, 2013 for couples with type 2 diabetes from Berg et al., 2003) asking them to think about the ways in which participants and their partners have collaborated to manage their diabetes as a couple (e.g., “The two of you shared feelings and concerns about managing [your; his/her] diabetes”) on a 5-point Likert scale from 1 (“not at all”) to 5 (“everyday”). The 5 items were averaged to create a composite scale of collaborative coping (α = .94). The original measure was reported to be significantly associated with other types of positive partner involvement (Berg et al., 2003).

Primary independent variables (Individual-level)

Positive relationship quality

All participants completed the Marital Quality Index (Norton, 1983), a 5-item scale asking them to rate the extent to which they agree or disagree with statements about their relationship (e.g., “You have a good marriage”) on a 6-point scale from 1 (“strongly disagree”) to 6 (“strongly agree”). The five items were averaged to create a composite scale of positive relationship quality (α = .98). This measure has been found to be moderately to strongly associated with other measures of health-related interpersonal experiences in the expected direction (August et al., 2013).

Negative relationship quality

All participants completed a 6-item questionnaire adapted from the Midlife in the United States study (National Institute on Aging, 2022) (https://www.icpsr.umich.edu/web/pages/NACDA/midus.html) asking them to indicate how often the quality of their relationship is negative (e.g., “How often does your spouse make too many demands of you?”) on a 4-point scale that was reverse-coded from 1 (“never”) to 4 (“often”). Items were averaged to create a composite scale of negative relationship quality (α = .90). This measure has been found to be significantly associated with adverse mental health (Brooks et al., 2014).

Communal interpersonal problems (IP)

To assess interdependent personality traits, all participants completed the Inventory of Interpersonal Problems – Short Form Circumplex (IIP-SC; Soldz et al., 1995), a 32-item questionnaire that assesses the eight octants of the interpersonal circumplex (Leary, 1957). Participants were asked to rate the extent to which statements that describe difficulty relating to others apply to them (e.g., “I put other people’s needs before my own too much”) on a 5-point scale from 1 (“not at all”) to 5 (“extremely”). A scale was calculated to assess the extent to which participants were communal (cold vs. overly-nurturant). Each standardized octant score was weighted by multiplying it by the cosine (to calculate communal IPs) of a given octant’s angular location (θ) on the circumplex. These values were then summed to represent a communal IP score, using the following geometric formula (Wiggins, 1995):

Communal IPs = (.30) ΣZi cos θi

where .30 is a scaling factor, Zi represents the standardized score of the ith octant and θi is the angle of the ith octant (e.g., 0º, 45º, 90º; see Gurtman, 2011).

Other studies have found that the short form of the circumplex is a valid measure comparable to other widely utilized assessments of interpersonal personality and interpersonal problems (Markey et al., 2014).

Primary independent variables (couple-level)

Diagnostic length

Persons with diabetes (PWD) completed a 1-item, open-ended question asking, “How long have you been diagnosed with type 2 diabetes?” (in years).

Diabetes symptoms

Persons with diabetes (PWD) completed a 13-item questionnaire (on hyperglycemic and hypoglycemic symptoms, adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD, 2022) (https://www.niddk.nih.gov/) asking PWD, “How often have you experienced the following symptoms related to your diabetes?” (e.g., extreme thirst, dizziness) on a 6-point scale from 1 (“never”) to 6 (“always”). Summed scores were created to represent the frequency of experiencing diabetes symptoms (α = .91).

Diabetes complications

Persons with diabetes (PWD) completed a 1-item question based on information from the American Diabetes Association (https://www.diabetes.org/) asking PWD, “Have you ever had any of the following problems or complications as a direct result of your diabetes?” Participants were able to select all complications that applied to them from a list of 6 complications (loss of eyesight, neuropathy, frequent yeast infections, kidney failure, amputation of any extremity), with an “other” write-in option. A count of the number of affirmative responses was created.

Relationship length

Persons with diabetes (PWD) completed a 1-item, open-ended question asking, “How long have you and your spouse been married?” (in years).

