Journal of Family Psychology
2009, Vol. 23, No. 4, 521–530
© 2009 American Psychological Association
0893-3200/09/$12.00
DOI: 10.1037/a0015556
The Fit Between Stress Appraisal and Dyadic Coping in
Understanding Perceived Coping Effectiveness for Adolescents With
Type 1 Diabetes
Cynthia A. Berg, Michelle Skinner, Kelly Ko,
and Jorie M. Butler
Debra L. Palmer
University of Wisconsin–Stevens Point
University of Utah
Jonathan Butner
Deborah J. Wiebe
University of Utah
University of Texas Southwestern Medical Center
This study examined whether perceived coping effectiveness (PCE) was associated with
better diabetes management and was higher when adolescents’ dyadic coping was matched to
shared stress appraisals. There were 252 adolescents with Type 1 diabetes who completed
stress and coping interviews where they appraised mothers’ and fathers’ involvement in stress
ownership (mine, indirectly shared, directly shared with parent), in coping (uninvolved,
supportive, collaborative, or controlling), and rated their effectiveness in coping. Adolescents
completed assessments of depressive symptoms (Children’s Depression Inventory), self-care
behaviors (Self-Care Inventory), and efficacy of disease management (Diabetes SelfEfficacy). Glycosylated hemoglobin levels were obtained from medical records. Higher PCE
was associated with fewer depressive symptoms, self-care behaviors, and efficacy across age
and, more strongly for older adolescents’ metabolic control. Appraisals of support or
collaboration from parents were more frequent when stressors were appraised as shared. PCE
was enhanced when dyadic coping with mothers (but not fathers) was consistent with stress
appraisals (e.g., shared stressors together with collaborative coping). Stress and coping is
embedded within a relational context and this context is useful in understanding the coping
effectiveness of adolescents.
Keywords: dyadic coping, diabetes, adolescence, stress and coping, parental involvement
Adolescents with chronic illnesses such as Type 1 diabetes experience stressful events surrounding their illness
(Beveridge, Berg, Wiebe, & Palmer, 2006; Seiffge-Krenke,
2001) and benefit from parental involvement (Anderson,
Ho, Brackett, Finkelstein, & Laffel, 1997; Wiebe et al.,
2005). Adolescents with diabetes report stressful events
such as regulating highs and lows in blood glucose and
problems in food intake and exercise (Beveridge et al.,
2006). An assumption is that adolescents’ ability to deal
effectively with such stressors is associated with enhanced
psychosocial and diabetes adjustment, an assumption that
has yet to be rigorously tested in the adolescent literature.
Further, dyadic models of coping suggest that perceived
coping effectiveness (PCE, evaluation of how well one’s
coping strategies deal with the stressful event) is enhanced
if (a) adolescents perceive mothers as involved in coping
(Berg et al., 2007; Wiebe et al., 2005) and (b) this involvement in coping is consistent with adolescents’ stress appraisals of whether the stressor is something that is the
adolescent’s alone or shared with the mother (Berg &
Upchurch, 2007). Fathers’ involvement in adolescents’ coping has not yet been thoroughly examined, despite the
importance of fathers providing support and monitoring of
adolescents’ diabetes (Berg, Butler, et al., 2008; Wysocki &
Gavin, 2006). In the present study, we examined whether
PCE was enhanced when adolescents’ dyadic coping (e.g.,
parent is uninvolved or collaborative) was consistent with
Cynthia A. Berg, Michelle Skinner, Kelly Ko, Jorie M. Butler,
and Jonathan Butner, Department of Psychology, University of
Utah; Debra L. Palmer, Department of Psychology, University of
Wisconsin–Stevens Point; Deborah J. Wiebe, Department of Psychiatry, University of Texas Southwestern Medical Center.
The project was supported by Grant Number R01DK063044
from the National Institute of Diabetes and Digestive and Kidney
Diseases. The content is solely the responsibility of the authors and
does not necessarily represent the official views of the National
Institute of Diabetes and Digestive and Kidney Diseases or the
National Institutes of Health. We thank the families who participated,
the staff of the Utah Diabetes Center and Michael Swinyard’s practice, as well as the additional members of the ADAPT team (David
Donaldson, Katie Fortenberry, Donna Gelfand, Dwayne Horton, Hai
Le, Rob Lindsay, Jenni McCabe, Mary Murray, Peter Osborn, Marejka Shaevitz, Nathan Story, and Mike Swinyward).
Portions of this work were presented at the meetings of the
American Psychological Association, August, 2007.
Address correspondence to Cynthia A. Berg, 380 S. 1530 E.,
Department of Psychology, University of Utah, Salt Lake City, UT
84112. E-mail: cynthia.berg@psych.utah.edu
521
522
BERG ET AL.
their stress appraisals (e.g., stressor is mine or shared with
the parent), comparing the involvement of mothers and
fathers.
Although the association between PCE and psychosocial
adaptation has been examined in the adult literature, the
child and adolescent literature largely excludes the measurement of perceived coping effectiveness (Grant et al., 2006),
defining effectiveness as psychosocial adjustment. When
adults cope with stress, PCE is associated with better psychological well-being (McCrae & Costa, 1986), lower stress
reactivity (Brauer, 2001), and use of active coping strategies
in health stressors (Zautra & Wrabetz, 1991). Perceived
coping effectiveness may be particularly important for older
adolescents, as they expand and build effective coping repertoires (Brotman-Band & Weisz, 1988; Grant et al., 2006),
face new stressors, and employ more independent coping
strategies (Rudolph, Dennig, & Weisz, 1995). For example,
PCE may be associated with better psychosocial adjustment
(e.g., lower depressive symptoms) as well as diabetes management (better adherence, self-efficacy for diabetes management, and metabolic control) in adolescence (Band &
Weisz, 1990).
