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Article(id=1240395008105304423, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202501140, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1736265600000, receivedDateStr=2025-01-08, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773662815357, onlineDateStr=2026-03-16, pubDate=1753372800000, pubDateStr=2025-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773662815357, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773662815357, creator=13701087609, updateTime=1773662815357, updator=13701087609, issue=Issue{id=1240395006914130733, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773662815073, creator=13701087609, updateTime=1773662858015, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240395187109810535, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240395187109810536, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2502, endPage=2506, ext={EN=ArticleExt(id=1240395009141297513, articleId=1240395008105304423, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Mediating effect of self-compassion on social support and diabetes distress in elderly patients with type 2 diabetes mellitus, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the mediating effect of self-compassion on social support and diabetes distress (DD) among community-dwelling elderly individuals with type 2 diabetes mellitus (T2DM).

Methods

From June to July 2024, a cross-sectional survey was conducted among elderly T2DM patients in communities in Nanjing. The survey used the general information questionnaire, DDS, SSRS, and SCS. A multiple linear regression model was employed to examine the factors influencing DD, and the mediating effect of self-compassion was analyzed by the Bootstrap method for validation.

Results

The prevalence of DD among the respondents was 35.1%, and the scores for social support and self-compassion were (39.48±8.13) and (91.18±9.10), respectively. Social support and self-compassion were significantly positively correlated (r=0.344, P<0.001). Social support (β=-0.132, P<0.001) and self-compassion (β=-0.216, P<0.001) were the influencing factors of DD, and self-compassion exhibited a partial mediating effect in the relationship between social support and DD, accounting for 37.02% of the total effect.

Conclusion

Community healthcare workers should pay attention to the screening of DD among elderly T2DM patients, and actively explore comprehensive intervention strategies that integrate social support with self-compassion to enhance their psychological well-being.

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目的

探讨社区老年2型糖尿病（T2DM）患者的自我同情在社会支持与糖尿病痛苦（DD）间的中介作用。

方法

2024年6—7月对南京市社区老年T2DM患者进行问卷调查，包括一般资料问卷、DDS、SSRS、SCS。采用多元线性回归模型分析DD的影响因素，使用Bootstrap法检验自我同情的中介效应。

结果

社区老年T2DM患者DD患病率为35.1%，社会支持、自我同情得分分别为（39.48±8.13）分、（91.18±9.10）分。社会支持与自我同情水平显著正相关（r=0.344，P<0.001），社会支持（β=-0.132，P<0.001）和自我同情（β=-0.216，P<0.001）是DD的影响因素，自我同情在社会支持与DD间存在部分中介效应，占总效应的37.02%。

结论

社区医务人员应重视老年T2DM患者DD的筛查，并积极构建整合社会支持网络与自我同情训练的综合干预策略，以提升该群体的心理健康水平。

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刘思浚，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=W5NYxnO1WxvoGBkiOVPoZw==, magXml=ez6rDvRQAgvmqkY+bVcImA==, pdfUrl=null, pdf=Z+5nvl+EUZfVAsoN4olN3A==, pdfFileSize=680803, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=VJD0R6/zzSnCBGD/LCaKtQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=ktMN+SZrfCaqeg42DU5/Ug==, mapNumber=null, authorCompany=null, fund=null, authors=

陆丽君（2000—），女，硕士在读，研究方向：慢性病流行病学和社会医学

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陆丽君（2000—），女，硕士在读，研究方向：慢性病流行病学和社会医学

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陆丽君（2000—），女，硕士在读，研究方向：慢性病流行病学和社会医学

