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RESEARCH ARTICLE

Association between stigma and positive mental well-being among patients with diabetes: The mediating role of psychological distress

Yingjie Wang1,2,3† ,  Beibei Zhang4† ,  Xingli Ma1,2,3 ,  Ao Zhang1,2,3 ,  Haipeng Wang1,2,3*
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1 Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong , China
2 NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong , China
3 Center for Health Management and Policy Research, Shandong Provincial Key New Think Tank, Shandong University, Jinan, Shandong , China
4 Department of Clinical Laboratory, Shandong Mental Health Center, Jinan, Shandong , China
†These authors contributed equally to this work.
HPR, 026270152 https://doi.org/10.36922/HPR026270152
Received: 4 July 2026 | Revised: 16 September 2026 | Accepted: 20 September 2026 | Published online: 22 October 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background: Diabetes can significantly impact patients’ positive mental well-being (PMWB).

Objective: This study aims to investigate the stigma, psychological distress, and PMWB of patients with diabetes, and explore the mediating role of psychological distress in the relationship between stigma and PMWB.

Methods: A multi-stage stratified random sampling method was used to randomly select 660 patients with diabetes from the central and western regions of Shandong Province, China. Path analysis was used to examine the mediating role of psychological distress in the relationship between stigma and PMWB in patients with diabetes.

Results: The mean value of PMWB was 71.72 ± 18.70. The direct effect value of stigma on PMWB was −0.173, accounting for 55.42% of the total effect. The indirect effect value of stigma on PMWB through psychological distress was −0.139, accounting for 44.58%.

Conclusion: Stigma not only directly impacts PMWB but also indirectly through its detrimental effect on psychological distress. Therefore, it is necessary to address stigma and reduce psychological distress to enhance the PMWB of patients with diabetes.

