Title Social Orientation and Diabetes-Related Distress in Japaneseand American Patients with Type 2 Diabetes

Objective: Recent evidence in cultural and social psychology suggests Eastern cultures’ emphasis on harmony and connection with others and Western cultures’ emphasis on self-direction and autonomy. In Eastern society, relational harmony is closely linked to people’s well-being. The impact of this cultural and social orientation on diabetes-related distress was investigated. Research Design and Methods: Japanese and American patients with type 2 diabetes were surveyed by well-established questionnaire in Japan and in the United States, respectively. The association of personal values for interdependence, perceived emotional support, and the Problem Areas in Diabetes scale (PAID) were analyzed. Results: A positive correlation between interdependence and PAID (r = 0.18; P = 0.025) and a negative correlation between perceived emotional support and PAID (r = 2 0.24; P = 0.004) were observed after adjustments for other factors in Japanese data (n = 149), but not in American data (r = 0.00; P = 0.990, r = 0.02; P = 0.917, respectively, n = 50). In Japanese data, the three-factor structure of PAID (negative feelings about total life with diabetes, about living conditions with diabetes, and about treatment of diabetes) was identified, and interdependence showed significant positive correlations with the first and second factors and perceived emotional support showed significant negative correlations with all three factors of PAID. Conclusions: These results suggest that personal values for interdependence may be linked to the level of diabetes-related distress and that the distress may be relieved by perception of emotional support, especially in an interdependent cultural context. Citation: Ikeda K, Fujimoto S, Morling B, Ayano-Takahara S, Carroll AE, et al. (2014) Social Orientation and Diabetes-Related Distress in Japanese and American Patients with Type 2 Diabetes. PLoS ONE 9(10): e109323. doi:10.1371/journal.pone.0109323 Editor: Sompop Bencharit, University of North Carolina at Chapel Hill, United States of America Received April 19, 2014; Accepted August 28, 2014; Published October 15, 2014 Copyright: 2014 Ikeda et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files. Funding: This work was supported by Kokoro Research Center Kyoto University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * Email: inagaki@metab.kuhp.kyoto-u.ac.jp