Fallah Fatemeh, Vahid Mohammad Kazem Atef, Salehi Mahdieh
Department of Health Psychology, School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Mansouri St., Niayesh St., Sattarkhan Blvd, P.O. Box: 1445613111, Tehran, Iran.
J Diabetes Metab Disord. 2025 Jun 2;24(1):137. doi: 10.1007/s40200-025-01650-4. eCollection 2025 Jun.
Diabetes is a widespread metabolic and chronic disease worldwide. Similar to other chronic diseases, psychological factors may play a role in the course of this disease. In this study, an attempt was made to examine the relationship between depression, anxiety and health literacy with the severity of diabetes and the mediating role of fear of disease progression.
A total of 225 patients with diabetes who visited the specialized and sub-specialized diabetes clinic in Amol city were selected through the they were selected using a convenient sampling method and a systematic approach based on inclusion criteria, and answered the 9-item Patient Health Questionnaire, Beck Anxiety Inventory, short form of Fear of Disease Progression and Health Literacy Inventory. To measure the severity of diabetes, HbA1c levels from the last blood test were measured. Structural equation modeling was used to test a hypothesized model. According to the fit indices, CMIN/df = 3.34, Goodness-of-fit index = 0.90, Normed Fit Index = 0.91, Comparative Fit Index = 0.90, and Root Mean Square Error of Approximation = 0.08 indicated an acceptable fit of the research model. The data were analyzed using SPSS version 26 and LISREL version 8/80 software.
The findings showed significantly positive relationships between anxiety (β = 0.29, = 0.552), depression (β = 0.13, = 0.485), fear of disease progression (β = 0.14, = 0.486) and the severity of diabetes. Also, a significantly negative relationship was observed between health literacy and severity of diabetes (β = -0.4, = -0.564). In addition, it was shown that in diabetic patients, the fear of disease progression plays a mediating role in the relationship between depression (B = 0.03, T-value = 2.12), anxiety (B = 0.03, T-value = 2.42) and health literacy (B = -0.03, T-value = -2.69) with the disease severity.
Therapeutic interventions to reduce the level of anxiety, depression and fear of disease progression and improve the level of health literacy of patients with diabetes can help in reducing the severity of diabetes. The generalizability of the results to other population requires confirmation by further research.
糖尿病是一种在全球广泛存在的代谢性慢性病。与其他慢性病类似，心理因素可能在该疾病的病程中发挥作用。在本研究中，试图探讨抑郁、焦虑和健康素养与糖尿病严重程度之间的关系以及疾病进展恐惧的中介作用。
通过便利抽样法并基于纳入标准采用系统方法，选取了225名前往阿莫勒市专科及亚专科糖尿病诊所就诊的糖尿病患者，他们回答了9项患者健康问卷、贝克焦虑量表、疾病进展恐惧简表和健康素养量表。为测量糖尿病的严重程度，测量了上次血液检测的糖化血红蛋白（HbA1c）水平。使用结构方程模型来检验一个假设模型。根据拟合指数，卡方值与自由度之比（CMIN/df）=3.34，拟合优度指数（Goodness-of-fit index）=0.90，规范拟合指数（Normed Fit Index）=0.91，比较拟合指数（Comparative Fit Index）=0.90，近似误差均方根（Root Mean Square Error of Approximation）=0.08，表明研究模型拟合可接受。数据使用SPSS 26版和LISREL 8/80版软件进行分析。
研究结果显示，焦虑（β = 0.29，p = 0.552）、抑郁（β = 0.13，p = 0.485）、疾病进展恐惧（β = 0.14，p = 0.486）与糖尿病严重程度之间存在显著正相关。此外，健康素养与糖尿病严重程度之间存在显著负相关（β = -0.4，p = -0.564）。另外，研究表明，在糖尿病患者中，疾病进展恐惧在抑郁（B = 0.03，T值 = 2.12）、焦虑（B = 0.03，T值 = 2.42）和健康素养（B = -0.03，T值 = -2.69）与疾病严重程度之间的关系中起中介作用。
降低糖尿病患者焦虑、抑郁和疾病进展恐惧水平并提高其健康素养的治疗干预措施有助于减轻糖尿病的严重程度。研究结果对其他人群的可推广性需要进一步研究予以证实。