Keywords
Diabetes
Stigma
Positive mental well-being
Psychological distress
Mediation
Funding
The research was supported by the National Key Research and Development Program of China (Grant Numbers: 2020YFC2006500 and 2020YFC2006505).
Conflict of interest
The authors declare that they have no competing interests.
References
  1. Gavin JR, Alberti KGMM, Davidson MB, et al. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(suppl 1):S5-S20. doi: 10.2337/diacare.26.2007.s5
  2. Jia W, Chan JC, Wong TY, Fisher EB. Diabetes in China: epidemiology, pathophysiology and multi-omics. Nat Metab. 2025;7(1):16-34. doi: 10.1038/s42255-024-01190-w
  3. Zhou YC, Liu JM, Zhao ZP, Zhou MG, Ng M. The national and provincial prevalence and non-fatal burdens of diabetes in China from 2005 to 2023 with projections of prevalence to 2050. Mil Med Res. 2025;12(1):28. doi: 10.1186/s40779-025-00615-1
  4. van Dieren S, Beulens JWJ, van der Schouw YT, Grobbee DE, Neal B. The global burden of diabetes and its complications: an emerging pandemic. Eur J Cardiovasc Prev Rehabil. 2010;17(suppl 1):S3-S8. doi: 10.1097/01.hjr.0000368191.86614.5a
  5. Huang Q, Li Y, Yu M, et al. Global burden and risk factors of type 2 diabetes mellitus from 1990 to 2021, with forecasts to 2050. Front Endocrinol (Lausanne). 2025;16:1538143. doi: 10.3389/fendo.2025.1538143
  6. Moradian S, Teufel M, Jahre L, et al. Mental health burden of patients with diabetes before and after the initial outbreak of COVID-19: predictors of mental health impairment. BMC Public Health. 2021;21(1):2068. doi: 10.1186/s12889-021-12101-z
  7. Naess S, Eriksen J, Midthjell K, Tambs K; Nord-Trøndelag Health Study. Subjective well-being before and after the onset of diabetes mellitus: results of the Nord-Trøndelag Health Study. J Diabetes Complications. 2005;19(2):88-95. doi: 10.1016/j.jdiacomp.2004.05.003
  8. Zhang JP, Yao SQ, Ye M, Huang HS, He GP, Leng XH. A study on the subjective well-being and its influential factors in chronically ill inpatients in Changsha, China. Appl Nurs Res. 2009;22(4):250-257. doi: 10.1016/j.apnr.2008.02.005
  9. Diener E, Oishi S, Tay L. Advances in subjective well-being research. Nat Hum Behav. 2018;2(4):253-260. doi: 10.1038/s41562-018-0307-6
  10. Hayes A, Dempsey M, Kells M, Murphy M. The relationship between social support, coping strategies and psychological distress and positive mental well-being in carers of people with borderline personality disorder. Borderline Personal Disord Emot Dysregul. 2023;10(1):31. doi: 10.1186/s40479-023-00237-w
  11. Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom. 2015;84(3):167-176. doi: 10.1159/000376585
  12. Domenech A, Kasujee I, Koscielny V, Griffiths CEM. Systematic review of the use of the WHO-5 Well-Being Index across different disease areas. Adv Ther. 2025;42(8):3657-3677. doi: 10.1007/s12325-025-03266-9
  13. Zhang Y, Sun L. The health status, social support, and subjective well-being of older individuals: evidence from the Chinese General Social Survey. Front Public Health. 2024;12:1312841. doi: 10.3389/fpubh.2024.1312841
  14. Reyes MF, Levy N, Maldonado Salamanca D, Lyons M, Leongómez JD. Mental health and subjective well-being of trans and non-binary population in Colombia. Neuroscience. 2025;590:72-82. doi: 10.1016/j.neuroscience.2025.10.039
  15. Pintaudi B, Lucisano G, Gentile S, et al. Correlates of diabetes-related distress in type 2 diabetes: findings from the benchmarking network for clinical and humanistic outcomes in diabetes (BENCH-D) study. J Psychosom Res. 2015;79(5):348-354. doi: 10.1016/j.jpsychores.2015.08.010
  16. Reach G, Consoli SM, Halimi S, et al. The multinational second Diabetes, Attitudes, Wishes and Needs study: results of the French survey. Patient Prefer Adherence. 2015;9:289-297. doi: 10.2147/PPA.S68941
  17. Chard S, Harris-Wallace B, Roth EG, et al. Successful aging among African American older adults with type 2 diabetes. J Gerontol B Psychol Sci Soc Sci. 2017;72(2):319-327. doi: 10.1093/geronb/gbw119
