Spousal communication, marital satisfaction, and diabetes self-management among married adults with type 2 diabetes: a multi-group analysis by gender

Spousal communication may be associated with diabetes self-management, but the role of marital satisfaction and potential gender differences remain unclear. This study examined the direct and indirect associations among spousal communication patterns, marital satisfaction, and diabetes self-management among married adults with type 2 diabetes. Cross-sectional survey data were collected from 569 married adults with type 2 diabetes (235 men and 334 women). Multigroup structural equation modeling was used to examine associations involving mutual constructive communication (MCC), total demand–withdraw communication (TDW), marital satisfaction (MSS), and diabetes self-management. Indirect associations through marital satisfaction were evaluated using 5,000 bias-corrected bootstrap resamples, and formal between-group tests were conducted to assess gender differences. MCC was positively associated with marital satisfaction in both men ( β = 0.592, p < .001) and women ( β = 0.553, p < .001), whereas TDW was negatively associated with marital satisfaction (men: β = −0.468, p < .001; women: β = −0.308, p < .001). TDW was negatively associated with diabetes self-management in both men ( β = −0.356, p < .001) and women ( β = −0.345, p < .001), while MCC was positively associated with self-management (men: β = 0.295, p = .028; women: β = 0.223, p = .004). The associations between marital satisfaction and self-management were not statistically significant. A small negative indirect association between TDW and self-management through marital satisfaction was identified among women ( B = − 0.047, 95% bias-corrected CI [− 0.116, − 0.002]), whereas the other indirect associations were nonsignificant. Formal tests showed no significant gender differences in the structural paths (Wald χ ²(5) = 1.980, p = .852) or indirect associations. Spousal communication patterns were associated with diabetes self-management in both men and women. Evidence for indirect associations through marital satisfaction was limited, and no statistically significant gender differences were identified. Longitudinal research is needed to clarify the underlying processes.