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Article(id=1322609094071014045, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202506200, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1749657600000, receivedDateStr=2025-06-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793264180915, onlineDateStr=2026-10-29, pubDate=1764000000000, pubDateStr=2025-11-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793264180915, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793264180915, creator=13701087609, updateTime=1793264180915, updator=13701087609, issue=Issue{id=1322609030938346427, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='22', pageStart='4033', pageEnd='4224', issueExtLink='null', onlineDate='null', pubDate='1764000000000', pubDateStr='2025-11-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793264165863, creator='13701087609', updateTime=1793264299902, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609593264489401, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609593264489402, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4138, endPage=4142, ext={EN=ArticleExt(id=1322609094364615326, articleId=1322609094071014045, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=A study on the mediating role of sleep quality between social capital and anxiety symptoms in patients with type 2 diabetes mellitus, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the pathway through which social capital influences anxiety symptoms in patients with type 2 diabetes mellitus（T2DM）and to explore the mediating effect of sleep quality between these variables, thereby providing evidence for intervention strategies.

Methods

A total of 1 726 T2DM patients from 10 hospitals in Ningxia, China, were enrolled. Data were collected via face-to-face interviews using the Self-Rating Anxiety（SAS）and the Chinese version of the Social Capital Scale. The Bootstrap procedure was employed to test the mediating effects.

Results

After adjusting for confounders, social capital exhibited a negative correlation with the prevalence of anxiety symptoms（r=-0.12, P<0.001）, sleep quality was negatively correlated with SAS scores（r=-0.32, P<0.001）, while social capital was positively correlated with sleep quality（r=0.07, P<0.05）. Sleep quality exhibited a partial mediating effect between social capital and anxiety symptoms（β=-0.025, 95% CI: -0.042- -0.009）. Age-stratified analysis revealed that in the elderly group, sleep quality demonstrated a significant mediating effect accounting for 29.2% of the total effect（β=-0.049, 95% CI: -0.079- -0.025）, whereas no statistically significant mediation was observed in the non-elderly group（P>0.05）.

Conclusions

Social capital may indirectly alleviate anxiety symptoms in T2DM patients through improving sleep quality, with this mediating pathway being particularly significant in the elderly population. In clinical practice, it is crucial to emphasize the integration of interventions targeting social capital reconstruction（e.g., community mutual-aid network development）and sleep management（e.g., cognitive behavioral therapy）. Particularly for elderly patients, this combined approach may enhance mental health outcomes through synergistic socio-physio-psychological mechanisms.

, authors=Xing-yu ZHANG, Ling-ling MA, Xue MA, Yan MA, He-li LIU, Hua MA, Li-qun WANG, authorsList=Xing-yu ZHANG, Ling-ling MA, Xue MA, Yan MA, He-li LIU, Hua MA, Li-qun WANG, authorCompany=null, correspAuthors=Li-qun WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322609096193331889, articleId=1322609094071014045, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=睡眠质量在2型糖尿病患者社会资本与焦虑症状间的中介作用研究, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

分析2型糖尿病（Type 2 Diabetes Mellitus，T2DM）患者社会资本对焦虑症状的影响路径，并探讨睡眠质量在二者间的中介效应，为其制定干预策略提供依据。

方法

选取宁夏地区10家医院1 726例T2DM患者，采用焦虑自评量表（Self-Rating Anxiety Scale，SAS）和中文版社会资本量表对T2DM患者进行面对面访谈收集其资料信息，采用Bootstrap程序检验中介效应。

结果

校正混杂因素后，社会资本与焦虑症状呈负相关（r=-0.12，P<0.001）；睡眠质量与SAS得分呈负相关（r=-0.32，P<0.001）；社会资本与睡眠质量呈正相关（r=0.07，P<0.05）；睡眠质量在社会资本与焦虑症状之间呈现部分中介效应（β=-0.025，95% CI：-0.042~ -0.009）；对年龄进行分层后发现在老年组中，睡眠质量的中介效应占比29.2%（β=-0.049，95% CI：-0.079~ -0.025），而非老年组未达显著水平（P>0.05）。

结论

社会资本可通过改善T2DM患者睡眠质量间接缓解焦虑症状，且在老年群体中尤为显著。提示临床实践中需重视社会资本重构（如社区互助网络建设）与睡眠管理（如认知行为疗法）的整合干预，尤其针对老年患者，可通过“社会－生理－心理”多重机制提升心理健康水平。