Secondary independent variable (Moderator)

PWD

Given research suggesting that PWD and their partners may derive distinct benefits from engagement in collaborative coping (Van Vleet et al., 2019), whether a participant was identified as the PWD (coded 1) or the partner (coded 0) in this study was considered as a moderator in the association between theorized predictors and collaborative coping. (When both partners reported diabetes, the Qualtrics panel member who responded as someone with diabetes and completed the survey designed for PWD was coded as such).

Covariates

The following sociodemographic and health factors were considered as possible covariates: Gender, given gender differences in collaborative coping experiences in the context of type 2 diabetes (Helgeson et al., 2021), interdependence (Cross & Madson, 1997) and reports of relationship quality (Jackson et al., 2014); age, as researchers have found age differences in appraisal and coping with chronic illness (Chen et al., 2018) and positive relationship quality (Orbuch et al., 1996); race/ethnicity (non-Hispanic White vs. non-White), given racial/ethnic differences in interdependent personality traits and diabetes management (Fisher et al., 2000); education level (less than a bachelor’s degree vs. bachelor’s degree or higher), as education has been shown to be important for diabetes management and outcomes (Walker et al., 2016); and number of chronic conditions not including diabetes (hypertension, asthma, emphysema or chronic bronchitis, arthritis or rheumatism, cancer or any kind of malignancy), whether partners had a condition requiring dietary change (e.g., heart disease, hypertension, high cholesterol, weight-related issues, gastrointestinal issues, kidney/bladder issues, or other issues only mentioned once – e.g., gluten intolerance), and whether partners also had diabetes, as the presence of any one health condition may prompt coping, and additional conditions may influence engagement in coping (Afifi et al., 2020). Only race/ethnicity was significantly associated with collaborative coping in multilevel models and was thus included in final models as a covariate.

Analytic plan

We used multilevel models (Kenny et al., 2006) due to the nested nature of the data as distinguishable dyads.³ Models were estimated with random intercepts using full maximum likelihood. Random slopes were not specified, as dyadic analyses limit the number of random effects parameters that can be estimated (Kenny et al., 2006). For descriptive analyses, we examined role differences in the key variables by estimating multilevel models for each with PWD (vs. partner) as the predictor (full models not shown). Pairwise intraclass correlations were calculated to examine the extent of concordance (or agreement of reports) between PWD’s and partners’ collaborative coping, controlling for whether the partner was the PWD (Gonzalez, 2003). To test the study aims, we estimated a series of multivariate models as follows: (1) all predictor variables (linear effects; Aims 1–3); (2) all predictor variables interacted with PWD (Aim 4); (3) all predictor variables squared (exploratory); and (4) all predictor variables squared and interacted with PWD (exploratory). The equations for each of these models are available in the supplemental materials. All predictor variables in the multivariate models were grand-mean centered. To provide a measure of effect size, the t statistics from each term in the multivariate multilevel models were transformed into partial correlations (pr = √ (t²∕ (t² + df)). All analyses were conducted using SPSS version 28 and HLM 7 software.

Results

Descriptive results

Table 1 reports participant characteristics and the means and standard deviations of key variables by role (PWD vs. partner). On average, PWD reported a diagnostic length of 12.13 years, experienced symptoms infrequently (M = 28.91), reported little to no diabetes complications (M = 0.89), and reported a relationship length of 33.34 years. Both PWD and partners reported relatively high positive relationship quality (M = 5.35 PWD; M = 5.43 partners) and low negative relationship quality (M = 2.13 PWD; M = 2.08 partners), as well as low communal IPs (M = 0, SD = .60 PWD; M = 0, SD = .68 partners). Finally, PWD (M = 2.65) and partners (M = 2.36) reported low (once or twice) to moderate (about once a week) frequency of engagement in collaborative coping. Results from pairwise correlations revealed that partners had a high degree of concordance in reports of collaborative coping (r = .73, p < .001).

Multilevel models that examined role as a predictor of each individual-level variable revealed that compared to partners, PWD had significantly higher odds of having a bachelor’s degree or higher (OR = 2.23, p < .01), reported more chronic conditions (b = 0.35, p < .001), and more frequent collaborative coping (b = 0.30, p < .001). There were no significant differences between PWD and partners on gender, race/ethnicity, age, positive relationship quality, negative relationship quality, or communal IPs.

