HIGH LO W
L O W 8 29
CONTROLS
HIGH 1 2
In total, only 3 controls had high negative evaluation of attributes, compared to 9 subjects with diabetes. This aspect of NES was not influenced by subjects' social class or ethnic group. However, diabetic females were significantly mor e likely to have negative evaluation of attributes compared w ith diabetic males (9 vs 0 ; p<0.01). This sex difference was not found for the healthy controls. Respondents often described themselves in both positive and negative terms, and these would be rated on two separate scales:
D004: "I'm a bit shy. I'm not really intelligent, I'm not backward though, I'm somewhere in between. I give way to other people. I like to get on wit h people, I don't like to be enemies with people. I'm a friendly p e r s o n . "
C0011 "I can be fun, I can be moody. If I don't feel well I can be irritable. I've never been a very confident person, I don't mix very easily. I'm quite efficient. I'm not of the highest intelligence, but I'm not stupid."
Other respondents reported mainly negative attributes such as the following two subjects:
D003: "A bit shy, stubborn, I don't think I'm worse than other people, I'm average. There are some things about me that people hate."
C0031: "I'd like m y weight to go down a bit more and I want my stammering to stop forever, but I can't see that happening whatever happens. No, I think I'm bloody ugly, that's how I feel about myself inside, that I'm not n i c e ."
General Self - Definition.
The third aspect of NES is the degree (either high or moderate) of negative self-evaluation in terms of the subject's general self definition. This rating took into account both negative evaluation of attributes as in the previous rating, but also incorporated negative evaluation in terms of the subject's positions or roles in life, for example as a parent, or spouse, or as a student or employee. When mak i n g this rating it was necessary to look for evaluative statements regarding attributes and also comments relating to the subject's performance in roles that w ere relevant for that particular individual. Indicators for this rating also included the subject's comparison of their performance in these
roles with that of others, as well as in terms of their own personal standards.
To assist in this rating, the scores given on the felt competence/incompetence scales in the marriage, motherhood, education and w o r k sections were also taken into account. As with the previous ratings, the four-point scale was dichotomized for
analysis into high and low scores.
A matched pairs analysis demonstrated that four subjects with diabetes had high negative general self-definition w h e n their m a t ched controls did not, compared with only one healthy control who had high negative general self-definition w hen their matched diabetic subject did not (n/s) (see Table 8).
Table 8: McNemar's test to evaluate the level of agreement between pairs for the presence of high vs low negative self-definition - general-definition. DIABETIC SUBJECTS HIGH LOW 4 CONTROLS HIGH 0 L O W 34 1
The first subject recorded b elow exhibited high negative general self-definition. She was studying for her A' levels through a correspondence course. A good education was of paramount importance to her, as it was a means not only to becoming educated (an important goal in itself in her eyes), but it was also a door to the outside world; a way to leave home through attending college or University. This subject lived wit h her parents who had been on the verge of separation for many years and her earliest memories were of her "parents arguing and the n da d walking out".
Her older sister shared a bed w ith her, w hich made it difficult for her to sleep, and she often tried to snatch a few hours sleep during the day. She received little, if any, sympathy or support from her family in relation to her diabetes, and had decided that the most important aim in her life was to leave home and 'better herself'. However, although her commitment to education was high, this subject's felt competence in educational terms was not, and her self-esteem was low:
I: "What do you think matters most to you?"
D003: "Getting m y A'levels, getting healthier. Most w omen feel they're going to finish their secondary school and go and get married and that, but to me, I'm not thinking of getting married, I'm thinking of how to better m y s e l f . "
I: "Have you done well at school?"
D003: "No, I don't th i n k so. If its common sense yes, but when it comes to studying I'm slow".
"I always seem to be late for school."
"No-one can tell me what to do, I've always b een like that." (feels this is detrimental to her studies)
The following young female with diabetes reported that she felt that she had been good at sports until she was diagnosed as having diabetes at the age of 12. Her parents had worked abroad, although this had not led to frequent changes of environment or school for her. By the age of 16, this subject had completely lost the sight in one eye, and had had an operation on the other:
D035: "I was quite a good runner before I became diabetic. I was 12, before that I won all these cups, all these medals. I had long legs then. I used to w i n all the medals. When my diabetes hit me, you sort of lose all confidence. You think, ’if I run too fast I'm g oing to have a hypo'. At m y last school I wasn't that good anymore, there were people better than me."
It is important when measuring self-esteem to take into account other social roles that are significant in young adults' lives. This m a y be central to the development of self-esteem for certain individuals, for example being a parent or a w ife or having a specific level of felt competence in social roles, as a 'social animal', as the following example illustrates:
C0011: "I've never been a very confident person, I don't mix very easily. I find it hard if I'm in a crowd of people and I don't know everyone. Unless someone talks to me or makes the effort I'm inclined to just sit there and not ..., but then I've always b e e n like that. Now I'm going out more again I do try and t a l k to p e o p l e . "
This last respondent had been fairly isolated as a single mother caring for her young child. At the time of interview she exhibited a high commitment to a social life, having decided that it was time to get out more, and had been taking up offers of child-minding from her close family. Thus w hen rating this subject it was important to take account of how she felt w ith regard to her sociability.