, authors=张兴玉, 马玲玲, 马雪, 马燕, 刘河利, 马华, 王立群, authorsList=张兴玉, 马玲玲, 马雪, 马燕, 刘河利, 马华, 王立群, authorCompany=null, correspAuthors=王立群, authorNote=

张兴玉（2004—），女，本科在读，研究方向：慢性病流行病学

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王立群，E-mail：
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Medicine and Society, 2023, 36 (9): 85-89, 95.（In Chinese）, articleTitle=Association of sleep status with the risk of anxiety disorders in the old adults in China, refAbstract=null)], funds=[Fund(id=1322609103382369006, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, awardId=82204955, language=CN, fundingSource=国家自然科学基金(82204955), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322609096411435698, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, xref=null, ext=[AuthorCompanyExt(id=1322609096419824307, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, companyId=1322609096411435698, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=College of Public Health, Ningxia Medical University, Yinchuan, Ningxia 750004, China), AuthorCompanyExt(id=1322609096428212916, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, companyId=1322609096411435698, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=宁夏医科大学公共卫生学院，宁夏　银川　750004)])], figs=[ArticleFig(id=1322609100593156834, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=EN, label=Fig.1, caption=Schematic diagram of the mediation effect（hypothetical）, figureFileSmall=inZBc1To/0RWza7o6vb4IQ==, figureFileBig=Fbw/Cqy9xyaiNp0kYOp+rg==, tableContent=null), ArticleFig(id=1322609100664460003, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=CN, label=图1, caption=中介效应示意图（假设）, figureFileSmall=inZBc1To/0RWza7o6vb4IQ==, figureFileBig=Fbw/Cqy9xyaiNp0kYOp+rg==, tableContent=null), ArticleFig(id=1322609100903535332, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=EN, label=Table 1, caption=

Basic characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计n=1 726
年龄[（岁），]58.6± 12.2
性别，男性[n（%）]953（55.2）
婚姻，已婚[n（%）]1 612（93.4）
户籍，城市[n（%）]1 088（63.0）
教育水平[n（%）]
小学以下水平332（19.2）
小学384（22.2）
中学和中专616（35.7）
大学或以上学历394（22.8）
职业，农民[n（%）]691（40.0）
家庭人均月收入，<3 000[n（%）]1 090（63.2）
吸烟[n（%）]391（22.7）
饮酒[n（%）]367（21.3）
T2DM并发症，是[n（%）]1 032（59.8）
午睡，是[n（%）]848（49.1）
BMI[n（%）]
消瘦669（38.8）
正常753（43.6）
超重或肥胖304（17.6）
是否服药1 438（83.3）
睡眠时间[（h），]8.2± 1.1
睡眠质量，差[n（%）]383（22.2）
SAS[（分），]31.8± 6.5
社会资本评分[（分），]27.7± 6.5
), ArticleFig(id=1322609100979032805, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=CN, label=表1, caption=

基本情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计n=1 726
年龄[（岁），]58.6± 12.2
性别，男性[n（%）]953（55.2）
婚姻，已婚[n（%）]1 612（93.4）
户籍，城市[n（%）]1 088（63.0）
教育水平[n（%）]
小学以下水平332（19.2）
小学384（22.2）
中学和中专616（35.7）
大学或以上学历394（22.8）
职业，农民[n（%）]691（40.0）
家庭人均月收入，<3 000[n（%）]1 090（63.2）
吸烟[n（%）]391（22.7）
饮酒[n（%）]367（21.3）
T2DM并发症，是[n（%）]1 032（59.8）
午睡，是[n（%）]848（49.1）
BMI[n（%）]
消瘦669（38.8）
正常753（43.6）
超重或肥胖304（17.6）
是否服药1 438（83.3）
睡眠时间[（h），]8.2± 1.1
睡眠质量，差[n（%）]383（22.2）
SAS[（分），]31.8± 6.5
社会资本评分[（分），]27.7± 6.5
), ArticleFig(id=1322609101058724582, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=EN, label=Table 2, caption=

Correlation coefficient（r）of sleep quality, social capital and anxiety symptoms

, figureFileSmall=null, figureFileBig=null, tableContent=
变量平均值sSAS社会资本睡眠质量
SAS31.86.51.00--
社会资本27.76.5-0.12a1.00-
睡眠质量2.10.7-0.32a0.07b1.00
), ArticleFig(id=1322609101130027751, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=CN, label=表2, caption=