Multivariate results

Linear main effects

Results for Aims 1–3 (linear main effects) are shown in Model 1 of Table 2. Results revealed only one significant linear association; specifically, greater positive relationship quality was associated with more frequent engagement in collaborative coping, with a one-point increase in positive relationship quality predicting about a quarter-point more collaborative coping (b = 0.23, p < .01, pr = .24). There were no significant linear associations between diagnostic length, diabetes symptoms, diabetes complications, relationship length, negative relationship quality, or communal IPs and collaborative coping.

Table 2.

Multilevel Regression models examining predictors of collaborative coping.

	Model 1: Linear main effects		Model 2: Linear interactions with PWD		Model 3: Nonlinear main effects		Model 4: Nonlinear interactions with PWD
	B (SE)	pr	B (SE)	pr	B (SE)	pr	B (SE)	pr
Fixed effects
Main effects
Individual level
Key predictors
Positive relationship quality	.23 (.08)**	.24	.20 (.08)**	.15	.34 (.13)**	.21	.34 (.13)**	.15
Positive relationship quality²	--------------	-----	--------------	-----	.05 (.04)	.11	.06 (.04)	.08
Negative relationship quality	−.08 (.10)	.07	−.13 (.10)	.07	−.03 (.11)	.02	−.08 (.12)	.04
Negative relationship quality²	--------------	-----	--------------	-----	.03(.10)	.03	.07 (.11)	.04
Communal IP	−.04 (.07)	.04	−.04 (.07)	.03	−.08 (.07)	.09	−.10 (.07)	.08
Communal IP²	--------------	-----	--------------	-----	−.07 (.07)	.10	−.10 (.06)	.08
PWD (moderator)	.32 (.07)***	.36	.32 (.07)***	.36	.32 (.07)***	.36	.12 (.15)	.07
Covariates^a
Non-Hispanic White	−.38 (.15)**	.21	−.35 (.15)*	.14	−.32 (.15)**	.18	−.38 (.14)**	.15
Couple level
Diagnostic length	.02 (.01)	.11	.02 (.01)	.12	<.01 (.01)	<.01	<-.01 (.01)	<.01
Diagnostic length²	--------------	-----	--------------	-----	<.01 (<.01)*	.19	<-.01 (<.01)**	.23
Diabetes symptoms	.01 (.01)	.12	.01 (.01)	.07	.01 (.01)	.09	.01 (.01)	.05
Diabetes symptoms²	--------------	-----	--------------	-----	<-.01 (<.01)	.03	<-.01 (<.01)	.01
Diabetes complications	.09 (.14)	.05	.16 (.16)	.08	.14 (.16)	.08	.22 (.18)	.10
Diabetes complications²	--------------	-----	--------------	-----	−.11 (.06)	.14	−.11 (.07)	.13
Relationship length	−.01 (.01)	.12	−.01 (.01)	.09	<.01 (.01)	.03	.01 (.01)	.09
Relationship length²	--------------	-----	--------------	-----	<.01 (<.01)**	.20	<.01 (<.01)**	.25
Interaction effects
Individual level
Positive relationship quality × PWD	--------------	-----	.02 (.05)	.02	--------------	-----	.14 (.07)	.11
Positive relationship quality² × PWD	--------------	-----	--------------	-----	--------------	-----	.05 (.03)*	.12
Negative relationship quality × PWD	--------------	-----	−.01 (.07)	.01	--------------	-----	<.01 (.08)	<.01
Negative relationship quality² × PWD	--------------	-----	--------------	-----	--------------	-----	.01 (.08)	<.01
Communal IP × PWD	--------------	-----	.11 (.07)	.09	--------------	-----	.08 (.07)	.07
Communal IP² × PWD	--------------	-----	--------------	-----	--------------	-----	.06 (.06)	.06
Cross-level
Diagnostic length × PWD	--------------	-----	−.01 (.01)	.09	--------------	-----	<.01 (.01)	.02
Diagnostic length² × PWD	--------------	-----	--------------	-----	--------------	-----	<-.01 (<.01)*	.19
Diabetes symptoms × PWD	--------------	-----	.01 (.01)	.07	--------------	-----	.01 (.01)	.12
Diabetes symptoms² × PWD	--------------	-----	--------------	-----	--------------	-----	<-.01(<.01)	.06
Diabetes complications × PWD	--------------	-----	−.15 (.12)	.12	--------------	-----	−.17 (.13)	.11
Diabetes complications² × PWD	--------------	-----	--------------	-----	--------------	-----	<-.01 (<.01)	.01
Relationship length × PWD	--------------	-----	<-.01 (<.01)	.02	--------------	-----	−.01 (.01)	.14
Relationship length² × PWD	--------------	-----	--------------	-----	--------------	-----	<-.01 (<.01)**	.21
df (Individual level)	288		285		285		279
df (Couple level)	142		138		138		130