  18. Kasteleyn MJ, de Vries L, van Puffelen AL, et al. Diabetes-related distress over the course of illness: results from the Diacourse study. Diabet Med. 2015;32(12):1617-1624. doi: 10.1111/dme.12743
  19. Imamatsu Y, Oe N, Ito E, et al. Subjective well-being and related factors among independent, healthy, community-dwelling older adults in Japan. Healthcare (Basel). 2023;11(15):2211. doi: 10.3390/healthcare11152211
  20. Awata S, Bech P, Yoshida S, et al. Reliability and validity of the Japanese version of the World Health Organization-Five Well-Being Index in the context of detecting depression in diabetic patients. Psychiatry Clin Neurosci. 2007;61(1):112-119. doi: 10.1111/j.1440-1819.2007.01619.x
  21. Perez-Garin D, Molero F, Bos AER. Internalized mental illness stigma and subjective well-being: the mediating role of psychological well-being. Psychiatry Res. 2015;228(3):325-331. doi: 10.1016/j.psychres.2015.06.029
  22. A D, K B, C H, S B. The relationship between stigma and subjective quality of life in psychosis: a systematic review and meta-analysis. Clin Psychol Rev. 2021;85:102003. doi: 10.1016/j.cpr.2021.102003
  23. Fife BL, Wright ER. The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer. J Health Soc Behav. 2000;41(1):50-67. doi: 10.2307/2676360
  24. Link BG, Struening EL, Rahav M, Phelan JC, Nuttbrock L. On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav. 1997;38(2):177. doi: 10.2307/2955424
  25. Corrigan PW, Watson AC. The paradox of self-stigma and mental illness. Clin Psychol Sci Pract. 2002;9(1):35-53. doi: 10.1093/clipsy.9.1.35
  26. Liu NF, Brown AS, Folias AE, et al. Stigma in people with type 1 or type 2 diabetes. Clin Diabetes. 2017;35(1):27-34. doi: 10.2337/cd16-0020
  27. Earnshaw VA, Quinn DM. The impact of stigma in healthcare on people living with chronic illnesses. J Health Psychol. 2012;17(2):157-168. doi: 10.1177/1359105311414952
  28. Speight J, Holmes-Truscott E, Garza M, et al. Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations. Lancet Diabetes Endocrinol. 2024;12(1):61-82. doi: 10.1016/S2213-8587(23)00347-9
  29. Akyirem S, Ekpor E, Namumbejja Abwoye D, Batten J, Nelson LE. Type 2 diabetes stigma and its association with clinical, psychological, and behavioral outcomes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2023;202:110774. doi: 10.1016/j.diabres.2023.110774
  30. Li M, Khairani AZ, Jiang W. The impact of problematic social media use on subjective well-being among higher vocational college students: the chain mediating role of psychological distress and sleep disturbance. Medicine (Baltimore). 2025;104(24):e42542. doi: 10.1097/MD.0000000000042542
  31. Egede LE, Ellis C. Diabetes and depression: global perspectives. Diabetes Res Clin Pract. 2010;87(3):302-312. doi: 10.1016/j.diabres.2010.01.024
  32. Ducat L, Philipson LH, Anderson BJ. The mental health comorbidities of diabetes. JAMA. 2014;312(7):691-692. doi: 10.1001/jama.2014.8040
  33. van Sloten T, Schram M. Understanding depression in type 2 diabetes: a biological approach in observational studies. F1000Res. 2018;7:1283. doi: 10.12688/f1000research.13898.1
  34. Mezuk B, Eaton WW, Albrecht S, Golden SH. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care. 2008;31(12):2383-2390. doi: 10.2337/dc08-0985
  35. Morgades-Bamba CI, Fuster-Ruizdeapodaca MJ, Molero F. The impact of stigma on subjective well-being in people with mental disorders. Clin Schizophr Relat Psychoses. 2017. doi: 10.3371/CSRP.CBMF.071317
  36. Magallares A, Perez-Garin D, Molero F. Social stigma and well-being in a sample of schizophrenia patients. Clin Schizophr Relat Psychoses. 2016;10(1):51-57. doi: 10.3371/CSRP.MAPE.043013
  37. Doric SN. HIV-related stigma and subjective well-being: the mediating role of the Belief in a Just World. J Health Psychol. 2020;25(5):598-605. doi: 10.1177/1359105317726150