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Clinical Psychology, 2019, 26(4): e12304., articleTitle=Commentary on"in search of the best evidence for Life review therapy to reduce depressive symptoms in older adults:a meta-analysis of randomized controlled trials": Some thoughts on how Life review reminiscence therapy can inform clinical theory and practice for both younger and older adults, refAbstract=null)], funds=[Fund(id=1240413549076468084, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, awardId=71974101, language=CN, fundingSource=国家自然科学基金面上项目(71974101), fundOrder=null, country=null), Fund(id=1240413549223268729, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, awardId=2024KF0103, language=CN, fundingSource=南京市中医药传承创新发展示范试点项目(2024KF0103), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240413538045449076, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, xref=1., ext=[AuthorCompanyExt(id=1240413538053837685, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, companyId=1240413538045449076, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China), AuthorCompanyExt(id=1240413538066420598, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, companyId=1240413538045449076, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.南京医科大学公共卫生学院，江苏 南京 211166)]), AuthorCompany(id=1240413539584758656, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, xref=2., ext=[AuthorCompanyExt(id=1240413539588952961, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, companyId=1240413539584758656, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.南京市鼓楼区疾病预防控制中心)]), AuthorCompany(id=1240413539689616266, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, xref=3., ext=[AuthorCompanyExt(id=1240413539698004875, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, companyId=1240413539689616266, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.南京市疾病预防控制中心)])], figs=[ArticleFig(id=1240413546119483673, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, language=EN, label=Fig.1, caption=The mediating role of self-compassion between social support and DD, figureFileSmall=gYrTxyE792o2Q2TuMaIBmw==, figureFileBig=ewW30Z3aAVohExDXJPSXFg==, tableContent=null), ArticleFig(id=1240413546245312802, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, language=CN, label=图1, caption=自我同情在社会支持和DD间的中介效应

注：**为P<0.01，***为P<0.001。

, figureFileSmall=gYrTxyE792o2Q2TuMaIBmw==, figureFileBig=ewW30Z3aAVohExDXJPSXFg==, tableContent=null), ArticleFig(id=1240413546484388143, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, language=EN, label=Table 1, caption=

Univariate analysis of DDS scores

, figureFileSmall=null, figureFileBig=null, tableContent=
变量n（%）DDS得分t/F值P值
年龄（岁）3.0200.050
60~69237（39.2）29.11±8.03
70~79273（45.2）30.62±8.60
≥8094（15.6）31.30±9.67
性别-1.9080.057
男性292（48.3）29.45±8.23
女性312（51.7）30.77±8.87
文化程度1.0670.363
小学及以下121（20.0）30.40±9.22
初中210（34.8）30.09±8.11
高中/中专162（26.8）29.30±8.33
大学及以上111（18.4）31.14±9.10
婚姻状况2.2370.027
在婚496（82.1）29.72±8.22
非在婚108（17.9）32.01±9.01
居住状态1.2850.202
独居80（13.2）31.44±9.96
非独居524（86.8）29.93±8.35
家庭人均月收入（元）1.6790.188
<3 000100（16.6）29.69±8.79
3 000~5 000310（51.3）30.75±8.44
>5 000194（32.1）29.38±8.68
医疗费用支付方式0.7990.495
自费10（1.7）26.80±8.97
公费11（1.8）27.82±7.83
城乡居民医保120（19.9）30.32±9.11
城镇职工医保463（76.7）30.21±8.46
糖尿病知识教育活动2.3570.019
未参加过255（42.2）31.09±8.68
参加过349（57.8）29.43±8.46
糖尿病病程（年）-2.6060.009
≤10303（50.2）29.23±8.18
>10301（49.8）31.04±8.90
糖尿病并发症-8.853<0.001
无418（69.2）28.09±7.65
有186（30.8）34.71±8.82
糖尿病治疗方式0.2270.877
仅饮食运动40（6.6）30.28±8.57
单独药物治疗450（74.5）30.10±8.66
单独胰岛素治疗28（4.6）29.04±8.70
胰岛素联合药物治疗86（14.2）30.56±8.27
), ArticleFig(id=1240413546601828665, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, language=CN, label=表1, caption=

