Zara Sandra, Ullrich Imogen Carla, Leveling Anna Maria, Saretzki Friederike Gisela Genoveva, Schmitz Jana, Eckhard Michael, Kruse Johannes, Kampling Hanna
Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Gissen, Giessen, Germany.
GZW Diabetes-Klinik Bad Nauheim, Bad Nauheim, Germany.
Front Psychiatry. 2025 Jul 17;16:1608601. doi: 10.3389/fpsyt.2025.1608601. eCollection 2025.
Patients with diabetes exhibit high frequencies of psychological burden and diabetes-related distress. Child maltreatment has been independently linked to both diabetes and psychological burden. We aimed 1) to explore the association between child maltreatment and diabetes-related distress, and between child maltreatment and psychological burden, and 2) to investigate the mediating role of personality functioning (psychological abilities with regard to the self and others) in this association. We included epistemic trust (openness for social learning) and its impairments mistrust (the tendency to consider information sources as unreliable or ill-intended) and credulity (lack of vigilance and discrimination between trustworthy and untrustworthy information) as covariates.
In a sample of n=119 patients with type 1 or 2 diabetes aged 18-69, self-report questionnaires assessed diabetes-related distress (PAID-5), psychological burden (PHQ-D, PHQ-9, PHQ-15), child maltreatment (CTQ), personality functioning (OPD-SQS), and epistemic trust, mistrust, and credulity (ETMCQ). Mediation analyses assessed the role of personality functioning in the association between child maltreatment, diabetes-related distress, and psychological burden, including epistemic trust, mistrust, and credulity as covariates.
Patients with child maltreatment compared to those without showed higher diabetes-related distress ( =4.033, <.001, =.756) and higher frequencies of major depressive syndrome (χ =10.968, <.001, φ=.310) with medium effect sizes. They showed higher frequencies of somatoform syndrome (χ =8.130, =.004, φ=.267), panic syndrome (χ =6.281, =.012, φ=.235), and other anxiety syndromes (χ =8.828, =.003, φ=.278), with small effect sizes. Impairments in personality functioning were more severe ( =5.136, <.001, d=.967), with a large effect size. Epistemic mistrust and credulity were significantly higher (mistrust: =3.677, <.001, d=.692; credulity: =5.000, <.001, d=.941), with medium and large effect sizes. No differences regarding epistemic trust were found ( =.409, .683, d=.077), with the effect size below the threshold for small effects. Personality functioning mediated the association between child maltreatment and diabetes-related distress (b=.03, 95%-CI [.005,.053]), depressive symptoms (b=.08, 95%-CI [.030,.129]), and somatic symptoms (b=.06, 95%-CI [.020,.122]).
In a clinical diabetes sample, diabetes-related distress and psychological burden are frequently reported, and personality functioning is impaired, particularly after child maltreatment. Addressing these impairments and initiating psychosomatic treatment including psychodynamic or mentalization-based interventions might offer new clinical treatment avenues.
糖尿病患者出现心理负担和糖尿病相关困扰的频率较高。儿童期受虐与糖尿病及心理负担均独立相关。我们旨在：1）探究儿童期受虐与糖尿病相关困扰之间以及儿童期受虐与心理负担之间的关联；2）研究人格功能（关于自我和他人的心理能力）在这种关联中的中介作用。我们将认知信任（对社会学习的开放性）及其损害——不信任（将信息来源视为不可靠或恶意的倾向）和轻信（在可信与不可信信息之间缺乏警惕和辨别力）作为协变量纳入研究。
在一个由119名年龄在18 - 69岁的1型或2型糖尿病患者组成的样本中，通过自我报告问卷评估糖尿病相关困扰（PAID - 5）、心理负担（PHQ - D、PHQ - 9、PHQ - 15）、儿童期受虐（CTQ）、人格功能（OPD - SQS）以及认知信任、不信任和轻信（ETMCQ）。中介分析评估人格功能在儿童期受虐、糖尿病相关困扰和心理负担之间关联中的作用，将认知信任、不信任和轻信作为协变量纳入。
与未经历儿童期受虐的患者相比，经历过儿童期受虐的患者表现出更高的糖尿病相关困扰（t = 4.033，p <.001，r =.756）以及更高频率的重度抑郁综合征（χ² = 10.968，p <.001，φ =.310），效应量为中等。他们还表现出更高频率的躯体形式综合征（χ² = 8.130，p =.004，φ =.267）、惊恐综合征（χ² = 6.281，p =.012，φ =.235）和其他焦虑综合征（χ² = 8.828，p =.003，φ =.278），效应量为小。人格功能损害更为严重（t = 5.136，p <.001，d =.967），效应量为大。认知不信任和轻信显著更高（不信任：t = 3.677，p <.001，d =.692；轻信：t = 5.000，p <.001，d =.941），效应量分别为中等和大。在认知信任方面未发现差异（t =.409，p =.683，d =.077），效应量低于小效应的阈值。人格功能介导了儿童期受虐与糖尿病相关困扰（b =.03，95%置信区间[.005,.053]）、抑郁症状（b =.08，95%置信区间[.030,.129]）和躯体症状（b =.06，95%置信区间[.020,.122]）之间的关联。
在临床糖尿病样本中，经常报告糖尿病相关困扰和心理负担，且人格功能受损，尤其是在儿童期受虐之后。解决这些损害并启动包括心理动力或基于心理化的干预在内的身心治疗可能会提供新的临床治疗途径。