睡眠质量、社会资本和焦虑症状的相关系数（r）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量平均值sSAS社会资本睡眠质量
SAS31.86.51.00--
社会资本27.76.5-0.12a1.00-
睡眠质量2.10.7-0.32a0.07b1.00
), ArticleFig(id=1322609102832915176, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=EN, label=Table 3, caption=

Linear regression model of the interaction effect between social capital and sleep quality on anxiety symptoms

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
β（95% CI）P值β（95% CI）P值β（95% CI）P值
社会资本0.03（-0.02~0.07）0.260-0.24（-0.36~0.13）<0.001-0.31（-0.48~-0.15）<0.001
睡眠质量-3.04（-3.43~-2.65）<0.001-2.70（-3.09~-2.30）<0.001-3.64（-5.23~-2.04）<0.001
年龄NANA0.04（0.01~0.06）0.0120.04（0.01~0.06）0.017
性别NANA-1.08（-1.76~-0.40）0.002-1.09（-1.77~-0.41）0.002
职业NANA0.40（-0.46~1.24）0.3630.39（-0.46~1.24）0.365
教育NANA-0.11（-0.50~0.29）0.592-0.11（-0.51~0.28）0.580
户籍NANA-1.61（-2.39~-0.83）<0.001-1.60（-2.38~-0.82）<0.001
地域NANA0.28（-0.02~0.58）0.0650.28（-0.02~0.58）0.069
家庭人均月收入NANA0.10（-0.16~0.36）0.4420.09（-0.17~0.35）0.497
吸烟NANA1.12（0.33~1.92）0.0061.13（0.33~1.93）0.006
饮酒NANA-0.90（-1.71~-0.09）0.029-0.87（-1.68~-0.06）0.036
T2DM并发症NANA0.35（-0.27~0.97）0.2720.35（-0.28~0.97）0.275
午睡NANA0.40（-0.18~0.98）0.1750.40（-0.18~0.98）0.173
新发疾病NANA-0.67（-1.56~0.21）0.136-0.67（-1.56~0.21）0.136
BMINANA-0.10（-0.50~0.30）0.613-0.10（-0.50~0.30）0.622
病情NANA0.23（-0.19~0.64）0.2850.23（-0.18~0.65）0.268
病程NANA0.04（-0.01~0.09）0.0560.04（-0.01~0.09）0.054
疾病NANA0.74（0.11~1.37）0.0200.75（0.12~1.38）0.019
社交NANA0.32（0.14~0.50）<0.0010.32（0.14~0.50）<0.001
社会资本×睡眠质量NANANANA0.03（-0.02~0.09）0.234
), ArticleFig(id=1322609102929384169, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=CN, label=表3, caption=

社会资本与睡眠质量对焦虑症状交互作用的线性回归模型

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
β（95% CI）P值β（95% CI）P值β（95% CI）P值
社会资本0.03（-0.02~0.07）0.260-0.24（-0.36~0.13）<0.001-0.31（-0.48~-0.15）<0.001
睡眠质量-3.04（-3.43~-2.65）<0.001-2.70（-3.09~-2.30）<0.001-3.64（-5.23~-2.04）<0.001
年龄NANA0.04（0.01~0.06）0.0120.04（0.01~0.06）0.017
性别NANA-1.08（-1.76~-0.40）0.002-1.09（-1.77~-0.41）0.002
职业NANA0.40（-0.46~1.24）0.3630.39（-0.46~1.24）0.365
教育NANA-0.11（-0.50~0.29）0.592-0.11（-0.51~0.28）0.580
户籍NANA-1.61（-2.39~-0.83）<0.001-1.60（-2.38~-0.82）<0.001
地域NANA0.28（-0.02~0.58）0.0650.28（-0.02~0.58）0.069
家庭人均月收入NANA0.10（-0.16~0.36）0.4420.09（-0.17~0.35）0.497
吸烟NANA1.12（0.33~1.92）0.0061.13（0.33~1.93）0.006
饮酒NANA-0.90（-1.71~-0.09）0.029-0.87（-1.68~-0.06）0.036
T2DM并发症NANA0.35（-0.27~0.97）0.2720.35（-0.28~0.97）0.275
午睡NANA0.40（-0.18~0.98）0.1750.40（-0.18~0.98）0.173
新发疾病NANA-0.67（-1.56~0.21）0.136-0.67（-1.56~0.21）0.136
BMINANA-0.10（-0.50~0.30）0.613-0.10（-0.50~0.30）0.622
病情NANA0.23（-0.19~0.64）0.2850.23（-0.18~0.65）0.268
病程NANA0.04（-0.01~0.09）0.0560.04（-0.01~0.09）0.054
疾病NANA0.74（0.11~1.37）0.0200.75（0.12~1.38）0.019
社交NANA0.32（0.14~0.50）<0.0010.32（0.14~0.50）<0.001
社会资本×睡眠质量NANANANA0.03（-0.02~0.09）0.234
), ArticleFig(id=1322609103017464554, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=EN, label=Table 4, caption=