The ability to deal effectively with stressful life events
surrounding chronic illness may be enhanced when close
relationship partners are viewed as actively engaged in
coping, consistent with recent dyadic approaches to stress
and coping (Berg & Upchurch, 2007; Revenson, Kayser, &
Bodenman, 2005). In adolescents coping with diabetes,
collaborative coping (where adolescents and mothers pool
resources and jointly problem solve together) has been
associated with fewer depressive symptoms (Berg et al.,
2007), better glucose control, and adherence (Wiebe et al.,
2005), greater parental involvement (Wiebe et al., 2005) and
greater parental acceptance (Berg, Schindler, & Maharajh,
2008). In married couples, collaborative coping has been
associated with better coping effectiveness (Berg, Wiebe et
al., 2008) and higher global self-efficacy (Coyne & Smith,
1991; Kuijer et al., 2000). However, not all research indicates that collaborative coping is associated with better
psychosocial adjustment. For instance, wives whose husbands were recovering from a myocardial infarction reported greater distress with more active engagement with
husbands (Coyne & Smith, 1991). The lack of benefit to
active engagement may have occurred because of a mismatch between dyadic coping and stress appraisal (Manne
& Zautra, 1989).
Dyadic coping may be associated with PCE to the extent
that it fits with how the stressful event is appraised in
relation to others (Berg & Upchurch, 2007; Lyons et al.,
1995). Stress appraisal in the present study refers to how
individuals appraise the ownership of the stressful event
(e.g., mine, shared with others). Initial work on dyadic
coping viewed stressors as potentially appraised as the
person’s alone (e.g., the adolescent’s stressor) as well as the
property of a dyadic unit (the adolescent’s and the mother’s
shared stressor) (Acitelli & Badr, 2005; Lyons et al., 1995).
Families frequently appraise Type 1 diabetes as shared
within the family rather than as the adolescent’s issue alone
(Beveridge et al., 2006; Hauser et al., 1993). Berg and
Upchurch (2007) posit that dyadic coping will be more
frequent when stressors are appraised as shared versus appraised as the adolescent’s alone. Further, PCE may be best
when collaborative coping occurs together with one’s own
appraisal of the stressor as shared and less effective when
one appraises the stressor as his or hers alone.
The importance of the fit between stress appraisal and
dyadic coping for PCE could differ for adolescents’ perceptions of mothers’ and fathers’ involvement. Little research
has focused on fathers’ involvement in the coping efforts of
their children (Kliewer, Fearnow, & Miller, 1996; SeiffgeKrenke, 2002). However, fathers play an important role in
their children’s lives in general (Bumpus et al., 2006) and in
the context of chronic disease, especially during adolescence (Berg, Butler, et al., 2008; Laffel et al., 2003; Palmer
et al., 2009; Wysocki & Gavin, 2006). Adolescents may
perceive mothers to be more involved in their coping efforts
than fathers as mothers are more likely to participate in
everyday caregiving behaviors (Phares, Lopez, Fields, Kamboukos, & Duhig, 2005). Thus, we compared adolescents’
perceptions of the involvement of mothers and fathers in
coping.
The goal of the study was to explore whether PCE was
associated with better diabetes adjustment and whether PCE
was enhanced when adolescents’ dyadic coping was fit to
stress appraisal. Adolescents described the two most stressful events of the week dealing with their diabetes, and three
coping strategies they used to deal with each event. They
then appraised the dyadic nature of each coping strategy
(parent uninvolved, supportive, collaborative, or controlling), and stress appraisal (mine, indirectly or directly
shared with parent), and how well they handled each event
(PCE). First, we established that PCE was associated with
multiple indicators of adjustment to diabetes (i.e., self care
behaviors, depressive symptoms, self-efficacy, metabolic
control). Second, we examined the link between stress appraisal and dyadic coping. We hypothesized that collaborative coping would occur more frequently in the context of
shared stress appraisal. Third, we examined whether a
greater link between shared stress appraisal and collaborative coping was associated with greater perceived efficacy
in dealing with the stressful event.
Method
Participants
Participants included 252 adolescents (M age ⫽ 12.49
years, SD ⫽ 1.53, 53.6% females) diagnosed with Type 1
diabetes mellitus, their mothers (M age ⫽ 39.64 years,
SD ⫽ 6.34) and 188 fathers (M age ⫽ 42.08 years, SD ⫽
6.32) recruited from a university/private partnership clinic
(76%) and a community-based private practice (24%), that
followed similar treatment regimens and clinic procedures.
Eligibility criteria included that adolescents were between
10 and 14 years of age, had diabetes more than 1 year (M ⫽
4.13 years, SD ⫽ 3), and were able to read and write either
English or Spanish. For each adolescent, one mother and
one father were eligible to participate (74% of fathers par-
STRESS APPRAISAL AND DYADIC COPING
ticipated). Adolescents were required to be living with their
participating mother, to facilitate modeling changes in
mother-child relationships over time in the larger project.
Step-mothers or adoptive mothers (3.2%) were eligible if
they had lived with the adolescent for at least 1 year. If both
a biological father and a step- or adoptive father were
eligible, we recruited the father that adolescents reported
was most involved in their diabetes management. Most
(74.6%) participating fathers were biological, with the remainder being step-fathers or adoptive fathers. Approximately half (50.8%) of adolescents were on an insulin
pump, with the remainder prescribed multiple daily injections (MDI). Mothers of adolescents on MDI reported physicians recommended an average of 4.14 insulin injections
(SD ⫽ 1.81, range: 0-10) and 5.53 blood glucose checks per
day (SD ⫽ 1.70, range: 1-11).
Of the qualifying individuals approached, 66% agreed to
participate in the study, the first wave of a 3-year longitudinal study (see Berg, Butler, et al., 2008 for further details
concerning sample selection). Families were largely White
(94%) and middle class: most (73%) reported household
incomes averaging $50,000 or more annually, 51% of mothers and 58% of fathers reported education levels of 2 years
of college or beyond, and an average Hollingshead index
(1975) value of 42.04 indicating a medium business, minor
professional, technical status.