不同特征T2DM患者的DDS得分比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量n（%）DDS得分t/F值P值
年龄（岁）3.0200.050
60~69237（39.2）29.11±8.03
70~79273（45.2）30.62±8.60
≥8094（15.6）31.30±9.67
性别-1.9080.057
男性292（48.3）29.45±8.23
女性312（51.7）30.77±8.87
文化程度1.0670.363
小学及以下121（20.0）30.40±9.22
初中210（34.8）30.09±8.11
高中/中专162（26.8）29.30±8.33
大学及以上111（18.4）31.14±9.10
婚姻状况2.2370.027
在婚496（82.1）29.72±8.22
非在婚108（17.9）32.01±9.01
居住状态1.2850.202
独居80（13.2）31.44±9.96
非独居524（86.8）29.93±8.35
家庭人均月收入（元）1.6790.188
<3 000100（16.6）29.69±8.79
3 000~5 000310（51.3）30.75±8.44
>5 000194（32.1）29.38±8.68
医疗费用支付方式0.7990.495
自费10（1.7）26.80±8.97
公费11（1.8）27.82±7.83
城乡居民医保120（19.9）30.32±9.11
城镇职工医保463（76.7）30.21±8.46
糖尿病知识教育活动2.3570.019
未参加过255（42.2）31.09±8.68
参加过349（57.8）29.43±8.46
糖尿病病程（年）-2.6060.009
≤10303（50.2）29.23±8.18
>10301（49.8）31.04±8.90
糖尿病并发症-8.853<0.001
无418（69.2）28.09±7.65
有186（30.8）34.71±8.82
糖尿病治疗方式0.2270.877
仅饮食运动40（6.6）30.28±8.57
单独药物治疗450（74.5）30.10±8.66
单独胰岛素治疗28（4.6）29.04±8.70
胰岛素联合药物治疗86（14.2）30.56±8.27
), ArticleFig(id=1240413546698297664, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, language=EN, label=Table 2, caption=

Correlation analysis of social support, self-compassion and DD in elderly T2DM patients (r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量社会支持自我同情DD
社会支持1.000
自我同情0.344a1.000
DD-0.273a-0.277a1.000
), ArticleFig(id=1240413546912207180, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, language=CN, label=表2, caption=

老年T2DM患者社会支持、自我同情与糖尿病痛苦的相关性（r）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量社会支持自我同情DD
社会支持1.000
自我同情0.344a1.000
DD-0.273a-0.277a1.000
), ArticleFig(id=1240413547025453395, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, language=EN, label=Table 3, caption=

Multiple linearregression analysis of DD in elderly T2DM patients

, figureFileSmall=null, figureFileBig=null, tableContent=
变量BSE标准化Bt值P值
常量52.203.179-16.418<0.001
性别（参照：男性）1.4350.6150.0842.3340.020
糖尿病知识教育活动（参照：未参加过）-2.2450.644-0.129-3.487<0.001
病程（参照：≤10年）1.4970.6470.0872.3130.021
糖尿病并发症（参照：无）5.9380.6970.3208.525<0.001
社会支持-0.1390.041-0.132-3.389<0.001
自我同情-0.2040.036-0.216-5.651<0.001
), ArticleFig(id=1240413548527014239, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, language=CN, label=表3, caption=

老年T2DM患者DD的多元线性回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量BSE标准化Bt值P值
常量52.203.179-16.418<0.001
性别（参照：男性）1.4350.6150.0842.3340.020
糖尿病知识教育活动（参照：未参加过）-2.2450.644-0.129-3.487<0.001
病程（参照：≤10年）1.4970.6470.0872.3130.021
糖尿病并发症（参照：无）5.9380.6970.3208.525<0.001
社会支持-0.1390.041-0.132-3.389<0.001
自我同情-0.2040.036-0.216-5.651<0.001
), ArticleFig(id=1240413548644454755, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, language=EN, label=Table 4, caption=

Analysis of the mediating effect of self-compassion between social support and DD