Mediating Effect of Social Capital Mediated by Sleep Quality on Anxiety Symptoms in Patients with T2DM

, figureFileSmall=null, figureFileBig=null, tableContent=
效应 P值β（95% CI）
总效应0.0250.002-0.078（-0.127~-0.029）
间接效应0.0080.002-0.025（-0.042~-0.009）
直接效应0.0240.024-0.053（-0.099~-0.007）
), ArticleFig(id=1322609103101350635, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=CN, label=表4, caption=

睡眠质量介导的社会资本与T2DM患者焦虑症状的中介效应分析

, figureFileSmall=null, figureFileBig=null, tableContent=
效应 P值β（95% CI）
总效应0.0250.002-0.078（-0.127~-0.029）
间接效应0.0080.002-0.025（-0.042~-0.009）
直接效应0.0240.024-0.053（-0.099~-0.007）
), ArticleFig(id=1322609103172653804, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=EN, label=Table 5, caption=

Mediation Effect Analysis of Social Capital and Anxiety Symptoms Mediated by Sleep Quality in T2DM Patients Stratified by Age

, figureFileSmall=null, figureFileBig=null, tableContent=
效应 P值β（95% CI）
年龄 <60岁
总效应0.0320.9390.003（-0.061~0.066）
间接效应0.0100.592-0.006（-0.026~0.015）
直接效应0.0310.7920.008（-0.052~0.068）
年龄≥60岁
总效应0.038<0.001-0.168（-0.243~-0.093）
间接效应0.014<0.001-0.049（-0.079~-0.025）
直接效应0.0370.001-0.119（-0.191~-0.047）
), ArticleFig(id=1322609103256539885, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609094071014045, language=CN, label=表5, caption=

按照年龄分层后的睡眠质量介导的社会资本与T2DM患者焦虑症状的中介效应分析

, figureFileSmall=null, figureFileBig=null, tableContent=
效应 P值β（95% CI）
年龄 <60岁
总效应0.0320.9390.003（-0.061~0.066）
间接效应0.0100.592-0.006（-0.026~0.015）
直接效应0.0310.7920.008（-0.052~0.068）
年龄≥60岁
总效应0.038<0.001-0.168（-0.243~-0.093）
间接效应0.014<0.001-0.049（-0.079~-0.025）
直接效应0.0370.001-0.119（-0.191~-0.047）
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睡眠质量在2型糖尿病患者社会资本与焦虑症状间的中介作用研究
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张兴玉 , 马玲玲 , 马雪 , 马燕 , 刘河利 , 马华 , 王立群
现代预防医学 | 健康与社会行为 2025,52(22): 4138-4142
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现代预防医学 |健康与社会行为 2025 , 52 (22) : 4138 -4142
睡眠质量在2型糖尿病患者社会资本与焦虑症状间的中介作用研究
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张兴玉, 马玲玲, 马雪, 马燕, 刘河利, 马华, 王立群
作者信息
  • 宁夏医科大学公共卫生学院，宁夏　银川　750004
通讯作者:
王立群，E-mail：
作者简介:

张兴玉（2004—），女，本科在读，研究方向：慢性病流行病学

A study on the mediating role of sleep quality between social capital and anxiety symptoms in patients with type 2 diabetes mellitus
Xing-yu ZHANG, Ling-ling MA, Xue MA, Yan MA, He-li LIU, Hua MA, Li-qun WANG
Affiliations
  • College of Public Health, Ningxia Medical University, Yinchuan, Ningxia 750004, China
出版时间: 2025-11-25 doi: 10.20043/j.cnki.MPM.202506200
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摘要
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目的

分析2型糖尿病（Type 2 Diabetes Mellitus，T2DM）患者社会资本对焦虑症状的影响路径，并探讨睡眠质量在二者间的中介效应，为其制定干预策略提供依据。

