Role of Expressed Emotion and Gender in Adversarial Growth of People with Type 2 Diabetes

The chronic illness tends to have a greater impact on the well-being of the people compared to acute illness. Diabetes mellitus (DM) is a chronic illness where its management requires an effective interplay of bio-psycho-social factors. However, this approach of management is rarely utilized by both including individuals with diabetes and health professionals. Among all the Asian countries, India has the highest prevalence of diabetic patients (King & Rewers, 1993; Ramachandran, Snehalatha, Dharmaraj, & Viswanathan, 1992; DECODA study group, 2003) with Andhra Pradesh reporting very high prevalence rates similar to those in urban Indian populations (Chow et al., 2006) and Hyderabad showing high rates of diabetes and impaired glucose tolerance in the southern part of India (Ramachandran et al., 2001).While many factors play an important role in managing diabetes, family is one of the most prominent factors for the self-care management of the patients in addition to themselves (Etzwiler, 1994). Behavior and affective attitude of the family towards the patient-expressed emotion (Kazarian, 1992) - can be negative, positive, or both. It has a significant impact on psychological factors (like emotions, beliefs, behavior, perception of illness, adherence, and adversarial growth) and social factors (social relationships, occupation, and economic conditions). Five components of expressed emotions are described by Brown (1985), which includes emotional over-involvement, hostility, critical comments, positive remarks, and warmth. As the present study investigated expressed emotion from the perspective of the recipient it measured two major indicators such as perceived criticism and emotional involvement but, not emotional over-involvement as it implied a negative value judgment about behavior, which was preferred to be avoided in the study, whereas perceived criticism measured negative behavior of the family. Perceived criticism refers to critical comments expressed by the family regarding a patient's behavior as perceived by the recipient. Emotional involvement does not hold a negative connotation as held by emotional over-involvement and is referred to as a caregiver's support, empathy and concern towards the individual that can either be high, moderate or low. Moreover, the study also focused on a person's emotional perspective of his or her family in a holistic way.Expressed emotion affects both treatment outcome (Wearden, Tarrier, & Barrowclough, 2000) and one's relationships (Chesla et al., 2004) with emotional over-involvement showing an association with better metabolic control (Dashiff, Hardeman, & Mclain, 2007) and hostility with increased glycated haemoglobin (Worrall-Davies, Owens, Holland, & Haigh, 2002). Expressed emotion, which involves both positive and negative indicators, shapes a person's perception of the chronic illness and associated affect, cognition, and quality of life that may either be positive or negative.Adversarial growth refers to the positive psychosocial changes that can be attributed to adverse life circumstances (Linley & Joseph, 2004). While adversarial growth is a positive growth following a traumatic experience, it is greatly affected by one's social environment, personality, spirituality, affect, and coping styles (Linley & Joseph, 2004). The same pattern is followed in terms of chronic illness, where adversarial growth is affected by one's social relationships (Cordova, Cunningham, Carlson, & Andrykowski, 2001; Maercker & Langner, 2001), cognitive (Armeli, Gunthert, & Cohen, 2001; Waysman, Schwarzwald, & Solomon, 2001) and affective process (Evers et al., 2001), and spirituality (Pargament, Koenig, & Perez, 2000), which further is likely to affect the management of illness. The research findings signify the importance of biological, psychological and social factors in adversarial growth. Recent research has shown that socio-demographic variables such as gender (Weiss, 2002), age (Evers et al. …