Procedure
The study was approved by the appropriate Institutional
Review Board, with parents providing informed consent
and adolescents providing written assent. During recruitment at their diabetes clinics, participants were scheduled
for a laboratory appointment and received questionnaires to
be completed individually before their appointment. In the
laboratory, adolescents completed questionnaires that were
time-sensitive (e.g., CDI) and participated in a digitally
recorded interview regarding stress and coping. The measures reported here contain only a subset of those included
in the larger study (e.g., parental well-being, parental involvement) and there is no overlap between the results
reported in this study and other papers from this larger study
(Berg, Butler et al., 2008; Palmer et al., 2009).
Measures
Stress and coping interview. The stress and coping interview was a structured interview designed to elicit two
detailed descriptions of adolescents’ diabetes stressful
events that happened in the last week and stress appraisals
and dyadic coping. Consistent with our previous protocol
(Berg et al., 2007; Wiebe et al., 2005), adolescents were first
asked to report one thing that they did each day to remind
them of the past week’s events. They then reported the two
most stressful events of the past week regarding their diabetes. If adolescents could not think of a stressful event
dealing with diabetes, they were prompted with examples
concerning problems that a friend with asthma experienced;
if they still could not think of a diabetes event, they de-
523
scribed the most stressful event of the week. Adolescents
overwhelmingly described diabetes stressors (96.2% of adolescents’ first stressors, 89.3% of the second). We included
all stressors in the analyses as the analyses reported below
were unchanged when the results were restricted to only
diabetes stressors. These stressors were similar to our past
work with adolescents in the same age group (Beveridge et
al., 2006) and included problems with metabolic control,
food management, exercise management, testing, forgetting
diabetes supplies, and management away from home. Adolescents were then asked to describe three coping strategies (thoughts, actions, feelings) they used to manage or
cope with each stressful event. For adolescents who did
not spontaneously mention three strategies, they were
prompted twice with “what else did you do, think or
feel.” If they had difficult thinking of a strategy they were
prompted with examples of strategies that a person with
asthma might use to deal with a stressful event (85.5% of
adolescents mentioned three strategies for the first stressful event and 78.3% for the second stressful event). These
coping responses included a range of actions (e.g., took
insulin, gave a shot, called mom), thoughts (e.g., went
over what I’m supposed to do in my head), and emotions
(e.g., tell myself to calm down). This process was repeated for the second stressor.
Dyadic stress appraisal. Following adolescents’ descriptions of stressful events and coping strategies, they
were asked to appraise each event in relation to their mother
and then to their father. They were asked to first think about
how their mother was involved in each of the two stressful
events, choosing one of the following phrases to describe
each event: (a) stress is mine (my mother does not think
about the stress and isn’t affected by it) indicating individual appraisal, (b) My stress affects my mother (it is my
stress but I know that it affects my mother) indicating
indirectly shared appraisal, or (c) stress is ours (it is something that is shared with my mother) indicating directly
shared appraisal.
Dyadic coping. For each coping strategy that adolescents described as using to deal with the stressor, adolescents were given four categories and then asked to
categorize their mothers’ and then their fathers’ involvement as uninvolved (I worked alone), supportive (mother/
father provided emotional support, encouraged, changed
plans on account of me), collaborative/worked together
(mother/father and I worked together), or controlling (my
mother/father told me what to do). Proportions of uninvolved, supportive, collaborative, and controlling coping
were calculated across the three strategies adolescents
mentioned for each stressful event. For example, if an
adolescent reported that mother was collaborative for all
coping strategies, he or she received a score of 1 for
collaborative/worked together and a score of 0 for supportive or uninvolved.
Perceived coping effectiveness. After describing each
stressful event, adolescents rated one item asking how
well they handled the event (1 ⫽ very badly to 5 ⫽ very
good).
524
BERG ET AL.
Indices of Adjustment to Diabetes
Depressive symptoms. The Children’s Depression Inventory (Kovacs, 1985) indicated the extent to which the
child experienced depressive symptoms in the past 2 weeks.
This 27-item scale has high internal consistency and testretest reliability and is sensitive to difficulties in managing
diabetes (e.g., Grey et al., 2001). Reliability in the present
study was excellent (␣ ⫽.84).
Self report of self-care behaviors. Adolescents individually completed a 16-item Self Care Inventory (adapted
from La Greca et al., 1990) to assess adherence to the
diabetes regimen over the preceding month. The scale was
adapted to reflect current diabetes regimens (e.g., calculating insulin doses based on carbohydrate content of meals or
snacks) by a certified diabetes educator. Reliability in the
present study was excellent (␣ ⫽.85).
Self-efficacy. The Self-Efficacy for Diabetes Management Scale (Iannotti et al., 2006) was used as convergent
validation for the measure of PCE. It assesses the adolescent’s confidence in being able to manage diabetes across
ten problematic situations. Items were rated from 1 ⫽ not at
all sure to 10 ⫽ completely sure and averaged (␣ ⫽.81).
Metabolic control. Children’s glycosylated hemoglobin
(HbA1c) levels were obtained from clinic visits. HbA1c
represents average blood glucose levels over the preceding
three months (higher indicates poorer metabolic control)
and was obtained using the Bayer DCA2000.
Results
Descriptive Statistics
Adolescents categorized mothers most frequently as sharing their stressful event (40.4% and 32.6% for first and
second stressful event, respectively), followed by mine
(31.4% and 40.8%), and then indirectly sharing (28.2% and
26.6%). In contrast, adolescents appraised their stressor in
relation to their father to be largely “mine” (53.3% and
61.4%), followed by indirectly shared (28.6% and 22.3%)
and finally shared (18.1% and 16.3%). Adolescents perceived their mothers were most likely uninvolved, followed
by collaborative and then supportive in their coping efforts.