  38. Browne JL, Ventura AD, Mosely K, Speight J. Measuring the stigma surrounding type 2 diabetes: development and validation of the Type 2 Diabetes Stigma Assessment Scale (DSAS-2). Diabetes Care. 2016;39(12):2141-2148. doi: 10.2337/dc16-0117
  39. Li Y, Ma H, Hou R, Zhang Y, Cui C, Jin C. Erxing tangniaobing bingchigan pinggu liangbiao de hanhua ji xinxiaodu yanjiu [Reliability and validity of the Chinese version of the Type 2 Diabetes Stigma Assessment Scale]. Chin J Pract Nurs. 2017;33(30):2343-2347. [In Chinese]. doi: 10.3760/cma.j.issn.1672-7088.2017.30.006
  40. Calkin CJ, Numbers K, Brodaty H, Sachdev PS, Medvedev ON. Measuring distress in older population: Rasch analysis of the Kessler Psychological Distress Scale. J Affect Disord. 2023;330:117-124. doi: 10.1016/j.jad.2023.02.116
  41. Song K, Zhao Z, Zhang J, Li J, Lipowski M. Community-based square dancing is associated with improved physical and mental health in older adults: a 12-week randomized controlled trial in China. Front Public Health. 2026;14. doi: 10.3389/fpubh.2026.1758255
  42. Sayed Ahmed HA, Abdallah EM, Mohamed MAE, Aboelfotoh TM, Nour-Eldein H, Fouad AM. Association between erectile dysfunction and subjective well-being in primary care patients with type 2 diabetes. Diabetol Int. 2024;15(3):421-432. doi: 10.1007/s13340-024-00699-5
  43. Duffy RM, Mullin K, O'Dwyer S, Wrigley M, Kelly BD. The economic recession and subjective well-being in older adults in the Republic of Ireland. Ir J Psychol Med. 2019;36(2):99-104. doi: 10.1017/ipm.2016.21
  44. Savli H, Sevinc A. The evaluation of the Turkish version of the Well-being Questionnaire (WBQ-22) in patients with type 2 diabetes: the effects of diabetic complications. J Endocrinol Invest. 2005;28(10):683-691. doi: 10.1007/BF03347550
  45. Pérez-Fernández A, Fernández-Berrocal P, Gutiérrez-Cobo MJ. The relationship between well-being and HbA1c in adults with type 1 diabetes: a systematic review. J Diabetes. 2023;15(2):152-164. doi: 10.1111/1753-0407.13357
  46. Schabert J, Browne JL, Mosely K, Speight J. Social stigma in diabetes: a framework to understand a growing problem for an increasing epidemic. Patient. 2013;6(1):1-10. doi: 10.1007/s40271-012-0001-0
  47. Tak-Ying Shiu A, Kwan JJYM, Wong RYM. Social stigma as a barrier to diabetes self-management: implications for multi-level interventions. J Clin Nurs. 2003;12(1):149-150. doi: 10.1046/j.1365-2702.2003.00735.x
  48. Ghaffari F, Salsali M, Rahnavard Z, Parvizy S. Compliance with treatment regimen in women with gestational diabetes: living with fear. Iran J Nurs Midwifery Res. 2014;19(7 suppl 1):S103-S111.
  49. Sun N, Lou P, Shang Y, et al. Prevalence and determinants of depressive and anxiety symptoms in adults with type 2 diabetes in China: a cross-sectional study. BMJ Open. 2016;6(8):e012540. doi: 10.1136/bmjopen-2016-012540
  50. Blixen CE, Kanuch S, Perzynski AT, Thomas C, Dawson NV, Sajatovic M. Barriers to self-management of serious mental illness and diabetes. Am J Health Behav. 2016;40(2):194-204. doi: 10.5993/AJHB.40.2.4
  51. Kanaley JA, Colberg SR, Corcoran MH, et al. Exercise/physical activity in individuals with type 2 diabetes: a consensus statement from the American College of Sports Medicine. Med Sci Sports Exerc. 2022;54(2):353-368. doi: 10.1249/MSS.0000000000002800
  52. Brazeau AS, Nakhla M, Wright M, et al. Stigma and its association with glycemic control and hypoglycemia in adolescents and young adults with type 1 diabetes: cross-sectional study. J Med Internet Res. 2018;20(4):e151. doi: 10.2196/jmir.9432
  53. Guerrero Fernández de Alba I, Gimeno-Miguel A, Poblador-Plou B, et al. Association between mental health comorbidity and health outcomes in type 2 diabetes mellitus patients. Sci Rep. 2020;10(1):19583. doi: 10.1038/s41598-020-76546-9
  54. Vadiee M. The UK "Expert Patient Program" and self-care in chronic disease management: an analysis. Eur Geriatr Med. 2012;3(3):201-205. doi: 10.1016/j.eurger.2012.02.003
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