The relationship between depression, anxiety and health literacy with the severity of diabetes: the mediating role of fear of disease progression

Fatemeh Fallah; Mohammad Kazem Atef Vahid; Mahdieh Salehi

doi:10.1007/s40200-025-01650-4

The relationship between depression, anxiety and health literacy with the severity of diabetes: the mediating role of fear of disease progression

J Diabetes Metab Disord. 2025 Jun 2;24(1):137. doi: 10.1007/s40200-025-01650-4. eCollection 2025 Jun.

Authors

Fatemeh Fallah¹, Mohammad Kazem Atef Vahid¹, Mahdieh Salehi¹

Affiliation

¹ Department of Health Psychology, School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Mansouri St., Niayesh St., Sattarkhan Blvd, P.O. Box: 1445613111, Tehran, Iran.

PMID: 40469911
PMCID: PMC12130382 (available on 2026-06-02)
DOI: 10.1007/s40200-025-01650-4

Abstract

Objective: Diabetes is a widespread metabolic and chronic disease worldwide. Similar to other chronic diseases, psychological factors may play a role in the course of this disease. In this study, an attempt was made to examine the relationship between depression, anxiety and health literacy with the severity of diabetes and the mediating role of fear of disease progression.

Methods: A total of 225 patients with diabetes who visited the specialized and sub-specialized diabetes clinic in Amol city were selected through the they were selected using a convenient sampling method and a systematic approach based on inclusion criteria, and answered the 9-item Patient Health Questionnaire, Beck Anxiety Inventory, short form of Fear of Disease Progression and Health Literacy Inventory. To measure the severity of diabetes, HbA1c levels from the last blood test were measured. Structural equation modeling was used to test a hypothesized model. According to the fit indices, CMIN/df = 3.34, Goodness-of-fit index = 0.90, Normed Fit Index = 0.91, Comparative Fit Index = 0.90, and Root Mean Square Error of Approximation = 0.08 indicated an acceptable fit of the research model. The data were analyzed using SPSS version 26 and LISREL version 8/80 software.

Results: The findings showed significantly positive relationships between anxiety (β = 0.29, r = 0.552), depression (β‌ = 0.13, r = 0.485), fear of disease progression (β = 0.14, r = 0.486) and the severity of diabetes. Also, a significantly negative relationship was observed between health literacy and severity of diabetes (β = -0.4, r = -0.564). In addition, it was shown that in diabetic patients, the fear of disease progression plays a mediating role in the relationship between depression (B = 0.03, T-value = 2.12), anxiety (B = 0.03, T-value = 2.42) and health literacy (B = -0.03, T-value = -2.69) with the disease severity.

Conclusion: Therapeutic interventions to reduce the level of anxiety, depression and fear of disease progression and improve the level of health literacy of patients with diabetes can help in reducing the severity of diabetes. The generalizability of the results to other population requires confirmation by further research.

Keywords: Anxiety; Depression; Fear of disease progression; Health literacy; Severity of diabetes.

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