, figureFileSmall=null, figureFileBig=null, tableContent=
路径效应系数 (Boot 95% CI)SE中介效应占比
社会支持→DD（直接效应c’）-0.131 (-0.212~-0.046)0.043-
社会支持→自我同情→DD（中介效应）-0.077 (-0.112~-0.044)0.01837.02%
总效应c-0.208 (-0.284~-0.127)0.042-
), ArticleFig(id=1240413548803838317, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395008105304423, language=CN, label=表4, caption=

自我同情在社会支持和糖尿病痛苦间的中介效应

, figureFileSmall=null, figureFileBig=null, tableContent=
路径效应系数 (Boot 95% CI)SE中介效应占比
社会支持→DD（直接效应c’）-0.131 (-0.212~-0.046)0.043-
社会支持→自我同情→DD（中介效应）-0.077 (-0.112~-0.044)0.01837.02%
总效应c-0.208 (-0.284~-0.127)0.042-
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自我同情在老年2型糖尿病患者社会支持与糖尿病痛苦间的中介效应
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陆丽君 1 , 赵君艳 1 , 赵锦航 1 , 沈真杰 1 , 李殿江 1 , 陈伟 2 , 王志勇 3 , 刘思浚 1
现代预防医学 | 流行病与统计方法 2025,52(14): 2502-2506
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现代预防医学 | 流行病与统计方法 2025, 52(14): 2502-2506
自我同情在老年2型糖尿病患者社会支持与糖尿病痛苦间的中介效应
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陆丽君1, 赵君艳1, 赵锦航1, 沈真杰1, 李殿江1, 陈伟2, 王志勇3, 刘思浚1
作者信息
  • 1.南京医科大学公共卫生学院，江苏 南京 211166
  • 2.南京市鼓楼区疾病预防控制中心
  • 3.南京市疾病预防控制中心

    • 陆丽君（2000—），女，硕士在读，研究方向：慢性病流行病学和社会医学

通讯作者:

刘思浚，E-mail：
Mediating effect of self-compassion on social support and diabetes distress in elderly patients with type 2 diabetes mellitus
Li-jun LU1, Jun-yan ZHAO1, Jin-hang ZHAO1, Zhen-jie SHEN1, Dian-jiang LI1, Wei CHEN2, Zhi-yong WANG3, Si-jun LIU1
Affiliations
  • School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
出版时间: 2025-07-25 doi: 10.20043/j.cnki.MPM.202501140
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摘要
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目的

探讨社区老年2型糖尿病（T2DM）患者的自我同情在社会支持与糖尿病痛苦（DD）间的中介作用。

方法

2024年6—7月对南京市社区老年T2DM患者进行问卷调查，包括一般资料问卷、DDS、SSRS、SCS。采用多元线性回归模型分析DD的影响因素，使用Bootstrap法检验自我同情的中介效应。

结果

社区老年T2DM患者DD患病率为35.1%，社会支持、自我同情得分分别为（39.48±8.13）分、（91.18±9.10）分。社会支持与自我同情水平显著正相关（r=0.344，P<0.001），社会支持（β=-0.132，P<0.001）和自我同情（β=-0.216，P<0.001）是DD的影响因素，自我同情在社会支持与DD间存在部分中介效应，占总效应的37.02%。

结论

社区医务人员应重视老年T2DM患者DD的筛查，并积极构建整合社会支持网络与自我同情训练的综合干预策略，以提升该群体的心理健康水平。

2型糖尿病  /  糖尿病痛苦  /  自我同情  /  社会支持  /  中介效应
Objective

To explore the mediating effect of self-compassion on social support and diabetes distress (DD) among community-dwelling elderly individuals with type 2 diabetes mellitus (T2DM).

Methods

From June to July 2024, a cross-sectional survey was conducted among elderly T2DM patients in communities in Nanjing. The survey used the general information questionnaire, DDS, SSRS, and SCS. A multiple linear regression model was employed to examine the factors influencing DD, and the mediating effect of self-compassion was analyzed by the Bootstrap method for validation.