	Variance	χ²	Variance	χ²	Variance	χ²	Variance	χ²
Variance components
Random intercept (df)	0.84 (142)	828.74***	1.08 (138)	700.16***	0.74 (138)	760.57***	0.93 (130)	684.6***
Residual	0.36		0.29		0.35		0.26
Model Fit Indices
Deviance	788.67		777.81		770.99		745.00
AIC	800.68		819.82		808.99		815.00
BIC	818.33		829.72		817.95		831.50
Chi-Square (Δχ²)^b	39.97***		10.86*		17.68*		25.99***

Note. SE = standard error; pr = partial correlation; IP = interpersonal problems; df = degrees of freedom. All predictors were run in the same model. Significant findings are bolded.

^aOther individual- and couple-level characteristics listed in Table 1—gender, education, number of chronic conditions (excluding diabetes), whether the partner had a condition requiring dietary changes, whether the partner also had diabetes, and household income—were not statistically significant in any multivariate model and thus excluded.

^bThis value reflects differences in nested models - the current (complex) model versus the simpler model. Model: Model 1 versus a null model with no predictors; Model 2: Model 2 versus Model 1; Model 3: Model 3 versus Model 1; Model 4: Model 4 versus Model 3.

*p < .05. **p < .01. ***p < .001.

Linear interactions with role

Results for Aim 4 (linear interactions) are shown in Model 2 of Table 2. Role did not significantly moderate any of the linear associations between diagnostic length, diabetes symptoms, diabetes complications, relationship length, positive relationship quality, negative relationship quality, or communal IPs and collaborative coping.

Nonlinear main effects

Results for Aims 1–3 (nonlinear main effects) are shown in Model 3 of Table 2. Results revealed significant nonlinear associations between diagnostic length and relationship length with collaborative coping. A quadratic association was found for diagnostic length (b < .01, p < .05, pr = .19), such that couples reported more frequent engagement in collaborative coping when the PWD reported a shorter or longer diagnostic length, and less frequent collabortive coping in couples in which the PWD reported a moderate diagnostic length. A similar quadratic association was found between relationship length (b < .01, p < .01, pr = .20) and collaborative coping, such that couples reported more frequent engagement in collaborative coping when the PWD reported a shorter or longer relationship length, and less frequent collaborative coping in couples in which the PWD reported a moderate relationship length. There were no significant nonlinear associations between diabetes symptoms, diabetes complications, positive relationship quality, negative relationship quality, or communal IPs and collaborative coping.

Nonlinear interactions with role

Results for Aim 4 (nonlinear interactions) are shown in Model 4 of Table 2. Results revealed that role significantly moderated two nonlinear associations. Specifically, the quadratic association between diagnostic length and collaborative coping was moderated by role (b < −.01, p < .05, pr = .19). As shown in Figure 2, the nonlinear association exhibited a similar U-shape for both partners and PWD, with more frequent engagement in collaborative coping in couples in which the PWD reported a shorter or longer diagnostic length, and less frequent collaborative coping in couples in which the PWD reported a moderate diagnostic length. This association was stronger among PWD than partners, however. Similarly, role significantly moderated the quadratic association between relationship length and collaborative coping (b < −.01, p < .01, pr = .21). As shown in Figure 3, the nonlinear association exhibited a similar U-shape for both partners and PWD, with more frequent engagement in collaborative coping in couples in which the PWD reported a shorter or longer relationship length, and less frequent engagement in collaborative coping in which the PWD reported moderate relationship length. This association was stronger among PWD than partners, however. Role did not significantly moderate the nonlinear associations between diabetes symptoms, diabetes complications, positive relationship quality, negative relationship quality, or communal IPs and collaborative coping.

