基于多源病耻感的青少年1型糖尿病患者心理韧性复杂网络研究

doi:10.12114/j.issn.1007-9572.2025.0153

中国全科医学 ›› 2026, Vol. 29 ›› Issue (16): 2264-2272.DOI: 10.12114/j.issn.1007-9572.2025.0153

所属专题：内分泌代谢性疾病最新文章合辑

• 论著·糖尿病专病管理研究 • 上一篇

基于多源病耻感的青少年1型糖尿病患者心理韧性复杂网络研究

王睿¹, 罗丹¹^,^*(), 杨翠翠¹, 翁欣怡¹, 王玉冰², 徐晶晶³^,⁴

1．210000　江苏省南京市，南京中医药大学护理学院
2．210000　江苏省南京市，南京医科大学附属儿童医院内分泌科
3．210000　江苏省南京市，南京医科大学第一附属医院护理部
4．210000　江苏省南京市，南京医科大学第一附属医院内分泌科

收稿日期:2025-06-25 修回日期:2025-09-29 出版日期:2026-06-05 发布日期:2026-05-21
通讯作者: 罗丹
作者贡献：
王睿负责研究过程实施，数据收集、整理与统计分析，撰写论文并负责终版修订，对文章整体负责；杨翠翠、翁欣怡参与数据收集与整理；王玉冰、徐晶晶参与数据收集和论文质量把控；罗丹提出研究思路，设计研究方案，负责文章的质量控制与审查，对文章整体负责，为研究课题提供资金支持。
基金资助:
国家自然科学基金青年基金项目(72204125); 江苏省研究生科研创新计划项目(KYCX24-2322)

Complex Network Analysis of Resilience in Adolescents with Type 1 Diabetes Mellitus Based on Multi-sourced Stigma

WANG Rui¹, LUO Dan¹^,^*(), YANG Cuicui¹, WENG Xinyi¹, WANG Yubing², XU Jingjing³^,⁴

1. School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210000, China
2. Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing 210000, China
3. Department of Nursing, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210000, China
4. Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210000, China

Received:2025-06-25 Revised:2025-09-29 Published:2026-06-05 Online:2026-05-21
Contact: LUO Dan

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摘要/Abstract

摘要： 背景心理韧性可有效改善青少年1型糖尿病（T1DM）患者健康结局，提升生活质量。然而，该群体深受多源病耻感困扰，严重损害其心理韧性。目前不同来源病耻感对心理韧性的作用机制尚不明晰。目的探索多源病耻感对青少年T1DM患者心理韧性的作用路径，识别核心病耻感来源，为消除病耻感并提高心理韧性提供依据。方法于2022年7月—2024年7月，便利选取南京市两所三级甲等医院就诊的364例青少年T1DM患者，使用青少年1型糖尿病病耻感评估量表、青少年糖尿病生活质量量表、青少年糖尿病优势与韧性量表进行调查。利用R软件进行复杂网络分析，并根据年龄行亚组分析。结果多源病耻感中"被认为有缺陷"（1.248）、"担心他人不好的反应"（1.132）、"他人排挤"（1.125）在网络中预期影响最大。多源病耻感间"担心他人不好的反应"与"隐瞒糖尿病"在网络中呈最强正相关（r=0.562）。疾病隐藏行为与心理韧性"寻求帮助"维度呈负相关（r=-0.098），父母过度保护则与心理韧性"家庭资源"维度呈正相关（r=0.007）。青春期前期组比青春期后期组网络连接更紧密（S=0.10，GS前期=10.47，GS后期=10.36，P=0.789）。结论公众误解、他人排斥和个体预期歧视是制约青少年T1DM患者心理韧性发展的关键病耻感来源，且处于青春期前期患者更易受到病耻感困扰，医护人员应识别并消除关键病耻感来源。

关键词: 糖尿病，1型, 青少年, 病耻感, 心理韧性, 复杂网络分析

Abstract:

Background

Resilience can effectively improve health outcomes and enhance the quality of life for adolescents with type 1 diabetes mellitus (T1DM). However, this population is plagued by multi-sourced stigma, which severely undermines their resilience. Currently, the mechanism of how stigma from different sources affects resilience remains unclear.