方法

选取宁夏地区10家医院1 726例T2DM患者，采用焦虑自评量表（Self-Rating Anxiety Scale，SAS）和中文版社会资本量表对T2DM患者进行面对面访谈收集其资料信息，采用Bootstrap程序检验中介效应。

结果

校正混杂因素后，社会资本与焦虑症状呈负相关（r=-0.12，P<0.001）；睡眠质量与SAS得分呈负相关（r=-0.32，P<0.001）；社会资本与睡眠质量呈正相关（r=0.07，P<0.05）；睡眠质量在社会资本与焦虑症状之间呈现部分中介效应（β=-0.025，95% CI：-0.042~ -0.009）；对年龄进行分层后发现在老年组中，睡眠质量的中介效应占比29.2%（β=-0.049，95% CI：-0.079~ -0.025），而非老年组未达显著水平（P>0.05）。

结论

社会资本可通过改善T2DM患者睡眠质量间接缓解焦虑症状，且在老年群体中尤为显著。提示临床实践中需重视社会资本重构（如社区互助网络建设）与睡眠管理（如认知行为疗法）的整合干预，尤其针对老年患者，可通过“社会－生理－心理”多重机制提升心理健康水平。

焦虑  /  睡眠质量  /  社会资本  /  2型糖尿病  /  中介作用
Objective

To analyze the pathway through which social capital influences anxiety symptoms in patients with type 2 diabetes mellitus（T2DM）and to explore the mediating effect of sleep quality between these variables, thereby providing evidence for intervention strategies.

Methods

A total of 1 726 T2DM patients from 10 hospitals in Ningxia, China, were enrolled. Data were collected via face-to-face interviews using the Self-Rating Anxiety（SAS）and the Chinese version of the Social Capital Scale. The Bootstrap procedure was employed to test the mediating effects.

Results

After adjusting for confounders, social capital exhibited a negative correlation with the prevalence of anxiety symptoms（r=-0.12, P<0.001）, sleep quality was negatively correlated with SAS scores（r=-0.32, P<0.001）, while social capital was positively correlated with sleep quality（r=0.07, P<0.05）. Sleep quality exhibited a partial mediating effect between social capital and anxiety symptoms（β=-0.025, 95% CI: -0.042- -0.009）. Age-stratified analysis revealed that in the elderly group, sleep quality demonstrated a significant mediating effect accounting for 29.2% of the total effect（β=-0.049, 95% CI: -0.079- -0.025）, whereas no statistically significant mediation was observed in the non-elderly group（P>0.05）.

Conclusions

Social capital may indirectly alleviate anxiety symptoms in T2DM patients through improving sleep quality, with this mediating pathway being particularly significant in the elderly population. In clinical practice, it is crucial to emphasize the integration of interventions targeting social capital reconstruction（e.g., community mutual-aid network development）and sleep management（e.g., cognitive behavioral therapy）. Particularly for elderly patients, this combined approach may enhance mental health outcomes through synergistic socio-physio-psychological mechanisms.