Figure 2.

Nonlinear Association between Diagnostic Length and Collaborative Coping by PWD (Role). Note. The nonlinear association between diagnostic length and collaborative coping moderated by PWD (role) depicted in this figure are derived from the following coefficients of Model 4 (“Nonlinear interactions with PWD”) in Table 2: The main effects for diagnostic length (b=<-.01), diagnostic length² (b < −.01), and PWD (b = .12), the interaction effects of diagnostic length × PWD (b = .01) and diagnostic length² × PWD (b < −.01), and the intercept (b = 2.11). All other predictors were held at their mean values. Centered means and standard deviations of diagnostic length were used. However, original scale values are provided for the predictor.

Figure 3.

Nonlinear Association between Relationship Length and Collaborative Coping by PWD (Role). Note. The nonlinear association between relationship length and collaborative coping moderated by PWD (role) depicted in this figure are derived from the following coefficients of Model 4 (“Nonlinear interactions with PWD) in Table 2: The main effects for relationship length (b = .01) and relationship length² (b < .01), and PWD (b = .12), the interaction effects of relationship length × PWD (b = −.01) and relationship length² × PWD (b < −.01), and the intercept (b = 2.11). All other predictors were held at their mean values. Centered means and standard deviations of relationship length were used. However, original scale values are provided for the predictor.

Post-hoc analyses

In an attempt to provide further clarity on some of our findings – both to understand unexpected findings and reveal additional information about expected ones – we undertook additional, post-hoc analyses. First, to understand the nonsignificant association between diabetes symptoms and collaborative coping, we examined the extent to which PWD experienced diabetes symptoms in our sample. We found that PWD experienced relatively few symptoms related to their diabetes (M = 2.25) and reported experiencing these symptoms “rarely.”

Second, as diabetes complications tend to develop over time, yet our findings for diabetes complications were nonsignificant (but those for diagnostic length were significant), we examined the association between diagnostic length and diabetes complications, which we found to be nonsignificant (r = −.04, p = .68).

Third, as which marriage individuals are in (i.e., first vs. second or later) might be an important consideration in interpreting our findings, and, given that this sample consists of older adult couples, we wanted to understand who in our sample may have shorter relationship lengths. Results revealed that the majority of the sample consisted of individuals in their first marriage (60.8% for PWD, 64.2% for partners). There was also a significant moderate association between relationship length and greater age for both PWD (r = .46, p < .001) and partners (r = .56, p < .001).

Fourth, given the gendered expectations regarding health management and gender differences in collaborative coping experiences in the context of type 2 diabetes in long-term different-sex couples (Meuwly et al., 2013; Umberson et al., 2016; Wang & Umberson, 2023), gender was considered as an additional moderator, despite gender not being associated with collaborative coping when specified as a control variable. Interactions with gender were examined in an exploratory fashion: the interaction between each predictor with gender, as well as 3-way interactions between each predictor, PWD, and gender. Results revealed nonsignificant interaction findings for all predictors. Models would not converge for 3-way interactions, due to limited power.

Finally, as instances wherein both PWD and partners had type 2 diabetes may be an important consideration in the context of collaborative coping, analyses were conducted in which partners who also had diabetes were excluded. The pattern of findings remained the same even after exclusion of these couples (see Supplemental Table 1 for findings in which partners who also had diabetes were excluded).

Discussion

The current study contributes to the literature on dyadic coping in the context of chronic illness by examining potential predictors of collaborative coping, which for the most part has focused on outcomes associated with both partners’ efforts to work together to manage chronic illnesses such as diabetes. These findings provide preliminary evidence for facets of the framework proposed by Helgeson and colleagues (2018) and Berg and Upchurch’s (2007) Developmental-Contextual Model (DCM) of factors predictive of a couple’s engagement in communal coping when managing a chronic illness. Specifically, results indicate that both members of the couple are highly concordant in their collaborative coping efforts and that certain illness and relationship factors may play a role in predicting engagement in collaboration among older adults managing type 2 diabetes, whereas the measure of interdependent personality traits assessed in the current study may be less important.

