The effect of social support, diabetes management self-efficacy, and diabetes distress on resilience among patients with type 2 diabetes: a moderated mediation analysis

BMC Public Health. 2024 Feb 15;24(1):477. doi: 10.1186/s12889-024-18022-x.


Background: Diabetes can result in distress. Improving Resilience is important in managing these conditions. It is also important to consider the mediating role of diabetes management self-efficacy (DMSE) between diabetes distress (DD) and Resilience. Likewise, understanding how social support (SS) buffers the impact of diabetes distress on Resilience is equally important.

Methods: The present study used a cross-sectional design and included 403 participants diagnosed with type 2 diabetes (T2D). The study was conducted in the south of Iran. The participants were selected through convenience sampling from July 2022 to January 2023. Self-reported questionnaires, namely the Diabetes Distress Scale (DDS), Diabetes Management Self-Efficacy Scale (DMSE), Perceived Social Support Scale (PSSS), and Resilience Scale, were used for data collection in the present study. Structural equation modelling was used for moderated mediation analysis.

Results: The results of the Pearson correlation analysis were indicative of a significant negative correlation (p < 0.01) between diabetes distress and diabetes management self-efficacy (r = - 0.607), social support (r = - 0.417), and Resilience (r = - 0.552). The findings further revealed that diabetes management self-efficacy had fully mediated the correlation between diabetes distress and Resilience. Moreover, the results indicated that social support had a moderating role in the DD-resilience link.

Conclusions: The present study's findings offer a new theoretical framework for T2DM that can benefit intervention designers. The results further suggest that promoting diabetes management self-efficacy can be an effective strategy to enhance Resilience and decrease diabetes distress. Also, nurses and other healthcare providers must pay close attention to support resources to improve the patients' Resilience and evaluate the distress associated with diabetes.

Keywords: Diabetes distress; Moderated mediation; Resilience; Self-efficacy; Self-management; Social support; Type 2 diabetes.

MeSH terms

  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2* / therapy
  • Humans
  • Mediation Analysis
  • Resilience, Psychological*
  • Self Efficacy
  • Social Support