Anxiety  /  Sleep quality  /  Social capital  /  Type 2 diabetes mellitus  /  Mediating
张兴玉, 马玲玲, 马雪, 马燕, 刘河利, 马华, 王立群. 睡眠质量在2型糖尿病患者社会资本与焦虑症状间的中介作用研究. 现代预防医学, 2025 , 52 (22) : 4138 -4142 . DOI: 10.20043/j.cnki.MPM.202506200
Xing-yu ZHANG, Ling-ling MA, Xue MA, Yan MA, He-li LIU, Hua MA, Li-qun WANG. A study on the mediating role of sleep quality between social capital and anxiety symptoms in patients with type 2 diabetes mellitus[J]. Modern Preventive Medicine, 2025 , 52 (22) : 4138 -4142 . DOI: 10.20043/j.cnki.MPM.202506200
正文
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糖尿病已成为日益严重的全球健康问题之一。国际糖尿病联盟发布的最新数据显示，作为目前世界上糖尿病患者数量最多的国家，2024年我国20岁到79岁成人糖尿病患者总数约为1.48亿，预测2050年将达到1.68亿，且其中绝大多数为2型糖尿病（Type 2 Diabetes Mellitus，T2DM）。而患者处于长期高血糖状态可能会导致一系列糖尿病并发症的产生，对其躯体及心理健康都将造成极大的损害。
焦虑障碍（anxiety disorders）作为最常见的心理障碍类型，其终生患病率在人群中可达到5%至20%不等。研究表明，T2DM患者是焦虑症状的高发人群，其患病风险显著高于普通人群[1]，这种焦虑不仅源于疾病本身的管理负担以及对并发症的担忧，也与多种生理心理因素交互作用相关。其中普遍存在的睡眠障碍[2]，如睡眠不足（睡眠剥夺、限制和中断）是加剧焦虑的关键危险因素[3]。社会资本是指个体或群体通过社会网络、规范和信任等社会结构获得的资源和优势，其可能通过多种途径影响T2DM患者的心理健康。研究表明，邻里社会凝聚力作为社会资本的一种形式，其与睡眠质量呈显著正相关[4]，这种关联在面临健康挑战（如T2DM管理）的个体中可能尤为关键。研究发现，社会资本与各种积极的精神健康结果相关，其在缓解焦虑方面发挥着重要的作用[5]，因此，并被认为能通过增加社会凝聚力来预防抑郁和焦虑等问题[6]。
既往研究提示睡眠质量可能在社会资本与焦虑症状中扮演一定角色，然而，目前关于睡眠质量在社会资本与T2DM患者焦虑症状相关性中的中介效应，相关研究报道甚少。考虑到上述问题，本研究基于以下假设展开：假设1：社会资本将与焦虑症状呈负相关且直接相关；假设2：社会资本将与良好睡眠质量呈正相关且直接相关；假设3：睡眠质量差（即睡眠质量不佳）将与焦虑症状呈正相关且直接相关；假设4：社会资本将通过睡眠质量这一中介变量与焦虑症状呈正相关且间接相关（见图1）。
1　研究对象与方法
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1.1　研究对象
本研究采用横断面调查研究设计方法，采用按规模大小成比例的概率抽样方法于2019年10月至2020年10月于宁夏10家医院选取了1 726名T2DM患者作为研究对象。样本量计算：参照横断面研究分类变量分析的样本量计算公式：N=400*q/p，其中，q=1-p。经查阅文献，T2DM患者焦虑的检出率为20.5%，则需要样本量1 551名，考虑到不应答率，增加10%样本量，则至少需要1 706名研究对象。
纳入标准：（1）18岁及以上（2）在宁夏居住6个月及以上（3）符合西医诊断标准的T2DM患者。排除标准：（1）糖尿病急性并发症患者（2）近一个月出现糖尿病酮症酸中毒等急性代谢紊乱及合并感染者（3）妊娠或哺乳期妇女（4）严重精神、认知、躯体功能障碍者（5）恶性肿瘤或传染病患者（6）拒绝知情同意者。本研究所有参与者均知情同意，经宁夏医科大学伦理审查委员会审核批准（宁医大伦理第2022-G124号），该项目符合国家生物医学研究伦理审查规定，同意开展相关科学研究工作。
1.2　研究方法
1.2.1　焦虑症状
焦虑自评量表（Self-Rating Anxiety Scale，SAS）是用于评定个体焦虑症状严重程度的心理量表，该量表包含20个项目，每个项目按照症状出现的频率可分为四级评分，其中15个为正向评分，5个为反向评分。将50分作为SAS标准分的分界值，分数越高焦虑倾向越明显，该量表在中国人群中具有很高的信度和效度[7]。