Illness factors

Although no linear associations emerged between illness factors and collaborative coping, partially consistent with expectations, we found a distinct nonlinear association for diagnostic length. A somewhat “U” shaped pattern emerged such that for PWD who had diabetes for a shorter or longer period of time, they engaged in collaborative coping more frequently compared to PWD who had diabetes for an average amount of time. This association was stronger for PWD than partners. One possible explanation for this finding could be the diabetes-specific distress or anxiety associated with diabetes experienced by PWD and partners. For example, research has found that compared to the general population, adults with type 2 diabetes had a 20% higher prevalence of anxiety (CDC, 2022; Li et al., 2008; Smith et al., 2012), with partners reported to experience anxiety at similar rates (Fisher et al., 2002); diabetes-specific distress is estimated to have a prevalence rate of 36% among PWD (Perrin et al., 2017). Perhaps when newly diagnosed, both partners work together to manage the illness and deal with the accompanying anxiety and stress that arises, as collaborative forms of coping have been found to reduce psychological distress among both PWD and partners (Helgeson et al., 2017; Van Vleet et al., 2019). Those that have been diagnosed for longer lengths of time may experience a resurgence of stress and anxiety, as diabetes is a chronic illness that progresses over time and can increase the risk of other serious health conditions (ADA 2023). As in early years, the stress and anxiety experienced by PWD and partners in later years of diagnosis may increase collaborative coping, as research suggests that spousal anxiety and stress promote more active involvement in their partner’s diabetes management (August, Franks et al., 2020; Helgeson et al., 2022). Those who have been diagnosed for a moderate length of time, however, may have adapted psychologically and behaviorally to their illness, including adhering to a self-management routine, resulting in less need for collaborative coping (Adu et al., 2019; Misra & Lager, 2008; Persell et al., 2004). Further research is needed to identify the specific mechanisms that promote increased engagement in collaborative coping.

Contrary to expectations, no significant associations were found between diabetes symptoms or diabetes complications and collaborative coping. As the PWD in this sample experienced few symptoms at infrequent rates, symptoms may have not raised concerns to prompt engagement in collaborative coping. Furthermore, diabetes symptoms may take years to develop, are often subtle, and may only be visible to the PWD themselves (NCCDPHP, 2022). Thus, if PWD do not communicate symptoms to their partners, partners may be unaware of an opportunity to collaborate; likewise, PWD experiencing little to no symptoms at infrequent intervals may opt to manage the symptoms on their own. Another potential explanation for the lack of association between diabetes symptoms and collaborative coping may be due to the diabetes symptoms measurement itself, as the measurement used was a composite of symptoms of both hyperglycemia and hypoglycemia, two states that differ in actions needed for management (CDC, 2021).

The lack of significant findings for diabetes complications in predicting collaborative coping was surprising and is inconsistent with previous research suggesting that the more complications experienced by PWD, the more involved partners are in the PWD’s diabetes management (August et al., 2013). These differences could be partially explained by the fact that the study by August and colleagues focused solely on dietary management, and not all aspects of diabetes management. Post-hoc analyses revealed that in this sample, diagnostic length and diabetes complications were not correlated, suggesting that this sample deviated from other studies that reported positive associations between diagnostic length and diabetes complications (Zoungas et al., 2014).

Relationship factors

The current study revealed that relationship length and positive relationship quality appear to be important in relation to collaborative coping. Similar to illness factors, no linear effects were found for relationship length, but instead we found a nonlinear association with collaborative coping that differed for PWD and partners. Individuals who had been in a relationship with their partner for both short and long lengths of time engaged in collaborative coping more frequently than individuals who had been in relationships for moderate lengths of time; this finding was stronger among PWD than partners. Our post-hoc analyses revealed that a majority of couples were in their first marriage and that relationship length was only moderately correlated with age, suggesting the possibility that those with shorter relationship lengths may be on their second marriage/marital-like relationship or more (Livingston, 2014; Brown & Lin, 2012).

