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| Mediating effect of self-efficacy on social support and depression symptoms among elderly patients with type 2 diabetes mellitus |
| ZHAO Jinhang1, LI Dianjiang1, CHEN Wei2, WANG Zhiyong3, PAN Zhi2, LIU Sijun1
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1. School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China;
2. Gulou District Center for Disease Control and Prevention, Nanjing, Jiangsu 210003, China;
3. Nanjing Center for Disease Control and Prevention, Nanjing, Jiangsu 210003, China |
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Abstract Objective To analyze the mediating effect of self-efficacy on the relationship between social support and depression symptoms among elderly patients with type 2 diabetes mellitus (T2DM), so as to provide the evidence for improving mental health intervention strategies in this population. Methods From June to July 2024, elderly patients aged ≥60 years with T2DM receiving basic public health management services were recruited from four community health service centers in Nanjing City using convenience sampling. Demographic and disease-related information were collected through questionnaire surveys. Depression symptoms, self-efficacy, and social support were assessed using the 9-item Patient Health Questionnaire, the Diabetes Self-Efficacy Scale, and the Social Support Rating Scale, respectively. A structural equation model was constructed using Mplus 8.3 to examine the mediating effect of self-efficacy on social support and depression symptoms. The significance of the mediating effect was tested using the Bootstrap method. Results A total of 604 elderly patients with T2DM were surveyed. The median age was 72.00 (interquartile range, 9.00) years. There were 292 males (48.34%) and 312 females (51.66%). The median score of depression symptoms was 2.00 (interquartile range, 5.00) points. A total of 176 participants were identified as having depressive symptoms, with a detection rate of 29.10%. The median scores of self-efficacy and social support were 4.11 (interquartile range, 0.78) and 39.00 (interquartile range, 11.00) points, respectively. The mediation analysis showed that social support had a direct negative effect on depression symptoms among elderly patients with T2DM, with an effect value of -0.137 (95%CI: -0.226 to -0.043). Social support also indirectly affected depression symptoms through self-efficacy, with an effect value of -0.066 (95%CI: -0.099 to -0.037). The mediating effect accounted for 32.51% of the total effect. Conclusions Self-efficacy plays a partial mediating role between social support and depressive symptoms among elderly patients with T2DM. It is recommended to reduce the risk of depression symptoms in this population by improving social support levels and enhancing self-efficacy.
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Received: 28 November 2025
Revised: 22 February 2026
Published: 21 April 2026
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