The Relationship of Coping Styles and Resilience with Quality of Life in Patients with Type 2 Diabetes

Abstract

ABSTRACT

This study aimed to examine the relationships of coping styles and resilience with quality of life in patients with type 2 diabetes and to determine the contribution of each variable to predicting quality of life. This cross-sectional study employed a correlational design. The statistical population comprised all patients with type 2 diabetes who attended a specialized endocrinology clinic in Tehran between September 2024 and March 2025. Using convenience sampling and based on the sample-size guideline proposed by Tabachnick and Fidell (2021), with an allowance for potential attrition, 250 patients were enrolled in the study. After providing written informed consent, the participants completed three standardized instruments: (1) the Coping Styles Questionnaire (CSQ) developed by Endler and Parker (1990), comprising the problem-focused coping subscale (24 items; Cronbach’s α = .86 in the present study) and the emotion-focused coping subscale (24 items; Cronbach’s α = .83); (2) the 25-item Connor–Davidson Resilience Scale (CD-RISC-25; Cronbach’s α = .91); and (3) the 36-Item Short Form Health Survey (SF-36; Cronbach’s α = .90). Demographic and clinical information, including age, sex, educational attainment, duration of diabetes, and glycated hemoglobin (HbA1c) level, was also recorded. Data were analyzed using SPSS version 26 at both descriptive and inferential levels. Descriptive statistics included means, standard deviations, and frequencies, whereas inferential analyses included Pearson’s correlation coefficient and stepwise multiple regression. Pearson’s correlation analysis indicated a significant positive correlation between problem-focused coping and quality of life (r = .58, p < .001) and a significant negative correlation between emotion-focused coping and quality of life (r = −.43, p < .001). A strong positive correlation was also observed between resilience and quality of life (r = .65, p < .001). The results of the stepwise regression analysis showed that, in the first step, resilience alone explained 42% of the variance in quality of life (β = .65, t = 13.20, p < .001). In the second step, the addition of problem-focused coping increased the model’s explained variance to 60% (ΔR² = .18, β = .38, t = 7.10, p < .001). Emotion-focused coping was entered into the equation in the third step; however, it did not make a significant contribution to predicting quality of life (β = −.09, p = .108) and was therefore excluded from the final model. Examination of the potential confounding variables, including duration of diabetes and HbA1c level, indicated that they did not significantly affect the observed relationships. From a clinical perspective, these findings suggest that psychological interventions for patients with diabetes should focus on two fundamental components: (a) strengthening resilience through cognitive-behavioral and mindfulness-based techniques and (b) teaching practical problem-solving skills and active coping strategies for managing the daily challenges associated with diabetes.