Results

The prevalence of DD among the respondents was 35.1%, and the scores for social support and self-compassion were (39.48±8.13) and (91.18±9.10), respectively. Social support and self-compassion were significantly positively correlated (r=0.344, P<0.001). Social support (β=-0.132, P<0.001) and self-compassion (β=-0.216, P<0.001) were the influencing factors of DD, and self-compassion exhibited a partial mediating effect in the relationship between social support and DD, accounting for 37.02% of the total effect.

Conclusion

Community healthcare workers should pay attention to the screening of DD among elderly T2DM patients, and actively explore comprehensive intervention strategies that integrate social support with self-compassion to enhance their psychological well-being.

Type 2 diabetes mellitus  /  Diabetes distress  /  Self-compassion  /  Social support  /  Mediating effect
陆丽君, 赵君艳, 赵锦航, 沈真杰, 李殿江, 陈伟, 王志勇, 刘思浚. 自我同情在老年2型糖尿病患者社会支持与糖尿病痛苦间的中介效应. 现代预防医学, 2025 , 52 (14) : 2502 -2506 . DOI: 10.20043/j.cnki.MPM.202501140
Li-jun LU, Jun-yan ZHAO, Jin-hang ZHAO, Zhen-jie SHEN, Dian-jiang LI, Wei CHEN, Zhi-yong WANG, Si-jun LIU. Mediating effect of self-compassion on social support and diabetes distress in elderly patients with type 2 diabetes mellitus[J]. Modern Preventive Medicine, 2025 , 52 (14) : 2502 -2506 . DOI: 10.20043/j.cnki.MPM.202501140
正文
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作为常见的慢性代谢性疾病，糖尿病已成为全球疾病负担的重要组成部分。2022年全球成年糖尿病患者达8.28亿，其中以2型糖尿病（type 2 diabetes mellitus，T2DM）最为普遍[1]。随着社会经济转型和膳食结构变迁，老年人群中T2DM的患病率持续上升，并且我国T2DM相关的死亡人数在70~74岁年龄组达到峰值[2]。老年T2DM患者常因合并症、功能性退化及疾病认知不足，面临更复杂的疾病管理，容易出现糖尿病痛苦（Diabetes Distress, DD），对治疗依从性、血糖控制等方面产生消极影响。我国一项meta分析[3]指出超半数的T2DM患者存在DD，在社区患者和60岁以上患者中更常见。
