| ObjectiveType 2 diabetes not only imposes a heavy medical care burden on middle-aged and elderly patients,but also causes mental health problems.Diabetes distress is a difficult to identify but more extensive clinical psychological disorder associated with the disease and plays an important role in the adherence to treatment.Previous studies have found that diabetic pain directly affects the patient’s blood glucose control and self-management behavior and is a predictor of depression.However,the current research on diabetes-related distress in middle-aged and older adults with type 2 diabetes is less,and there are insufficient empirical studies on which psychosocial factors influence diabetes distress.To address these issues,the present study aim to to reveal associations among Family Support,Resilience,and Diabetes Distress in the sample of middle-aged and elderly with Type 2 Diabetes,and to explore the potential role of resilience in the relationship between family support and diabetes distress.Methods256 participants were recruited through the purposive sampling from two hospitals.Three kinds of instrument were measured in the current study.The participants were asked to complete the Resilience Scale(CD-RISC),the Perceived Social Support Scale(PSSS),and the Diabetes Distress Scale(DDS).The data were analyzed by descriptive statistics,chi-square test,t-test,ANOVA,pearson correlation,structure equation model.Results1.There were 164(64.1%)patients with little or without diabetes distress,69(27%)with moderate diabetes distress,and 23(9%)with severe diabetes distress.In the four subscales of diabetes distress,the emotional burden subscale scored the highest(2.24±5.449),the regimen-related distress subscale(2.03±4.541),diabetes-related interpersonal distress(1.58±2.483),and the physician-related pain subscale scored the lowest(1.51±2.906).2.There were significant differences in the regimen-related distress subscales(t=4.602,p<0.001)and the diabetes distress(t=3.309,p<0.01)among patients of different ages with type 2 diabetes.The regimen-related distress of the employed group was significantly higher than that of the retired group(MD=0.536,p<0.01).There were significant differences in the emotional burden,regimen-related distress,and diabetes distress among the middle-aged and elderly with type 2 diabetes in the number of complications(p<0.001).There were significant differences in the treatment methods of diabetes(t=-4.474,p<0.001).Patients treated with combination therapy reported significantly higher levels of diabetes than patients treated with a single treatment.3.The resilience level of middle-aged and elderly with type 2 diabetes had significant differences in average monthly household income,employment status,and educational background(p<0.001).4.There is a significant difference in family support among middle-aged and elderly patients under different marital status(F=17.305,p<0.001).5.Pearson correlation analysis showed that there was a significant positive correlation between family support and resilience(r=0.356,p<0.01),a significant negative correlation between family support and diabetes distress(r=-0.374,p<0.01),and a significant negative correlation between resilience and diabetes distress(r=-0.651,p<0.01).6.Based on the structure equation model,we suggest that perceived family support does not directly affect diabetes-related distress.Family support is achieved through the direct mediation of resilience to affect diabetes-related distress.Conclusions1.There is the risk of suffering diabetes distress with type 2 diabetes.In health education,we should pay attention to diabetes-related distress,especially the emotional burden and the regimen-related distress.2.There were significant differences in the diabetes distress at different ages.The degree of the regimen-related distress and the diabetes distress in the 45 to 64-year-old age group was significantly higher than that in the elderly patients over the age of 65.The regimen-related distress in the employed group was significantly higher than that of the retired group.In the future clinical work,more attention should be given to patients who are still who are still in employment3.The greater the number of complications,the higher the level of diabetes distress.4.Patients treated with oral antidiabetic drugs plus insulin injections reported higher DDS score,diabetic patients with combined treatment were more likely to develop diabetes-related distress than patients treated with one treatment.5.The higher the average family monthly income level,the higher the level of resilience;the resilience level of the employed and retired patients is significantly higher than that of the unemployment or unemployed patients.6.Married middle-aged and elderly patients perceived the highest degree of family support,while married but separated patients perceived the lowest level of family support,which was lower than the degree of family support felt by divorced patients.7.There was a significant positive correlation between the participants’family support and resilience,and a significantly negative correlation between family support and diabetes distress.Also,There was significantly negative correlation between the participants’ resilience and diabetes distress.8.Resilience,as the potential pathway,has direct mediation effect to family support and diabetes distress.Policy implications of the present study should be concluded:a)Attach importance to the diabetes distress,which affects the psychological barriers of patients with type 2 diabetes,to strengthen the early screening of diabetic pain,and give early intervention measures to those with higher diabetes pain scores,so as to prevent the occurrence of depression in middle-aged and elderly patients with diabetes.b)Concerned about the effect of combination therapy and glycemic control on the mental health of middle-aged and elderly patients with diabetes,in order to improve the patient experience and health outcomes.c)In the future of clinical interventions,it may be possible to improve the resilience of middle-aged and elderly patients and provide methods to strengthen resilience to play a certain role in protecting the mental health of middle-aged and elderly patients with diabetes. |
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