Relationship Styles and Mortality in Patients with Diabetes

  1. Paul Ciechanowski, MD, MPH (pavelcie{at},
  2. Joan Russo, PhD1,
  3. Wayne J. Katon, MD1,
  4. Elizabeth H.B. Lin, MD, MPH3,
  5. Evette Ludman, PhD3,
  6. Susan Heckbert, MD, PhD2,3,
  7. Michael Von Korff, PhD3,
  8. Lisa H. Williams, MD4 and
  9. Bessie A. Young, MD, MPH3,4
  1. Departments of 1Psychiatry and
  2. 2Epidemiology, University of Washington, Seattle, WA
  3. 3Center for Health Studies, Group Health, Seattle, WA
  4. 4Veterans Administration Puget Sound Health Care System, Seattle, W A


Objective: Prior research has shown that less social support is associated with increased mortality in individuals with chronic illnesses. We set out to determine whether lower propensity to seek support as indicated by relationship style is associated with mortality in patients with diabetes.

Research Methods: A total of 3535 non-depressed adult patients with type 1 and 2 diabetes enrolled in a HMO in Washington State were surveyed at baseline and followed for five years. Relationship style was assessed at baseline. Patients with a greater propensity to seek support were classified as having an interactive relationship style and those less inclined to seek support as having an independent relationship style. We collected Washington State mortality data and used Cox proportional hazards models to estimate relative risk (RR) of death for relationship style groups.

Results: The rate of death in the independent and interactive relationship style groups was 39 and 29 per thousand individuals, respectively. Unadjusted RR of death was 1.33 (1.12 – 1.58), indicating an increased risk of death among individuals with independent relationship style. After adjusting for demographic and clinical covariates, those with an independent relationship style still had a greater risk of death compared to those with an interactive relationship style [HR = 1.20, 1.01 – 1.43].

Conclusion: In a large sample of adult patients with diabetes, a lower propensity to reach out to others is associated with higher mortality over five years. Further research is needed to examine possible mechanisms for this relationship and to develop appropriate interventions.


    • Received July 16, 2009.
    • Accepted November 19, 2009.

This Article

  1. Diabetes Care
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