社会支持是个人通过与家庭、朋友或社会组织的联系所获得的物质和心理支持[4]，已被证实能够帮助T2DM患者积极应对疾病管理中的挑战，有效减轻DD[5]。社会支持理论认为[6]，社会支持通过多种途径缓解个体在压力情境下的负面影响，从而促进心理健康。自我同情是指在面对失败或痛苦时善待自己的能力[7]，在调节T2DM患者情绪方面具有重要作用，被认为能直接或间接影响心理应激通路，减少患者负性情绪[8-9]。研究表明，社会支持与自我同情显著正相关[10-11]，二者作为积极心理学中的社会资源和个人资源，能够缓解压力带来的不良情绪。然而，关于社会支持、自我同情与DD之间的作用关系的研究在老年T2DM患者中仍较为有限。因此，本研究以基本公共卫生服务管理下的老年T2DM患者为研究对象，分析社会支持和自我同情对DD的影响，并探讨自我同情在其中的中介效应，以期为改善该人群的心理健康提供科学依据。
1　对象与方法
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1.1　研究对象
采用便利抽样法，于2024年6—7月选取南京市鼓楼区和江北新区4家社区卫生服务中心的老年T2DM患者为研究对象。纳入标准：(1)年龄≥60岁；(2)T2DM病程≥1年；(3)纳入基本公共卫生服务管理；(4)自愿配合调查，能有效沟通。排除标准：(1)其他类型的糖尿病；(2)合并恶性肿瘤等严重疾病；(3)存在认知障碍或精神障碍。所有研究对象在调查前已签署知情同意书，研究已通过南京医科大学伦理委员会审查批准（FWA00001501）。
1.2　研究方法
由统一培训的调查员对纳入的患者进行面对面问卷调查，内容包括一般资料调查表、糖尿病痛苦量表、社会支持量表和自我同情量表。若患者对于问卷内容理解存在问题，由调查员解释说明。本调查共发放610份问卷，实际回收有效问卷604份，有效回收率为99.0%。
1.2.1　一般资料调查表
包括年龄、性别、文化程度、婚姻状况等社会人口学特征，糖尿病知识教育活动、病程、并发症、治疗方式等糖尿病相关特征。
1.2.2　糖尿病痛苦量表（Diabetes Distress Scale，DDS）
本研究采用由Polonsky和Fisher等开发，杨青等[12]引入国内的量表，包括情感负担（EB）、生活规律相关痛苦（RD）、医生相关痛苦（PD）和人际关系相关痛苦（ID）4个维度，共17个条目。量表采用Likert 6级计分，得分范围为17~102分。以均分2分作为评价界值，<2分为无痛苦，≥2分为存在中度及以上痛苦。该量表已广泛用于我国T2DM人群，在本研究中的Cronbach α系数为0.856。
1.2.3　社会支持量表（Social Support Rating Scale，SSRS）
本研究采用由肖水源[13]编制的量表，涵盖客观支持、主观支持和对支持的利用度3个维度，共10个条目。采用Likert 4级计分，其中第5题A~E项的答案从“无”~“全力支持”依次赋予1~4分；第6、7题若为“无”记0分，否则按来源数计分。得分范围为12~66分，得分越高表明获得的社会支持程度越强。该量表广泛用于个体社会支持的评估，在本研究中的Cronbach α系数为0.773。
1.2.4　自我同情量表（Self-Compassion Scale，SCS）
该量表由Neff研制，陈健等[14]修订为中文版，共26个条目，包括自我宽容、自我批判、普遍人性感、孤立感、正念及过度认同6个维度。采用Likert 5级计分，“从不这样”~“总是这样”依次计1~5分，其中自我批判、孤立感和过度认同的维度需反向计分，得分范围26~130分，得分越高即自我同情水平越高。本研究中该量表的Cronbach α系数为0.877。
1.3　统计学方法
使用EpiData 3.1软件进行问卷双录入，R 4.4.1软件进行数据分析。计量资料经检验符合正态分布，以均数±标准差表示，计数资料以频数（构成比）表示。采用Harman单因子法检验共同方法偏差；单因素分析采用独立样本t检验和方差分析。Pearson相关分析用于评估三者间的关联性；逐步多元线性回归用于分析DD的影响因素。使用bruceR包构建社会支持为自变量，自我同情为中介变量，DD为因变量的中介效应模型，并采用Bootstrap法进行中介效应检验，重复采样1 000次。检验水准 α=0.05。
2　结果
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2.1　共同方法偏差检验
采用Harman单因子法进行共同方法偏差检验，结果显示，最大因子可解释的变异量为14.3%，低于临界值40%[15]，表明数据不存在严重的共同方法偏差。