One possible explanation for the finding for relationship length could be related to couples’ problem-solving skills. Some research suggests that cooperation in newlyweds is common among those in high quality marriages, which characterizes most of our sample who reported high positive relationship quality (Tallman & Hsiao, 2004). Further, couples in long-term marriages have solidified collaborative problem-solving skills with their partners across their marriage and have been found to display a blend of warmth and control during problem solving, and thus are in relationships conducive to successful collaboration (Berg & Upchurch, 2007; Smith et al., 2009). In contrast, in this sample of mostly older adults, those who have been in their relationship for a moderate length of time may be experiencing an influx of dynamic lifestyle changes on top of managing the PWD’s health condition. These changes could include financial and occupational stress related to preparing for and adjusting to retirement (Hurtado & Topa, 2019; Tretina, 2022). These stressors may overwhelm individuals and contribute to reduced engagement in collaborative coping with a chronic illness.

Consistent with expectations and previous literature, positive relationship quality was associated with collaborative coping in a positive linear way. Specifically, greater positive relationship quality was associated with more frequent engagement in collaborative coping, which aligns with previous research on dyadic forms of coping (Berg et al., 2008; Falconier et al., 2013a; Helgeson et al., 2017; Van Vleet et al., 2018). These results emphasize that collaborative coping has a robust, likely cyclical, association with positive relationship quality.

An unexpected finding was that negative relationship quality was not associated with collaborative coping. However, negative relationship quality was significantly and negatively associated with collaborative coping when other predictors were not in the model (data not shown). This finding suggests that although negative relationship quality might be associated with less collaborative coping, other factors (e.g., positive relationship quality) may be more consequential for understanding frequency of engagement in collaborative coping.

Interdependent personality traits

Contrary to expectations, our measure of interdependent personality traits, or the communal dimension of the Interpersonal Circumplex, appeared less important in understanding collaborative coping. One potential explanation for this nonsignificant finding may be that this construct is less closely associated with collaborative coping itself, but instead, indirectly related. For example, research has found that higher husband-reported communal problems among wives were associated with greater relationship quality for both partners (Bliton et al., 2022). This finding further highlights the importance of partners’ perceptions of interpersonal factors, which were not examined in our study. Additionally, other personality factors may be more closely associated with collaborative coping and explain this lack of findings. For example, one study found that extraversion, neuroticism, and conscientiousness were associated with dietary-related spousal involvement in a partner’s type 2 diabetes management (August, Kelly et al., 2020) with other research showing links between neuroticism and couple-level diabetes efficacy (Novak et al., 2017).

Person with diabetes (PWD)

The findings for diagnostic length and relationship length were the only findings in which role (PWD vs. partner) was a significant moderator in predicting collaborative coping; specifically, associations between both diagnostic and relationship length and collaborative coping were found to be stronger among PWD than partners. Collaborative coping activities may be particularly beneficial for PWD (Van Vleet et al., 2019), as collaborative coping in the context of a chronic illness may center around activities that primarily benefit the PWD, such as learning more about diabetes and discussing solutions to diabetes-related problems together (Helgeson et al., 2020). One potential explanation for the lack of other significant findings for role may be that, as adults age, the lines between PWD and partner may blur, with partners also managing their own conditions that may require collaboration (Helgeson et al., 2018). For example, within the current sample, a moderate proportion of partners also had type 2 diabetes, and a majority of partners reported having a condition requiring dietary change, such as heart disease. As such, partner and PWD roles in this sample may not be clearly defined, resulting in mutual coordinated efforts to manage the conditions of both members of the couple.

Limitations and future directions

These findings should be considered with respect to study limitations. This study was cross-sectional, and as such, is limited in its ability to make casual inferences. It is likely that some of the associations found in the current study are bidirectional in nature. For example, research often examines dyadic coping as a predictor of relationship quality (Falconier et al., 2013b). Future research would benefit from utilizing methods to determine causality in an attempt to tease apart the directionality of these associations. Additionally, we are unable to determine how collaborative coping changes over time in relation to diagnostic and relationship length. Future longitudinal studies assessing changes in the frequency of engagement in collaborative coping among couples over time are warranted. This study was also limited in the demographic characteristics of the sample. The sample only consisted of different-sex couples, as well as those who were mostly White, had higher levels of education, were older, and had a high level of positive relationship quality on average. Further, we do not have data on the actual marital and cohabitating status of participants, as the eligibility criterion simply asked participants if they were “married or in a marital-like relationship; ” we also do not have information regarding non-binary or transgender identities. More research is needed on gender and sexual minorities, in particular, given a limited understanding of collaborative coping, and health-related interactions, in general, in these populations (Meuwly et al., 2013; Umberson et al., 2016; Wang & Umberson, 2023). In doing so, future work may provide insight relevant to the development of tailored collaborative coping interventions for couples often underrepresented in research.

