Diabetes is a chronic disease in which blood sugar levels are not properly regulated. Type 1 diabetes occurs when the body does not produce sufficient insulin; Type 2 diabetes occurs when the cells in the body do not properly respond to insulin that is produced. Both types result in excess blood sugar levels, which in turn produces complications ranging from symptoms of increased thirst and urination to acute problems such as diabetic ketoacidosis and long-term damage to major organs such as heart, kidney, and eyes. The consequences of diabetes to the patient can be wide-ranging, including anger, depression, anxiety, eating disorders, and similar responses (Pearce, Pereira & Davis, 2013). Diabetic patients are between two and four times more likely to experience major depressive disorders (Bryan et al. 2010). Understanding the coping strategies diabetic patients use is thus a key part of caring for these individuals. This paper assesses the validity of the application of a psychometric tool, the General Coping Questionnaire (GCQ), in assessing the coping responses of diabetic patients.
Validity of Article
A descriptive correlative study evaluated the validity of the GCQ in two independent samples of diabetic patients in Sweden. Sample 1 included 119 Type 1 diabetics, and sample 2 included 184 Type 2 diabetics. The results from the GCQ were correlated with independent validated measures of quality of life (the SF-36 instrument), metabolic control (as measured by participants’ HbA1c levels) and the incidence of complications due to diabetes (Persson, Erichsen, Wändell & Gåfvels, 2013). The GCQ measures ten dimensions of coping, including self-trust, problem-reducing actions, change of values, social trust, minimization, fatalism, resignation, protest, isolation, and intrusion. Only Sample 1 was correlated with the SF-36 quality of life questionnaire, which is a self-rated scale of the participants’ perceived quality of life (Persson et al., 2013). The key hypothesis behind this paper was that effective coping strategies should lead to greater self-reported quality of life, particularly in mental health scales, and improved control of metabolic issues relating to the diabetes (Persson et al., 2013). Persson et al. (2013) asserted that prior research had shown that specific coping scales of problem-reducing actions, change of values, and social trust are most closely correlated to quality of life, and coping scales of resignation and isolation are negatively correlated to quality of life.

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Results
First, Persson et al. (2013) measured issues of internal structure and reliability, finding satisfactory convergent validity on all items in the GCQ (i.e., item-scale correlations >0.40 and as high as 0.85) and Cronbach’s alpha ranging from 0.78 to 0.90 depending on scale. Persson et al. (2013) also found in demographic and clinical variable correlations, age correlated significantly (0.25) only with fatalism, with greater fatalism at older ages for Type 1 sample; for the Type 2 sample, age correlations were found for minimalization (0.22) and intrusion (–0.17). HbA1c levels correlated primarily in the Type 2 patients, in scales of self-trust (–0.22), fatalism (0.21), resignation (0.27), protest (0.32), and intrusion (0.22). Persson et al. (2013) found that their hypotheses were only partially confirmed. While the negative coping dimensions correlated with most of the SF-36 domains as expected, the more positive ones had low correlations with the self-reported quality of life measure (Persson et al, 2013). Only the coping scale of minimization showed a positive quality of life correlation; this scale measures the degree to which the risk to the individual is minimized and positive aspects are emphasized (Persson et al., 2013). While no strong correlations to metabolic issues were expected, the Type 2 sample showed unexpectedly strong positive correlations between HbA1c levels and coping scales of fatalism, resignation, protest, and intrusion, and unexpectedly strong negative correlation with the self-trust coping scale.

Application
While this study provides good evidence of the validity of the GCQ coping measure as a way of determining how well diabetic patients are handling their chronic condition. Of particular note, however, is that the GCQ may not translate well to populations outside Sweden due to cultural differences. The GCQ has certain advantages in that it was created based on patients’ own descriptions of their coping strategies. Because it includes many dimensions of coping, it may provide stronger insight in clinical situations. Understanding how well, and how, patients are coping with chronic conditions such as diabetes, and thus provides guidance to clinicians to improve their care and patient outcomes. With the vulnerability of diabetic patients for major depressive disorders, it is important to monitor these patients for difficulty coping with their condition.

    References
  • Bryan, C., Songer, T., Brooks, M. M., Rush, A. J., Thase, M. E., Gaynes, B., Balasubramani, G. K., Trivedi, M. H., Fava, M. & Wisniewski, S. R. (2010). The impact of diabetes on depression treatment outcomes. General Hospital Psychiatry, 32(1), 33-41.
  • Pearce, M. J., Pereira, K., & Davis, E. (2013). The psychological impact of diabetes: A practical guide for the nurse practitioner. Journal of the American Association of Nurse Practitioners, 25(11), 578-583.
  • Persson, L-O, Erichsen, M., Wändell, P. & Gåfvels, C. (2013). Psychometric evaluation of a coping questionnaire in two independent samples of people with diabetes. Stress and Health, 29(4), 286-296.