Similarly, adolescents perceived their fathers as most likely
uninvolved, followed by collaborative and supportive. Strategies were infrequently categorized as controlling (3% for
mother’s involvement and 1% for fathers’ involvement) and
thus were not analyzed further. To analyze parent differences in dyadic coping, three repeated measures ANOVAs
(one for each coping category) were conducted with parent
(mother, father) and stressor number (first vs. second) as
within subject variables. Significant parent differences were
found for all coping categorizations: uninvolved F(1,
214) ⫽ 122.0, p ⬍ .01, collaborative F(1, 214) ⫽ 19.2, p ⬍
.01, and supportive coping F(1, 214) ⫽ 69.7, p ⬍ .01. As
can be seen in Table 1 (containing means and standard
deviations of variables), adolescents appraised mothers to
be less uninvolved, more collaborative, and more supportive
than fathers in their coping. Intercorrelations of the same
Table 1
Means and SDs of Study Variables
Study variable
Mean
SD
Mother collaboration Stressor 1
Mother collaboration Stressor 2
Mother support Stressor 1
Mother support Stressor 2
Mother uninvolved Stressor 1
Mother uninvolved Stressor 2
Father collaboration Stressor 1
Father collaboration Stressor 2
Father support Stressor 1
Father support Stressor 2
Father uninvolved Stressor 1
Father uninvolved Stressor 2
PCE Stressor 1
PCE Stressor 2
CDI
Self-care
Self-efficacy
HbA1c
.36
.28
.22
.17
.38
.52
.25
.22
.09
.08
.65
.68
3.8
3.7
5.4
3.9
6.7
8.4
.29
.30
.28
.29
.36
.38
.29
.29
.20
.19
.37
.36
.80
.84
5.2
.58
1.7
1.6
dyadic coping categories across the two stressful events
(e.g., collaboration on Stressor 1 with collaboration on
Stressor 2) revealed quite low correlations (range: .10, p ⬎
.05 to .33, p ⬍ .05 for mothers, .30 to .53, for fathers all
ps ⬍ .05).
PCE and Diabetes Outcomes
To examine whether PCE was associated with adjustment, a series of multiple regressions was conducted with
PCE, age of adolescent, and the interaction of PCE by age
as independent variables (each effect was first centered at its
mean and then interactions calculated; Aiken & West,
1991), and adherence, depressive symptoms, self-efficacy,
and HbA1c as dependent variables. Given correlations between PCE on Stressor 1 and Stressor 2 (r ⫽ .37, p ⬍ .01),
these two measures were combined for the analyses below.
The results remain the same when analyzed separately by
event. Higher PCE was associated with higher adherence
F(229) ⫽ 7.8, ␤ ⫽ .23, p ⬍ .01, R2 ⫽ .09, lower depressive
symptoms F(229) ⫽ 15.1, ␤ ⫽ ⫺.34, p ⬍ .01, R2 ⫽.12 and
higher self-efficacy, F(227) ⫽ 10.2, ␤ ⫽ .23, p ⬍ .01, R2 ⫽
.08. No interactions were found between PCE and age for
these variables (p ⬎ .05). Finally, better metabolic control
(lower HbA1c) occurred for adolescents with higher PCE,
F(229) ⫽ 7.0, ␤ ⫽ ⫺.20, p ⬍ .01, R2 ⫽ .07, but this was
modified by an interaction between PCE and age (␤ ⫽
⫺.14, p ⬍ .01, R2 change ⫽ .02). PCE was associated with
lower HbA1c, but this association was stronger among older
versus younger adolescents. These analyses support our
hypothesis that PCE would be associated with better diabetes adjustment.
Relation Between Stress Appraisal
and Dyadic Coping
To address whether stress appraisal was associated with
dyadic coping, ANOVAs were conducted separately for
STRESS APPRAISAL AND DYADIC COPING
Stressor 1 and 2, with stress appraisal as the independent
variable and the proportion of each dyadic coping measure
as the dependent variable (see Table 2). We used separate
ANOVAs to facilitate comparisons across stressor appraisal, rather than calculating multiple dummy codes and
analyzing both stressors with repeated measures regression.
These analyses indicated that when adolescents viewed
stressors as their own, they viewed both mothers and fathers
as more uninvolved for each stressor. In contrast, when
adolescents viewed the stressor as either indirectly or directly shared, they were more likely to see their mothers and
fathers as involved via supportive and collaborative coping.
In 10 of the 12 cases, the difference between indirect and
shared appraisals was not significant using Scheffe post-hoc
comparisons. Thus, all further analyses were collapsed
across indirect and shared. These analyses confirm that there
is a link between stress appraisal and dyadic coping.
Fit Between Stress Appraisal and Dyadic Coping
Predicting PCE
The third aim examined whether PCE was higher when
there was a greater fit between stress appraisal and dyadic
coping; that is, whether stress appraisal interacted with
dyadic coping to predict PCE. Because stressors were
nested within individuals, and adolescent appraisals of
mother and father were nested within family, we used
multivariate hierarchical linear models with application to
matched pairs (HMLM2; Raudenbush, Bryk, Cheong, &
Congdon, 2000). This procedure simultaneously estimated
models for adolescents’ appraisals of mothers and fathers,
and allowed us to test for differences in regression weights
across parent (see also Berg et al., 2008). Using collaboration as an example, the independent variables were stress
appraisal for each stressor and the proportion of coping
525
strategies appraised as collaborative, and the interaction of
stressor appraisal and collaborative coping. Similar models
were analyzed with uninvolved and supportive coping as
independent variables. Stress appraisal was dummy
coded (1 ⫽ shared or indirect, ⫺1 ⫽ mine) and the
proportion of coping strategies (collaborative, uninvolved, or supportive) were centered around their mean
to create interaction terms (Aiken & West, 1991). Models
were initially conducted to test whether the stressor appraisal ⫻ coping interaction was modified by age or
gender; no significant effects were found, so we present
the reduced model. In addition, length of diagnosis was
used as a covariate in all models, but was not included in
the final models because it did not alter the results.