1.2.2　社会资本
采用中文版社会资本量表，从社会凝聚力和邻里互动两个方面进行评估，社会凝聚力包括四个条目，分别为“小区（村里）的人们愿意互相帮助”“小区（村里）的人们彼此间能和睦相处”“小区（村里）的人们值得信任”“小区（村里）的人们对客观事物的看法比较一致”，每个条目1-5级评分，1为完全不同意，2为不同意，3为中立，4为同意，5为完全同意。邻里互动包括五个条目，分别为“你和小区（村里）的人们互相帮助的情况”“当邻居不在家或出远门时，你帮他照看房屋或财物的情况”“你和小区（村里）的人们就一些个人事情互相咨询交流的情况”“你和小区（村里）里的其他人一起聚会或参加集体活动的情况”“你和小区（村里）里的其他人到家里或者在街上互相交流的情况”，每个条目均采用1-4级评分，1为从不，2为偶尔，3为有时，4为经常。既往研究结果显示：中文版社会资本量表在中国人群中具有良好的信度[8]。
1.2.3　睡眠质量
使用自我报告睡眠质量问卷，即“你的睡眠质量怎么样”，答案“差、一般和好”。
1.2.4　协变量
通过面对面访谈收集研究对象一般人口学特征、临床特征（病程）及生活行为特征等协变量。协变量包括年龄、性别（男性和女性）、教育程度（小学以下、小学、中学和大专、大学或以上学历）、户籍（城市和农村）、地域（银川、银北、银南、宁南）、职业（农民和非农）、家庭人均月收入（<1 000、1 000~、2 000~、3 000~、5 000~）、吸烟（每天至少一支香烟并持续6个月或更多）、饮酒（在过去12个月内至少喝一杯酒，相当于 l/2瓶啤酒或125毫升葡萄酒或果酒或40毫升白葡萄酒）、BMI（消瘦、正常、超重或肥胖）、病情（轻、中、重）、T2DM并发症、服药情况、睡眠时长、午睡、新发疾病、病程、疾病。
1.2.5　数据分析
使用SPSS 24.0版软件进行分析。对所有变量进行Shapiro-Wilk正态性检验，符合正态分布的计量资料，采用（均数±标准差）描述，以t检验或方差分析进行组间比较；定性资料用率表示，以卡方检验进行组间比较；采用多元线性回归模型检验社会资本与睡眠质量以及焦虑症状的相关性，采用Hayes PROCESS宏程序（Model 4）进行Bootstrap中介效应检验（重复抽样5 000次）用于检测睡眠质量对社会资本和焦虑症状相关性的中介作用，并通过年龄分层（<60岁 vs.≥ 60岁）分析效应异质性。检验水准α=0.05。
2　结果
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2.1　人口学统计特征
见表1，患者平均年龄为（58.6±12.2）岁，年龄范围为21~85岁；男性人数（55.2%）略高于一半；大约有1/5的患者教育程度是小学以下水平（19.2%）；93.4%患者已婚；患者平均睡眠时间为（8.2±1.1）h；接近1/5的患者处于超重或肥胖状态；社会资本平均得分为（27.7±6.5）分，SAS平均得分为（31.8±6.5）分；T2DM患者焦虑检出率为12.6%；383名（22.2%）患者睡眠质量较差。
2.2　睡眠质量、社会资本和焦虑症状相关性及分类分析
相关性分析见表2，在控制了社会人口统计学变量（年龄、性别、职业、婚姻状况、受教育程度、户籍、地域、家庭人均月收入）和健康变量（吸烟、饮酒、T2DM并发症、午新发疾病、BMI、病情、病程、疾病、社交）之后，社会资本与焦虑症状呈负相关（r=-0.12，P<0.001）；睡眠质量与SAS得分呈负相关（r=-0.32，P<0.001）；社会资本与睡眠质量呈正相关（r=0.07，P<0.05）。
如表3所示，睡眠质量与焦虑症状呈负相关（模型1）；在控制了社会人口统计学变量（年龄、性别、业、婚姻状况、受教育程度、户籍、地域、家庭人均月收入）和健康变量（吸烟、饮酒、T2DM并发症、午新发疾病、BMI、病情、病程、疾病、社交）之后，睡眠质量、社会资本都与焦虑症状呈负相关（模型2）；在模型3中，睡眠质量、社会资本都与焦虑症状呈负相关，而社会资本与睡眠质量之间的交互作用没有统计学意义，表明社会资本与睡眠质量之间不存在调节关系，可能存在中介作用。
2.3　睡眠质量介导的社会资本与T2DM患者焦虑症状的中介作用
如表4所示，在控制了社会人口统计学变量（年龄、性别、职业、婚姻状况、受教育程度、户籍、地域、家庭人均月收入）和健康变量（吸烟、饮酒、T2DM并发症、午新发疾病、BMI、病情、病程、疾病、社交）之后，睡眠质量部分中介社会资本对焦虑症状的总效应（β=-0.025，95% CI：-0.042~ -0.009），解释32.1%的变异。
2.4　按照年龄分层后的睡眠质量介导的社会资本与T2DM患者焦虑症状的中介作用