The predictors examined in this study were chosen based on Helgeson and colleagues’ (2018) theoretical framework that focused on communal coping, which considers an appraisal of illness as shared as the groundwork for collaboration. As the current study did not assess shared illness appraisals, the findings of this study only apply to the behavioral component of communal coping (i.e., collaborative coping). Lacking a measure of shared illness appraisals is a limitation as these appraisals have been found to be predictive of both engagement in collaborative coping and perceived effectiveness of collaborative coping on health outcomes related to diabetes management (Berg et al., 2020). Further, we did not measure interdependent self-construals, but another type of individual difference in interdependence in the form of communal interpersonal problems. Future research that examines the exact predictors specified and both the behavioral and appraisal component of this model would provide a more direct test of this framework.

Finally, our assessment of factors related to illness severity, such as diabetes symptoms and complications, was limited by the inability to assess the congruence of illness perceptions. Research has shown that congruent illness perceptions benefit adjustment outcomes for those managing chronic illness (Sterba et al., 2008). Future research on collaborative coping would benefit from including measures of illness perception congruence.

Implications for health promotion and interventions

Despite these limitations, findings from the current study have the potential to contribute to interventions for couples managing type 2 diabetes that aim to increase or implement dyadic coping modalities, such as collaborative coping. These interventions can be tailored to a couple’s relationship and disease experiences in an attempt to increase engagement in collaborative coping and subsequently impart benefits to both persons with diabetes and partners. Screening couples for illness and relationship factors and tailoring interventions accordingly in an attempt to promote teamwork and collaboration may be beneficial. For example, in a recent study by Zajdel and Helgeson (2022), couples assigned to the communal coping intervention group who received an intervention specifically tailored to their experiences exhibited increases in both illness appraisals and collaboration as well as other diabetes-related outcomes. Thus, intervention efforts should also focus on promoting a sense of “we-ness” in order to promote collaboration among couples (such as the narrative intervention described in Rohrbaugh, 2021), as shared illness appraisals are considered the foundation for collaboration in the context of coping with chronic illness (Helgeson et al., 2018). Our findings provide a foundation for future work looking to develop new or modify existing interventions aimed at increasing collaboration among couples managing type 2 diabetes.

Conclusion

This study contributes to the overlapping yet distinct literatures on dyadic coping, communal coping, and collaborative coping by utilizing Helgeson and colleagues’ (2018) framework of communal coping predictors to understand predictors of collaborative coping among older adult couples managing type 2 diabetes. The examination of both linear and nonlinear associations was important in uncovering the complex pattern of these associations. Although this study revealed significant associations of positive relationship quality, relationship length, and diagnostic length, the unexpected nonsignificant findings for diabetes symptoms, diabetes complications, negative relationship quality, and communal interpersonal problems require further study. These findings have implications for dyadic interventions aimed at increasing collaboration among couples managing chronic illness.

Supplemental Material

Supplemental Material - Predictors of collaborative coping in couples managing type 2 diabetes: Illness factors, relationship factors, and interdependent personality traits

Supplemental Material for Predictors of collaborative coping in couples managing type 2 diabetes: Illness factors, relationship factors, and interdependent personality traits by Megan B. Mason, Kristin J. August, Charlotte N. Markey, and Josh R. Novak in Journal of Social and Personal Relationships.

Footnotes

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a Rutgers University Research Council Grant.

Open research statement

As part of IARR’s encouragement of open research practices, the authors have provided the following information: This research was not pre-registered. The data used in the research cannot be publicly shared but are available upon request. The data can be obtained by emailing: kristin.august@rutgers.edu. The materials used in the research cannot be publicly shared but are available upon request. The materials can be obtained by emailing: kristin.august@rutgers.edu.

ORCID iDs

Megan B. Mason

Kristin J. August

Josh R. Novak

Supplemental Material

Supplemental material for this article is available online.

Notes

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