The model using collaborative coping revealed that there
was a significant interaction between stressor appraisal and
proportion of collaborative coping for Stressor 1, but the
effect was not significant for Stressor 2 (see Table 3). A test
of whether the interaction effect was different across Stressor 1 and Stressor 2 revealed no significant differences,
␹2(1) ⫽ 2.56, p ⬎ .10. Because this test was not significant,
we conducted a pooled test of the coefficient across stressors, which was significant, ␹2(1) ⫽ 4.36, p ⬍ .05. As can
be seen in Figure 1, greater use of collaborative coping was
only associated with greater PCE when adolescents perceived that the stressor was indirectly or directly shared
with their mother. When the stressor was appraised as
individual, greater use of collaborative coping was associated with poorer PCE.
A similar model was used to analyze the proportion of
uninvolved coping. A significant interaction between stressor appraisal and uninvolved coping occurred only for
Stressor 1, but the interaction was not significantly different
across Stressors 1 and 2, ␹2(1) ⫽ 1.68, p ⬎ .10. The pooled
Table 2
ANOVAs of Stress Appraisal Predicting Strategy Categorizations
Mine
Stress appraisal
Teen’s perceptions of mother
Stressor 1
1. Uninvolved
2. Collaborative
3. Supportive
Stressor 2
1. Uninvolved
2. Collaborative
3. Supportive
Teen’s perceptions of father
Stressor 1
1. Uninvolved
2. Collaborative
3. Supportive
Stressor 2: Stressor categorizations
1. Uninvolved
2. Collaborative
3. Supportive
Indirect
Shared
Mean
SE
Mean
SE
Mean
SE
F
df
.61a
.27a
.11a
.04
.03
.03
.32b
.42b
.22a,b
.04
.03
.03
.25b
.38b
.31b
.03
.03
.03
28.58ⴱⴱ
5.97ⴱⴱ
11.49ⴱⴱ
2, 241
2, 241
2, 241
.74a
.18a
.07a
.03
.03
.03
.45b
.40b
.15a
.04
.04
.03
.30c
.33b
.33b
.04
.03
.03
40.97ⴱⴱ
12.5ⴱⴱ
22.19ⴱⴱ
2, 230
2, 233
2, 230
.84a
.13a
.03a
.03
.03
.02
.49b
.39b
.12b
.04
.03
.03
.38b
.39b
.22b
.03
.04
.03
45.5ⴱⴱ
26.66ⴱⴱ
15.92ⴱⴱ
2, 223
2, 223
2, 223
.81a
.15a
.02a
.03
.03
.01
.51b
.37b
.12b
.05
.04
.03
.40b
.31b
.25c
.05
.05
.03
32.3ⴱⴱ
12.93ⴱⴱ
24.68ⴱⴱ
2, 212
2, 212
2, 212
Note. Means sharing same subscripts were not significantly different from one another.
ⴱⴱ
p ⬍ .01.
526
BERG ET AL.
Table 3
HMLM Coefficients for Models Examining Fit of Stressor
Appraisal and Dyadic Coping-Adolescents’ Appraisals of
Mothers’ Involvement
Perceived coping effectiveness
I. Collaborative strategies
Intercept
Stressor appraisal (SA)
Collaborative strategies (CS)
SA ⫻ CS
II. Uninvolved strategies
Intercept
Stressor appraisal (SA)
Uninvolved strategies (US)
SA ⫻ US
III. Supportive strategies
Intercept
Stressor appraisal (SA)
Supportive strategies (SS)
SA ⫻ SS
ⴱⴱ
Stressor 1
Stressor 2
Coeff
SE
Coeff
SE
3.64ⴱⴱ
.01
⫺.01
.15ⴱⴱ
.06
.05
.05
.05
3.68ⴱⴱ
⫺.03
.09
.02
.06
.06
.06
.06
3.60ⴱⴱ
.03
.03
⫺.15ⴱⴱ
.06
.06
.05
.05
3.66ⴱⴱ
⫺.04
⫺.09
⫺.05
.07
.06
.06
.06
3.63ⴱⴱ
.01
⫺.07
.07
.06
.06
.06
.06
3.68
⫺.03
.08
⫺.03
.06
.05
.06
.06
p ⬍ .01.
test of the coefficient across stressors was statistically significant, ␹2(1) ⫽ 6.03, p ⬍ .05. Greater use of uninvolved
coping was associated with greater PCE when adolescents
perceived that the stressor was theirs alone (Figure 2).
However, when the stressor was viewed as shared, greater
use of uninvolved coping was associated with poorer PCE.
Analyses conducted on supportive coping yielded no significant interactions (ps ⬎ .05).
A similar set of analyses was conducted for teen’s appraisals of father’s involvement. In analyses for collaborative, uninvolved and supportive coping, no significant interaction was found between stressor appraisal and strategy
categorizations (p ⬎ .05).
Discussion
PCE in managing diabetes stressors was associated with
depressive symptoms, self-efficacy for diabetes management, adherence, and metabolic control. Consistent with the
Developmental Contextual Model (Berg & Upchurch,
2007), dyadic coping was more frequent in stressors viewed
as shared. Further, results indicated that PCE was higher
when dyadic coping with mothers was consistent with adolescents’ appraisals of stressful situations. Our results
point towards the importance of examining adolescents’
appraisals of stressors, especially appraisals of how parents
are involved in coping.