2.2　研究对象基本情况及DD得分比较
604例社区老年T2DM患者的平均年龄（72.01±7.02）岁，男性292人（48.3%），女性312人（51.7%）；病程<10年的患者303例（50.2%），有349例患者参加过糖尿病知识教育活动（57.8%）。DD平均得分为（30.13±8.59）分，其中EB（2.20±0.86）和RD（1.97±0.66）平均得分较高，DD检出率35.1%。社会支持平均得分（39.48±8.13）分；自我同情平均得分（91.18±9.10）分，普遍人性感维度得分最高为（3.70±0.51）分。老年T2DM患者的DD在婚姻状况、糖尿病知识教育活动、病程、并发症间差异有统计学意义（P均<0.05）。见表1。
2.3　社会支持、自我同情与DD的相关性分析
老年T2DM患者的社会支持和自我同情正相关（r=0.344，P<0.001），社会支持和自我同情均与DD显著负相关，r分别为-0.273、-0.277（P<0.001）。见表2。
2.4　老年T2DM患者DD的影响因素
以DD作为因变量，年龄、性别、婚姻状况、糖尿病知识教育活动、病程、并发症、社会支持和自我同情作为自变量构建回归模型，进行逐步多元线性回归分析。结果表明，性别、糖尿病知识教育活动、病程、并发症、社会支持及自我同情是老年T2DM患者DD的影响因素。见表3。
2.5　自我同情在社会支持与DD间的中介效应
社会支持对老年T2DM患者的自我同情有正向预测作用（β=0.378，t=7.875，P<0.001），对DD有负向预测作用，总效应系数为-0.208（Boot 95% CI:-0.284~-0.127）；引入中介变量自我同情后，社会支持对DD的负向预测作用仍显著（β=-0.131，t=-3.062，P<0.01），自我同情的间接效应为-0.077（Boot 95% CI: -0.112~-0.044），中介效应占比37.02%。详见表4和图1。
3　讨论
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3.1　老年T2DM患者的DD、社会支持和自我同情现状
DD是糖尿病患者因疾病管理、情感负担、治疗方案等方面过于担心而产生的情绪反应[16]。作为慢性终身性疾病，患者需长期进行复杂繁琐的自我管理，易产生心理应激，出现DD。本研究显示，老年T2DM患者DD得分为（30.13±8.59）分，低于住院老年患者[17]；其中35.1%的患者存在中度及以上的DD，低于空巢老年患者（68.59%）[18]，表明DD的患病率在不同人群中存在差异。可能是因为本研究中的老年T2DM患者均参加基本公共卫生服务管理，较少患者出现糖尿病相关的并发症（30.8%），并且86.8%的老年T2DM患者和配偶或儿女一起生活，可以获得相关的心理支持较多。此外，情感负担和生活规律相关痛苦维度的得分较高，可能与严格的疾病管理和并发症的威胁给日常生活和家庭带来负担有关。多元线性回归分析显示，性别、糖尿病知识教育活动、病程和并发症是DD的重要影响因素。病程的延长及并发症的出现会对患者的生理机能造成损害，增加治疗难度，不仅给患者带来经济压力，还可能加剧心理痛苦。因此，老年T2DM患者需定期接受心理评估，积极参加科普讲座、糖尿病小屋等糖尿病知识教育活动。
本研究中，老年T2DM患者的社会支持得分为（39.48±8.13）分，处于中等水平，其中主观支持维度得分最高，其次为客观支持，均高于孙坤等对养老机构T2DM患者的调查结果[19]。本研究中86.8%的患者和家人共同生活，可获得更多的家庭支持和朋友支持，而养老机构患者离开家庭，缺乏情感支持。本研究中自我同情得分为（91.18±9.10）分，高于住院病人的调查结果[20]，可能与住院患者处于相对封闭的医疗环境中更易产生孤独感有关。在自我同情维度中，普遍人性感得分最高，自我批判得分最低。自我批判维度为反向计分，得分越低，说明患者关注自我管理的成败时越容易自责批评自己。本研究发现尽管老年T2DM患者意识到罹患慢性病是人类的共同经历，但在血糖控制不佳或出现并发症时，仍会感到挫败，增加自我批判的倾向。
3.2　老年T2DM患者DD与社会支持、自我同情的关系