如表5所示，对T2DM患者进行年龄分层，在控制了社会人口统计学变量（性别、婚姻状况、受教育程度、户籍）和健康变量（吸烟、饮酒、T2DM并发症、午新发疾病、BMI、病情、病程、疾病、社交）之后，老年组（≥ 60岁）中睡眠质量的中介效应占比29.2%（β=-0.049，95% CI：-0.079~-0.025），而非老年组未达显著水平（P>0.05）。
3　讨论
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（1）本研究T2DM患者伴有焦虑症状的检出率为12.60%，低于哈萨克斯坦（12.80%）[9]和欧美国家（如25.40%）[10]，但明显高于国内一般人群（约7.60%）[11]及上海某社区T2DM患者（7.07%）[12]。这种差异可能与文化背景、医疗资源及社会支持水平等因素有关。哈萨克斯坦研究中患者失眠症状高发可能加剧焦虑发生，而本研究显示良好的睡眠质量或有助于降低焦虑；与欧美国家相比，西北地区较强的家庭和社区支持可能是焦虑症状的保护因素；而与国内发达地区相比，本研究焦虑症状检出率略高，提示地域经济差异和医疗可及性可能对T2DM患者的心理健康产生影响。在未来需结合多层次社会生态因素进一步探讨地区差异成因。
（2）社会资本与睡眠质量呈正相关，而睡眠质量差则与焦虑症状正相关。与既往研究结果相一致，即使夜间睡眠轻微减少，也可能导致次日焦虑显著上升，这可能与睡眠不足影响前额叶皮层活动及其与边缘系统的连接有关，而非快速眼动慢波振荡则有助于缓解这些脑网络异常、减轻焦虑[13]。此外，感知社会信任作为认知社会资本的一种形式，也被发现能够促进良好睡眠[14]，其机制可能在于社会信任通过缓解压力、促进健康行为，进而改善睡眠并降低焦虑。因此，睡眠质量差可能是焦虑的一个重要风险因素，在对T2DM患者进行心理干预时，结合睡眠治疗可能会提高整体疗效。
（3）睡眠质量在社会资本与焦虑症状之间起到部分中介作用，其中介效应占总效应的32.10%，社会资本的水平越低，发生睡眠障碍的风险越高，睡眠质量越差[15]，其可能的机制是社会支持水平越高，意味着个体能够减少反复思考疾病带来的恐惧感，缓解负面心理，进而改善老年慢性病患者的睡眠质量[16]，而适宜的睡眠时长有利于缓解焦虑症状[17]。这一研究结果揭示了社会资本不仅直接影响T2DM患者的焦虑症状，还通过提升睡眠质量间接起效，符合“社会-生理-心理”多重机制模型。
（4）在老年组（≥ 60岁）中，睡眠质量的中介效应占比29.20%。先前一项纵向研究表明，社会资本的积累对睡眠质量的提升具有长期效应，而这种效应在老年人群中尤为突出，表明睡眠质量在老年人群中的部分中介作用相对显著。相比之下，非老年组的中介效应不显著，其原因可能为年轻患者的社会资本来源更加广泛，睡眠质量受其他影响因素更大，而社会资本作用相对较弱，且年轻人的睡眠问题可能更多由熬夜等行为习惯引起而非心理压力驱动，因此社会资本与睡眠质量之间的关联相对较弱。这提示我们，针对不同年龄段人群的心理健康干预策略应有所侧重，对于老年人，改善睡眠质量可能是缓解心理健康的关键。
本研究也存在不足之处：首先，横断面设计无法对社会资本和焦虑症状之间的关系做出因果推断，因此，更进一步的纵向设计尤为必要。其次，出于可行性的考虑，本研究采用自我报告睡眠质量问卷来收集睡眠质量数据，尽管其已被证实与活动测量有合理的相关性，但仍可能涉及回忆偏差等问题。综上所述，本研究表明在西北地区的老年T2DM患者中，社会资本不仅本身对缓解焦虑症状具有潜在作用，还可通过改善睡眠质量间接缓解焦虑症状，且该路径在老年群体中尤为显著。因此，在针对老年T2DM患者的临床实践与社区健康管理中，亟需打破传统单一维度干预局限，重视社会资本重构（如社区互助网络建设）与睡眠管理（如认知行为疗法）的整合干预，从而更全面、更有效地提升老年T2DM患者的整体心理健康水平和生活质量。
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2025年第52卷第22期
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doi: 10.20043/j.cnki.MPM.202506200
  • 接收时间：2025-06-12
  • 首发时间：2026-10-29
  • 出版时间：2025-11-25
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  • 收稿日期：2025-06-12
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    宁夏医科大学公共卫生学院，宁夏　银川　750004

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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