PCE and Adjustment
The results demonstrate the value of measuring appraisals
in addition to global adjustment. Adolescents’ appraisals of
3.9
3.8
Perceived Coping Effectiveness
3.7
3.6
Mine
Shared (Directly or Indirectly)
3.5
3.4
3.3
3.2
3.1
Low Collab
High Collab
Adolescents' Categorization of Mothers' Involvement
Figure 1. Perceived coping effectiveness as a function of adolescents’ stress appraisal and
collaborative coping with mothers.
STRESS APPRAISAL AND DYADIC COPING
527
3.8
Perceived Coping Effectiveness
3.7
3.6
3.5
Mine
Shared (Directly or Indirectly)
3.4
3.3
3.2
3.1
Involved
Uninvolved
Adolescents' Categorization of Mothers' Involvement
Figure 2. Perceived coping effectiveness as a function of adolescents’ stress appraisal and
uninvolved coping with mothers.
higher PCE were associated with lower depressive symptoms, higher self-efficacy for diabetes management, better
HbA1c, and better adherence. These findings lend support
to the assumption in the literature that when adolescents
effectively deal with specific stressful events, they experience better overall adjustment. The link between PCE and
adjustment is consistent with the adult literature (Brauer,
2001; McCrae, & Costa, 1986; Zautra, Hamilton, & Yocum,
2000; Zautra & Wrabetz, 1991). Additionally, our study is
consistent with the work of Band and Weisz (1990) that
coping effectiveness is associated with better diabetesrelated outcomes.
PCE was associated with adjustment similarly across age,
with the exception of its associations with metabolic control. That is, although perceived coping effectiveness was
associated with better metabolic control, this association
was stronger for older adolescents. It is possible that older
adolescents’ ability to cope effectively with diabetes stressors (many of which include regulating blood glucose) may
have a direct physiological pathway to metabolic control.
Alternatively, older adolescents may use HbA1c as a gauge
for how well they are coping with daily stressors more so
than younger adolescents. Our results do not point to overarching age differences in appraisals, in contrast to the
literature indicating marked age increases in cognitive or
emotion-focused coping strategies (Compas et al., 2001).
Age differences may appear in a slightly older sample of
adolescents, an issue that will be addressed in our longitudinal work with this sample. One limitation of the present
study was its somewhat restricted age range.
Stress Appraisal and Dyadic Coping and PCE
Conceptualizations of dyadic coping across the life-span
suggest that in addition to examining others’ involvement in
coping, others may also be involved in how stressors are
appraised (Berg & Upchurch, 2007). To our knowledge, our
results are the first to demonstrate a link between stress
appraisal and dyadic coping. For adolescents’ perceptions
of both mothers and fathers, perceptions that parents shared
their stressor were associated with greater collaborative
and supportive involvement, and lower uninvolvement,
in the strategies they used to cope with the stressful
event. Although stress appraisals were linked to dyadic
coping, stress appraisal and coping were not synonymous. Our results indicating the modest association between dyadic coping categories across the two stressful
events suggests that dyadic coping occurs in response to
specific contextual conditions and less a function of
person characteristics.
Results further indicate that PCE is associated with the
appraisal of the stressful event, and that congruence between stress appraisals of stress and dyadic coping is associated with higher PCE (Berg & Upchurch, 2007; Lyons et
al., 1995). We did not see simple associations between
collaborative, supportive, or uninvolved coping predicting effectiveness. Past work would indicate that perceptions of collaborative coping are associated with positive
adjustment in adolescents with diabetes (Berg et al.,
2007; Wiebe et al., 2005) and PCE in patients coping
with prostate cancer (Berg, Wiebe et al., 2008). It is
528
BERG ET AL.
possible that cohort differences between our previous
work and the present work may explain why we did not
see this anticipated finding. A potential cohort factor
could be rapidly changing medical technologies now
available for insulin delivery (e.g., the increasing number
of adolescents who manage their diabetes using an insulin pump), which may alter the role of parental involvement in adolescent diabetes management (Streisand,
Swift, & Wickmark, 2005).
When stressful events were viewed as shared with the
mother, the presence of collaborative coping was associated
with better PCE, whereas the presence of uninvolved coping
was associated with lower PCE. Thus, stress appraisal may
provide an important context for understanding the benefits
of dyadic coping. Our results suggest that collaborative
coping is not perceived as effective when adolescents
appraise the stressful event as their own, potentially
because such involvement may be perceived as intrusive
and overprotective (Holmbeck et al., 2002). The lack of
results for supportive coping here may be because of its
lower frequency, especially when adolescents appraised
their stressors as individual. The present results here on
dyadic stress appraisal and coping extends research
(Park, Armeli, & Tennen, 2004) on “goodness of fit” that
typically assesses the fit between appraisals of controllability and type of strategy (i.e., primary versus secondary
control; Lazarus & Folkman, 1984) to include the fit
between stressor ownership and dyadic coping.
Our results indicate that the associations of the fit between stress appraisal and coping and PCE is only applicable for mothers, but not fathers. Appraisals of mothers’ and
fathers’ involvement in both stress appraisal and dyadic
coping revealed several differences. Consistent with the
view of mothers as the primary caregiver in assisting children with practical and instrumental tasks (Phares et al.,
2005), mothers were viewed as far more involved both in
how the adolescent appraised stressful events and dyadic
coping. Fathers were perceived to be predominantly uninvolved in adolescents’ coping. Fathers may play more
of a distant role rather than being active in managing
adolescents’ daily stressors (Faulkner, 1996), which may
explain their lower influence in adolescents’ coping
(Kliewer et al., 1996). Fathers’ greater uninvolvement in
stress appraisal and coping may have led to the lack of
interactions between adolescents’ appraisals and dyadic
coping predicting PCE.
