EXPLORING STRESS AND COPING STRATEGIES IN TYPE 2 DIABETES MELLITUS WITH CORONARY ARTERY DISEASE PATIENTS: A FOCUSED ASSESSMENT
DOI:
https://doi.org/10.55766/sujst9545Keywords:
Coping Strategies, Coronary Artery Disease (CAD), Mental Health, Psychological Interventions, Stress, Type 2 Diabetes Mellitus (T2DM)Abstract
Background: Long-term stress and inadequate coping mechanisms are widely recognized as important psychosocial factors in the advancement of non-communicable diseases, such as Type 2 diabetes mellitus (T2DM) and Coronary artery disease (CAD) (Riise et al., 2025). Objectives: This study examines perceived stress, coping strategies, and the predictive role of age, gender, and occupation in individuals with T2DM and CAD. Methods: A total of 100 patients with both T2DM and CAD participated in this cross-sectional study via purposive sampling. Stress and coping were measured using the Perceived Stress Scale (PSS-10) and Brief COPE Questionnaire. Analyses included descriptive statistics, t-tests, Pearson’s correlation, regression, and cluster analysis. Results: Over 78% reported moderate to high stress, with significant differences by gender (p = 0.003) and occupation (p = 0.021). Stress was positively correlated with maladaptive coping (r = 0.678, p<0.01) and negatively with adaptive coping (r = -0.523, p<0.01). Cluster analysis revealed three groups Adaptive, Maladaptive, and Mixed Copers each comprising about one-third of participants. Conclusion: Coping styles and demographic factors significantly predict stress levels in individuals with T2DM and CAD. The findings support the value of psychosocial assessments and interventions to reduce stress and promote adaptive coping in chronic disease management.
References
Aazami, S., Shamsuddin, K., and Akmal, S. (2015). Examining behavioural coping strategies as mediators between work-family conflict and psychological distress. The Scientific World Journal, 2015(1):343075. https://doi.org/10.1155/2015/343075
Airhihenbuwa, C.O., Tseng, T.-S., Sutton, V.D., and Price, L. (2021). Global perspectives on improving chronic disease prevention and management in diverse settings. Preventing Chronic Disease, 18:210055. https://doi.org/10.5888/pcd18.210055
Alosaimi, F.D., Alawad, H.S., Alamri, A.K., Saeed, A.I., Aljuaydi, K.A., Alotaibi, A.S., Alotaibi, K.M., and Alfaris, E.A. (2018). Stress and coping among consultant physicians working in Saudi Arabia. Annals of Saudi Medicine, 38(3):214–224. https://doi.org/10.5144/0256-4947.2018.214
Arnold, S.V., Bhatt, D.L., Barsness, G.W., Beatty, A.L., Deedwania, P.C., Inzucchi, S.E., Kosiborod, M., Leiter, L.A., Lipska, K.J., Newman, J.D., Welty, F.K., and American Heart Association Council on Lifestyle and Cardiometabolic Health and Council on Clinical Cardiology. (2020). Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: A scientific statement from the American Heart Association. Circulation, 141(19):e779-e806. https://doi.org/10.1161/CIR.0000000000000766
Bommer, C., Sagalova, V., Heesemann, E., Manne-Goehler, J., Atun, R., Bärnighausen, T., Davies, J., and Vollmer, S. (2018). Global economic burden of diabetes in adults: Projections from 2015 to 2030. Diabetes Care, 41(5):963-970. https://doi.org/10.2337/dc17-1962
Carver, C. S., Pozo, C., Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., Ketcham, A. S., Moffat Jr., F. L., & Clark, K. C. (1997). How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. Journal of Personality and Social Psychology, 65(2):375–390. https://doi.org/10.1037/0022-3514.65.2.375
Chaaya, R., Sfeir, M., Khoury, S.E., Malhab, S.B., and Malhame, M.E.K. (2025). Adaptive versus maladaptive coping strategies: Insight from Lebanese young adults navigating multiple crises. BMC Public Health, 25:1464. https://doi.org/10.1186/s12889-025-22608-4
Compas, B.E., Jaser, S.S., Bettis, A.H., Watson, K.H., Gruhn, M.A., Dunbar, J.P., Williams, E., and Thigpen, J.C. (2017). Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review. Psychological Bulletin, 143(9):939–991. https://doi.org/10.1037/bul0000110
Garavand, S., Sedighyzade, S., Mahdavi, M., Esmaeilzadeh, A., and Rashidi, R. (2024). Investigating the relationship between occupational stress and demographic variables in dentists. Middle East Journal of Rehabilitation and Health Studies, 11(3):e141543. https://doi.org/10.5812/mejrh-141543
Gruber, E.N. and Biocina, S.M. (2024). Problem-focused coping strategies and high self-compassion as protective factors against stress, negative emotional reactions to job, and anxiety. European Psychiatry, 67(S1):S568–S569. https://doi.org/10.1192/j.eurpsy.2024.1182
Grünenwald, I., Kaluza, A.J., Schultze, M., and van Dick, R. (2022). Stress mindset and social identification in chronic pain patients and their relationship to coping, well-being & depression. Journal of Clinical Psychology in Medical Settings, 30(1):153–168. https://doi.org/10.1007/s10880-022-09883-8
Harun, S.N.F., Jasman, N., Mustapha, F., Jaafar, N., Nadzir, S.N.B.M., Zaini, Z., Krishnan, M., and Subramaniam, P. (2025). Noteworthy trends in maladaptive coping strategies and hindrances to help-seeking behaviour among adolescents living in Malaysia’s People’s Housing Project (PPR) during the COVID-19 pandemic: A qualitative study. PLoS ONE, 20(3):e0318381. https://doi.org/10.1371/journal.pone.0318381
Holton, M.K., Barry, A.E., and Chaney, J.D. (2016). Employee stress management: An examination of adaptive and maladaptive coping strategies on employee health. WORK: A Journal of Prevention, Assessment and Rehabilitation, 53(2):367–372. https://doi.org/10.3233/WOR-152145
Irawanto, D.W., Noermiyati, and Primasari, D. (2015). The effect of occupational stress on work performance of female employees: Study in Indonesia. Asia-Pacific Journal of Management Research and Innovation, 11(4):336–345. https://doi.org/10.1177/2319510X15602970
Ivanivna, O., Balakhtar, V., Pinchuk, N., Pustovalov, I., and Pavlenok, K. (2024). Coping with stressful situations using coping strategies and their impact on mental health. Multidisciplinary Reviews, 7:e2024spe034. https://doi.org/10.31893/multirev.2024spe034
Kohn, P.M., O'Brien, C., Bevington, M., and Pickering, D.I. (2023). Stress, adaptive coping and outcomes: Pilot testing of a new model. Quantitative and Qualitative Methods.
