Health ecology-based nursing impact on stigma, anxiety, and depression in young and middle-aged type 2 diabetes patients

Abstract

BACKGROUND

Most people with type 2 diabetes mellitus (T2DM) are young or middle-aged. These individuals often face pressure from work, society, and family, leading many to experience shame, anxiety, and depression related to T2DM. The nursing model based on health ecology theory provides multi-level nursing interventions at the individual, family, community, and societal levels. However, its effect on stigma, anxiety, and depression among young and middle-aged T2DM patients remains unclear.

AIM

To examine the effect of nursing intervention based on health ecology theory on stigma, anxiety, and depression in young and middle-aged T2DM patients.

METHODS

A total of 60 young and middle-aged T2DM patients hospitalized in the Department of Endocrinology and Traditional Chinese Medicine of the Ninth People’s Hospital of Suzhou from March 2024 to July 2025 were retrospectively selected as the research objects. Based on nursing approach, patients were divided into a control group (n = 30; routine nursing) and an observation group (n = 30; nursing based on health ecology theory). Scores for glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPBG), Diabetes Self-Care Scale (DSCS), Perceived Social Support from Family Scale (PSS-Fa), Social Support Rating Scale (SSRS), Type 2 Diabetes Stigma Assessment Scale (DSAS-2), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) were compared at admission, on the day of discharge, and three months after discharge.

RESULTS

At admission, the two groups showed no significant differences in the scores of HbA1c, FBG, 2hPBG, DSCS, PSS-Fa, SSRS, DSAS-2, SAS, and SDS (P > 0.05). On the day of discharge, no significant differences were observed in HbA1c, FBG, 2hPBG, or SSRS scores (P > 0.05). However, the observation group had higher DSCS (74.49 ± 11.72 points vs 65.76 ± 10.65 points, P = 0.004) and PSS-Fa (9.98 ± 1.25 points vs 7.42 ± 1.06 points, P < 0.001) scores, and lower DSAS-2 (54.45 ± 5.61 points vs 57.46 ± 5.88 points, P = 0.047), SAS (46.34 ± 2.87 points vs 48.83 ± 3.12 points, P = 0.047), and SDS (45.25 ± 2.59 points vs 47.64 ± 3.25 points, P = 0.003) scores than the control group. At 3-month follow-up, the observation group had lower HbA1c (6.15% ± 0.87% vs 6.76% ± 0.93%, P = 0.011), lower FBG (6.36 ± 0.58 mmol/L vs 6.93 ± 0.62 mmol/L, P = 0.001), lower 2hPBG (7.81 ± 0.72 mmol/L vs 8.63 ± 0.95 mmol/L, P = 0.001) indexes, and significantly lower DSCS, PSS-Fa, SSRS, DSAS-2, SAS, and SDS scores than those of the control group (all P < 0.05).

CONCLUSION

Nursing intervention based on health ecology theory can improve self-management behaviors and glycemic indicators in young and middle-aged T2DM patients, improve family and social support, reduce stigma, and alleviate anxiety and depression.

Keywords: Health ecology; Nursing intervention; Young and middle-aged; Type 2 diabetes mellitus; Stigma; Anxiety; Depression

Core Tip: Many young and middle-aged patients with type 2 diabetes experience disruptions in daily life and work due to long-term glucose management, making them vulnerable to anxiety, depression, and stigma stemming from social discrimination. This study shows that nursing intervention based on health ecology theory improves diabetes self-management and glycemic control while reducing stigma and emotional distress, providing a reference for more effective type 2 diabetes management.