The results should be considered in the context of some
limitations. First, individuals were only asked about the two
most stressful events of the week. Our work with married
couples (Berg, Wiebe et al., 2008) suggests that greater
sampling of stressful events across the daily lives of families may be beneficial in understanding appraisal and dyadic
coping processes. Further, adolescents were the sole source
of data and the results could be due, in part, to shared
method variance. Further work with the present sample
includes daily diary analyses of adolescents, mothers, and
fathers, and will allow us to examine daily processes across
reporters. Second, reports of stressful events were retrospective in nature and the amount of time between recall and the
experience of the stressful event may have influenced both
how parental involvement and PCE was perceived. Thus,
we cannot interpret our results as indicating causal relationships. An alternative direction of causality is also plausible.
For instance, adolescents who have greater PCE may invite
parents into their stress and coping efforts, and perceive
greater shared ownership and collaborative coping. Third,
our conceptualization of dyadic coping was based on a
categorical view of parental involvement; future work is
needed to compare our categorical interview methods
with more typical continuous rating scales. In addition,
our categorization of dyadic coping is only one way in
which to categorize coping and comparisons of our categorization to more typical stressors categories (e.g.,
problem-focused vs. emotion-focused or adaptive vs. not
adaptive) would be fruitful. Fourth, participants were
almost exclusively White with above average levels of
socioeconomic status making it difficult to generalize
findings to the general population.
In general, the results indicate that stress and coping is
embedded within the dyadic coping context. As adolescents
manage stressors surrounding chronic illness, appraisal processes concerning the shared nature of stressors may provide a context for how effective dyadic coping will be. As
in the adult literature, interventions that promote coping
effectiveness may be a fruitful avenue for enhancing adolescents’ feelings of competence to manage illness-related
stressors. Further, including parents, especially mothers, in
these efforts may enhance both psychosocial and diabetesspecific adjustment by encouraging adaptive involvement
(e.g. matching adolescents’ perceptions with parental involvement in coping).
References
Acitelli, L. K., & Badr, H. (2005). My illness or our illness?
Attending to the relationship when one partner is ill. In T. A.
Revenson, K. Kayser, & G. Bodenmann (Eds.), Emerging perspectives on couples’ coping with stress (pp. 121–136). Washington, DC: American Psychological Association.
Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing
and interpreting interactions. Thousand Oaks, CA: Sage Publications.
Anderson, B. J., Ho, J., Brackett, J., Finkelstein, D., & Laffel, L.
(1997). Parental involvement in diabetes management tasks:
Relationships to blood-glucose monitoring, adherence, and metabolic control in young adolescents with IDDM. Journal of
Pediatrics, 130, 257–265.
Band, E., & Weisz, J. R. (1990). Developmental differences in
primary and secondary control coping and adjustment to juvenile
diabetes. Journal of Clinical and Child Psychology, 19, 150 –
158.
Berg, C. A., Butler, J., Osborn, P., King, G., Palmer, D., Butner, J.,
et al. (2008). The role of parental monitoring in understanding
the benefits of parental acceptance on adolescent adherence and
metabolic control of type 1 diabetes. Diabetes Care, 31, 678 –
683.
Berg, C. A., Schindler, I., & Marajh, S. (2008). Adolescents’ and
Mothers’ Perceptions of the Cognitive and Relational Functions
of Collaboration and Adjustment in Dealing with Type 1 Diabetes. Journal of Family Psychology, 22, 865– 874.
STRESS APPRAISAL AND DYADIC COPING
Berg, C. A., & Upchurch, R. (2007). A developmental-contextual
model of couples coping with chronic illness across the adult life
span. Psychological Bulletin, 133, 920 –954.
Berg, C. A., Wiebe, D. J., Beveridge, R. M., Palmer, D. L.,
Korbel, C. D., Upchurch, R., et al. (2007). Mother-child
appraised involvement in coping with diabetes stressors and
emotional adjustment. Journal of Pediatric Psychology, 32,
995–1005.
Berg, C. A., Wiebe, D. J., Bloor, L., Butner, J., Bradstreet, C.,
Upchurch, R., et al. (2008). Collaborative coping and daily mood
in couples dealing with prostate cancer. Psychology and Aging,
23, 505–516.
Beveridge, R. M., Berg, C. A., Wiebe, D. J., & Palmer, D. L.
(2006). Mother and adolescent representations of illness ownership and stressful events surrounding diabetes. Journal of Pediatrics Psychology, 31, 818 – 827.
Brauer, D. J. (2001). Common patterns of person-environment
interaction in persons with rheumatoid arthritis. Western Journal
of Nursing Research, 23, 414 – 430.
Brotman-Band, E. B., & Weisz, J. R. (1988). How to feel better
when it feels bad: Children’s perspectives on coping with everyday stress. Developmental Psychology, 24, 247–253.
Bumpus, M. F., Crouter, A. C., & McHale, S. M. (2006). Linkages
between negative work-to-family spillover and mothers’ and
fathers’ knowledge of their young adolescents’ daily lives. Journal of Early Adolescence, 26, 36 –59.
Compas, B., Connor-Smith, J., Saltzman, H., Thomsen, A., &
Wadsworth, M. (2001). Coping with stress during childhood and
adolescence: Problems, progress, and potential in theory and
research. Psychological Bulletin, 127, 87–127.
Coyne, J. C., & Smith, D. A. F. (1991). Couples coping with a
myocardial infarction: A contextual perspective on wives’ distress. Journal of Personality and Social Psychology, 61, 404 –
412.
Faulkner, M. S. (1996). Family responses to children with diabetes
and their influence on self-care. Journal of Pediatric Nursing, 11,
82–93.
Grant, K. E., Compas, B. E., Thurm, A. E., McMahon, S. D.,
Gipson, P. Y., Campbell, A. J., et al. (2006). Coping with stress
during childhood and adolescence: Problems, Progress, and Potential theory and research. Clinical Psychology Review, 26,
257–283.