Madhavan, H. (2017). Below the radar innovations and emerging property right approaches in Tibetan medicine. The Journal of World Intellectual Property, 20(5-6):239–257. https://doi.org/10.1111/jwip.12084
Maresova, P., Javanmardi, E., Barakovic, S., Husic, J.B., Tomsone, S., Krejcar, O., and Kuca, K. (2019). Consequences of chronic diseases and other limitations associated with old age: A scoping review. BMC Public Health, 19:1431. https://doi.org/10.1186/s12889-019-7762-5
Muhlestein, J.B., Lappé, D.L., Lima, J.A., Rosen, B.D., May, H.T., Knight, S., Bluemke, D.A., Towner, S.R., Le, V., Bair, T.L., Vavere, A.L., and Anderson, J.L. (2014). Effect of screening for coronary artery disease using CT angiography on mortality and cardiac events in high-risk patients with diabetes: The FACTOR-64 randomized clinical trial. JAMA, 312(21):2234–2243. https://doi.org/10.1001/jama.2014.15825
Özer, G., Griep, Y., and Escartín, J. (2022). The relationship between organizational environment and perpetrators’ physical and psychological state: A three-wave longitudinal study. International Journal of Environmental Research and Public Health, 19(6):3699. https://doi.org/10.3390/ijerph19063699
Pizga, A., Karatzanos, E., Tsikrika, S., Gioni, V., Vasileiadis, I., Nanas, S., and Kordoutis, P. (2022). Psychosocial interventions to enhance treatment adherence to lifestyle changes in cardiovascular disease: A review of the literature 2011–2021. European Journal of Environment and Public Health, 6(1):em0102. https://doi.org/10.21601/ejeph/11582
Reyes-García, R., Moreno-Pérez, Ó., Tejera-Pérez, C., Fernández-García, D., Bellido-Castañeda, V., de la Torre Casares, M.L., Rozas-Moreno, P., Fernández-García, J.C., Marco Martínez, A., Escalada-San Martín, J., Gargallo-Fernández, M., Botana-López, M., López-Fernández, J., González-Clemente, J.M., Jódar-Gimeno, E., and Mezquita-Raya, P. (2018). Document on a comprehensive approach to type 2 diabetes mellitus. Endocrinologia, Diabetes y Nutricion, 66(7):443–458. https://doi.org/10.1016/j.endinu.2018.10.010
Richer, M.-J., Grenier, S., Lupien, S., & Plusquellec, P. (2025). Increasing stress resilience in older adults through a 6-week prevention program: Effects on coping strategies, anxiety symptoms, and cortisol levels. Frontiers in Psychology, 15, 1499609. https://doi.org/10.3389/fpsyg.2024.1499609
Riise, H.K.R., Haugstvedt, A., Igland, J., Graue, M., Softeland, E., Hermann, M., Carlsson, S., Skinner, T.C., Asvold, B.O., and Iversen, M.M. (2025). Diabetes distress and associated psychosocial factors in type 2 diabetes: A population-based cross-sectional study. Diabetology and Metabolic Syndrome, 17:62. https://doi.org/10.1186/s13098-025-01631-w
Roohafza, H., Kabir, A., Sadeghi, M., and Shokouh, P. (2016). Stress as a risk factor for noncompliance with treatment regimens in patients with diabetes and hypertension. ARYA Atherosclerosis, 12(4):166–171.
Sharma, I. (2023). Effects of occupational stress and coping strategies on job satisfaction among employees. International Journal of Indian Psychology, 11(1):2182-2187. https://doi.org/10.25215/1101.218
Smith, M.M., Saklofske, D.H., Keefer, K.V., and Tremblay, P.F. (2016). Coping strategies and psychological outcomes: The moderating effects of personal resiliency. The Journal of Psychology, 150(3):318–332. https://doi.org/10.1080/00223980.2015.1036828
Tegegne, K.D., Gebeyehu, N.A., Yirdaw, L.T., Yitayew, Y.A., and Kassaw, M.W. (2024). Determinants of poor glycemic control among type 2 diabetes in Ethiopia: A systematic review and meta-analysis. Frontiers in Public Health, 12:1256024. https://doi.org/10.3389/fpubh.2024.1256024