Positive ratings on the SESS.
Two other aspects of self evaluation were recorded during the interview, although they did not make up part of the NES rating; firstly, that of positive self-definition in terms of attributes, and secondly, a rating of the level of positive general self definition.
The first, positive self-definition of attributes, t o o k into account similar aspects as the rating for negative self-definition of attributes, but, as the title suggests, t ook the positive aspects rather than the negative ones. As before, the ratings w ere divided into high and low scores.
Subjects with diabetes were significantly more likely to have a low positive self-definition in terms of attributes, compared w i t h the control group. In a matched pairs test, 10 subjects w i t h diabetes had low positive self-definition when their healthy controls did
not. None of the healthy controls had a low positive self-definition (p<0.01). Positive self-definition was not influenced by subjects' sex, social class or ethnic origin.
The following two respondents, the first a female w i t h diabetes and the second a diabetic male, exhibited a low degree of positive self definitions
Is "Do you feel you are an intelligent person, or not really?"
D013s "I wouldn't say I'm brilliant at anything, but I don't think I'm stupid."
Is "Do you feel you are an attractive person or not really?"
D013s "Not particularly. Other people might think I am, but I 'm not too s u r e ."
Is "Do you think you are better or worse than other people" D017s "Not either actually. I think I'm pretty average myself. I don't think I ’m very special. But certainly I think I have my own views and I think I v iew situations in a different way to other people. I believe I'm distinct in those terms."
The final aspect of self-evaluation measured in this study, level of positive general self-definition, took into account the subjects' descriptions of themselves in terms of both attributes and their performance in roles. Again, as with the previous rating, the indicators used were the positive aspects of the same scale that had
been used for rating negative general self-definition.
A m a t ched pairs analysis demonstrated that eleven subjects with diabetes had low general self-definition w hen their m a t ched controls did not, in comparison with none of the controls having a low
general self-definition w hen their matched controls did not (p<0.001).
The following respondent, a 22 y ear old female with diabetes, was not diagnosed with diabetes until after her 19th birthday, and had spent some of her teenage years away from the area where she grew up, when her parents decided to move away from London. She left home shortly after being diagnosed, and lived w i t h her boyfriend and his flat-mates. This subject had passed a two-year pre-nursing course and had initially been accepted to tr a i n as a nurse. However, after a medical, she was told they were unable able to accept her as they found her diabetes to be unstable. He r present occupation was as a clerical worker. She had only a few friends w h o m she saw 'once in a blue moon', and did not have anyone she felt very close to. She showed a low level of positive self-definition:
D016: "I'm OK at my job.
I: "Do you feel you are a sociable sort of person, or not really?"
D016: "No, not really. I think people find it hard to get on with me. I'm an easy person to live with. I wouldn't say I'm very popular, no I'm not popular, just average really. I wouldn't put over m y opinion, I'm a listener really, you never know, you could say the w rong thing, so I'm more of a listener.”
The following diabetic subject was one of the youngest to participate in this study, and was still at school studying for his
5th year exams:
I: "Do you feel you are a sociable person or not really" D023: "Sometimes. Not that popular, no."
I: "What kind of student are you?"
D023: "Average" (S doesn't k now w h e ther he is doing well in his studies).
Whilst in this sample the majority of subjects were single, did not have children, and were either in full-time education or employment, some had other important roles. The following healthy subject was a full-time mother, highly committed to the idea of motherhood, and
described her son as her "whole world":
C0011: "I think I'm a better person really. W hen you see girls of m y age and their kids, and they're all d o lled-up and the kids look bad, I think to myself, oh how can they be like that, I couldn't you know, C comes first - if he needs something I can go without. I can w a l k around in old clothes but not m y son. He always looks as nice as I can make him. I t h i n k I'm a better m u m for that.But I don't think I'm better in general than a n y o n e , but n o - o n e 's better than m e ."
N egative Evaluation of Self (NES) and the state of health of subjects with diabetes.
A comparison of the state of health of the diabetic subjects who did and did not have NES is shown in Table 9. The presence of diabetic complications was not significantly related to NES, although a slightly greater proportion of those w ith NES had complications (46% vs 33%; n/s). Diabetic subjects who had NES tended to have ha d their diabetes diagnosed at a slightly younger age compared to th o s e with diabetes who did not have NES (12.9 + 5.2 yrs vs 14.0 + 4.3 yrs n/s), but this was not significantly different. D u ration of diabetes
did not differ between these 2 groups (8.5 + 5.4 yrs vs 7.0 + 5.1
± a u j . x s n e a n . i i B u a u u a u i a u u j t j u u a w x u i u i a u e t . e a a i m
Negative Evaluation of Self (NES)
NES (n=13)
n <%)
W ith complications 6 (46)
W ith increase in
insulin dose in last year 7 (54)
NES