Grey, M., Davidson, M., Boland, E. A., & Tamborlane, W. V.
(2001). Clinical and psychosocial factors associated with
achievement of treatment goals in adolescents with diabetes
mellitus. Journal of Adolescent Health, 28, 377–385.
Hauser, S., DiPlacido, J., Jacobson, A., & Willett, J. (1993).
Family coping with an adolescent’s chronic illness: An approach
and three studies. Journal of Adolescence, 16, 305–329.
Holmbeck, G. N., Johnson, S. Z., Wills, K. E., McKernon, W.,
Rose, B., Erklin, S., et al. (2002). Observed and perceived
parental overprotection in relation to psychosocial adjustment in
preadolescents with a physical disability: The mediational role of
behavioral autonomy. Journal of Consulting and Clinical Psychology, 70, 96 –110.
Iannotti, R. J., Schneider, S., Nansel, T. R., Haynie, D. L., Plotnick, L. P., Clark, L. M., et al. (2006). Self-efficacy, outcome
expectations, and diabetes self-management in adolescents with
type 1 diabetes. Journal of Developmental and Behavioral Pediatrics, 27, 98 –105.
Kliewer, W., Fearnow, M. D., & Miller, P. A. (1996). Coping
socialization in middle childhood: Tests of maternal and paternal
influences. Child Development, 67, 2359 –2357.
529
Kovacs, M. (1985). The children’s depression inventory (CDI).
Psychopharmacology Bulletin, 21, 995–998.
Kuijer, R. G., Ybema, J. F., Buunk, B. P., de Jong, G. M.,
Thijs-Boer, F., & Sanderman, R. (2000). Active engagement,
protective buffering, and overprotection: Three ways of giving
support by intimate partners of patients with cancer. Journal
of Social and Clinical Psychology, 19, 256 –275.
Laffel, L. M., Connell, A., Vangsness, L., Goebel-Fabbri, A.,
Mansfield, A., & Anderson, B. J. (2003). General quality of life
in youth with type 1 diabetes: Relationship to patient management and diabetes-specific family conflict. Diabetes Care, 26,
3067–3073.
La Greca, A. M., Follansbee, D., & Skyler, J. S. (1990). Learned
helplessness in diabetic youths. Journal of Pediatric Psychology,
15, 581–594.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and
coping. New York: Springer Publishing Company.
Lyons, R., Sullivan, M., Ritvo, P., & Coyne, J. (1995). Relationships in chronic illness and disability. Thousand Oaks, CA: Sage.
Manne, S. L., & Zautra, A. J. (1989). Spouse criticism and support:
Their association with coping and psychological adjustment
among women with rheumatoid arthritis. Journal of Personality
and Social Psychology, 56, 608 – 617.
McCrae, R. R., & Costa, P. T. (1986). Personality, coping, and
coping effectiveness in an adult sample. Journal of Personality,
54, 385– 405.
Palmer, D. L., Berg, C. A., Butler, J., Fortenberry, K., Murray, M.,
Lindsay, R., et al. (2009). Mothers’, fathers’, and children’s
perceptions of parental diabetes responsibility in adolescence:
Examining the roles of age, pubertal status, and efficacy. Journal
of Pediatric Psychology, 34, 194 –204.
Park, C. L., Armeli, S., & Tennen, H. (2004). Appraisal-Coping
goodness of fit: A daily internet study. Personality and Social
Psychology Bulletin, 30, 558 –569.
Phares, V., Lopez, E., Fields, S., Kamboukos, D., & Duhig,
A. M. (2005). Are fathers involved in pediatric psychology
research and treatment? Journal of Pediatric Psychology, 30,
631– 643.
Raudenbush, S. W., Bryk, A., Cheong, Y. F., & Congdon, R.
(2000). HLM 5: Hierarchical linear and nonlinear modeling.
Chicago: Scientific Software International.
Revenson, T., Kayser, K., & Bodenmann, G. (2005). Couples
coping with stress: Emerging perspectives on dyadic coping.
Washington, DC: American Psychological Association.
Rudolph, K. D., Dennig, M. D., & Weisz, J. R. (1995). Determinants and consequences of children’s coping in the medical
setting: Conceptualization, review, and critique. Psychological
Bulletin, 118, 328 –357.
Seiffge-Krenke, I. (2001). Diabetic adolescents and their families:
Stress, coping, and adaptation. New York: Cambridge University Press.
Seiffge-Krenke, I. (2002). “Come on, say something, Dad!”: Communication and coping in fathers of diabetic adolescents. Journal
of Pediatric Psychology, 27, 439 – 450.
Streisand, R., Swift, E., & Wickmark, T. (2005). Pediatric parenting stress among parents of children with type 1 diabetes: The
role of self-efficacy, responsibility, and fear. Journal of Pediatric
Psychology, 30, 513–521.
Wiebe, D. J., Berg, C. A., Palmer, D., Korbel, C., Beveridge,
R., Swinyard, M., et al. (2005). Children’s appraisals of
maternal involvement in coping with diabetes: Enhancing our
understanding of adherence, metabolic control, and quality of
life across adolescence. Journal of Pediatric Psychology, 30,
167–178.
530
BERG ET AL.
Wysocki, T., & Gavin, L. (2006). Paternal involvement in the
management of pediatric chronic diseases: Associations with
adherence, quality of life, and health status. Journal of Pediatric
Psychology, 31, 501–511.
Zautra, A. J., Hamilton, N., & Yocum, D. (2000). Patterns of
positive social engagement among women with rheumatoid
arthritis. Occupational Therapy Journal of Research, 20, 21S–
40S.
Zautra, A. J., & Wrabetz, A. B. (1991). Coping success and its
relationship to psychological distress for older adults. Journal of
Personality and Social Psychology, 61, 801– 810.
Received July 3, 2008
Revision received January 26, 2009
Accepted January 27, 2009
䡲