本研究表明，社会支持和自我同情均与DD显著负相关，即老年T2DM患者的社会支持和自我同情水平越高，其DD程度越低。多元线性回归分析进一步验证了社会支持和自我同情是DD的显著预测因素,与先前的研究结果一致[4,9]。在“生物—心理—社会医学模式”的背景下，社会支持不仅能加强人际纽带，还通过提供主观情感慰藉和客观物质支持，帮助患者更有效地采取策略来降低负性情绪的发生风险[21]。同时，自我同情可通过调节压力的生理反应来改善情绪状态，如炎症反应和交感神经系统活动[22]。此外，与吴红伦等[20]的研究结果一致，T2DM患者的社会支持与自我同情正相关，提示社会支持水平较高的患者能以良好的心态管理疾病，更容易接纳自身的不足。
3.3　自我同情在老年T2DM患者社会支持和DD间的中介效应
中介效应分析结果显示，自我同情在社会支持与DD间存在部分中介效应，中介效应占比37.02%。这表明社会支持不仅能直接负向影响DD，对T2DM患者的情绪具有保护作用，减少其对未来糖尿病管理的恐惧、害怕，还能通过提升自我同情水平，间接缓解疾病管理压力对心理状况的消极影响，降低DD。这与李玲等人对中青年T2DM患者的研究一致[10]，本研究进一步证实了此中介效应在老年T2DM患者人群中仍显著。具体而言，当患者获得较高的社会支持时，一方面可以直接减少患者的负性情绪反应，保持良好的心理健康状态[13]；另一方面，通过家庭、朋友、医务人员、社区等提供的语言、行为或情感支持可以使患者感知到外界的帮助并更好地利用外部资源，将外部支持转化为内部资源，从而促进自我接纳和宽容的心理状态，提高其自我同情水平。自我同情能够抑制患者在面对挫折时产生的自我批评倾向，并通过激活安抚系统而非威胁系统实现情绪的自我调节[22]，这一机制强调了自我同情在缓解DD等负性情绪中的关键作用。相反，社会支持水平低的老年T2DM患者，他们可能由于缺乏足够的客观支持和主观支持，难以有效坚持长期的疾病管理和应对挑战，容易使自己产生孤立感、自我批判和过度认同的负面心理，从而加剧DD，另外，Molinari[23]指出具有自我批判性人格特质的个体更容易出现内源性抑郁，进一步削弱其疾病管理的主动积极性，增加DD的发生。因此，需要充分重视老年T2DM患者社会支持的构建与利用，医疗卫生服务机构应强化患者家庭成员的支持、提升卫生服务质量以及加强医患沟通，帮助患者更好地获取和利用社会支持资源，并结合自我同情相关的干预方法，如正念疗法和接纳与承诺疗法，进一步提高患者的自我同情水平，增强其心理适应能力，改善心理健康。
本研究还存在一定的局限性。首先，由于采用横断面研究设计，无法直接推断社会支持、自我同情和DD的因果关系；其次，研究样本采用便利抽样，选取来自社区卫生服务中心的老年T2DM患者，研究结论的推广受到限制，后续的研究会采用多中心、多组别设计；最后，本研究采用自我报告问卷收集数据，可能存在回忆偏倚和报告偏倚。
综上所述，在老年T2DM患者中，自我同情在社会支持与DD间存在中介效应，这表明社会支持和自我同情作为积极心理学中的关键因素，在缓解负性情绪和维持心理健康方面具有重要作用。因此，医务人员应加强对老年T2DM患者DD的筛查并及时提供心理疏导；同时，通过家庭、社区和医务人员的协同作用，为患者提供有效的社会支持体系，以提高其心理健康和生活质量。
基金
收起
  • 国家自然科学基金面上项目(71974101)
  • 南京市中医药传承创新发展示范试点项目(2024KF0103)
文献
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2025年第52卷第14期
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doi: 10.20043/j.cnki.MPM.202501140
  • 接收时间：2025-01-08
  • 首发时间：2026-03-16
  • 出版时间：2025-07-25
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  • 收稿日期：2025-01-08
基金
国家自然科学基金面上项目(71974101)
南京市中医药传承创新发展示范试点项目(2024KF0103)
作者信息
    1.南京医科大学公共卫生学院，江苏 南京 211166
    2.南京市鼓楼区疾病预防控制中心
    3.南京市疾病预防控制中心

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