Objective

To explore the pathways of multi-sourced stigma on the resilience of adolescents with T1DM, and identify the core sources of stigma.

Methods

From July 2022 to July 2024, a total of 364 adolescents with T1DM were conveniently selected from two tertiary hospitals in Nanjing. The data were collected by the Type 1 Diabetes Stigma Assessment Scale, the Short Form of the Chinese version Diabetes Quality of Life for Youth Scale, and the Diabetes Strengths and Resilience Measure for Adolescents with Type 1 Diabetes. Complex network analysis was performed using the R software, and subgroup analysis was performed based on age.

Results

Within multi-sourced stigma, "being perceived as defectiv" (1.248), "worrying about negative reactions from others" (1.132), and "being excluded by others" (1.125) had the greatest expected influence in the network. "Worrying about negative reactions from others" and "concealing diabetes" showed the strongest positive correlation (r=0.562). Concealment of the disease was negatively related with the resilience dimension "help-seeking" (r=-0.098), while parental over protection was positively related with the resilience dimension "family resources" (r=0.007). The network connections were tighter in the early adolescent group compared to the late adolescent group (S=0.10, GS_pre=10.47, GS_post=10.36, P=0.789).

Conclusion

Public misunderstanding, social exclusion, and individual anticipated discrimination are core sources of stigma that hinder the development of resilience in adolescents with T1DM. Moreover, the early adolescence group are more susceptible to stigma. Healthcare professionals should identify and address the core sources of stigma.

Key words: Diabetes mellitus, type 1, Adolescents, Stigma, Resilience, Complex network analysis

中图分类号:

R 587.1

王睿,罗丹,杨翠翠,等. 基于多源病耻感的青少年1型糖尿病患者心理韧性复杂网络研究[J]. 中国全科医学, 2026, 29(16): 2264-2272. DOI: 10.12114/j.issn.1007-9572.2025.0153.
WANG Rui,LUO Dan,YANG Cuicui, et al. Complex Network Analysis of Resilience in Adolescents with Type 1 Diabetes Mellitus Based on Multi-sourced Stigma[J]. Chinese General Practice, 2026, 29(16): 2264-2272. DOI: 10.12114/j.issn.1007-9572.2025.0153.

图/表 6

表1 青少年T1DM患者基本情况（n=364）

Table 1 Participants characteristics of adolescents with T1DM

项目	患者数[例（%）]
性别
男	162（44.5）
女	202（55.5）
年龄
<15岁	236（64.8）
≥15岁	128（35.2）
居住地
城市	190（52.2）
农村	174（47.8）
医疗费用支付方式
自费	102（28.0）
医保	262（72.0）
病程
<5年	73（20.0）
5~10年	143（39.3）
>10年	148（40.7）
控糖方式
胰岛素笔	238（65.4）
胰岛素泵	126（34.6）
HbA_1c
<7.5%	148（40.7）
≥7.5%	216（59.3）

表2 青少年T1DM患者多源病耻感与心理韧性得分（n=364）

Table 2 Scores of multi-sourced stigma and resilience in adolescents with T1DM

变量	维度	条目简称（序号）	得分（±s，分）
多源病耻感	身份问题	低血糖尴尬（a1）	2.08±1.11
		担心他人不好的反应（a2）	2.50±1.37
		对糖尿病设备不自在（a3）	2.15±1.61
		隐瞒糖尿病（a4）	2.70±1.40
		公共管理尴尬（a5）	2.62±1.39
	区别对待	他人社交排斥（b1）	2.06±1.12
		他人期望低（b2）	1.87±0.96
		在学校受到歧视（b3）	1.70±0.92
		他人不信任（b4）	1.72±0.92
		他人排挤（b5）	1.65±0.92
		被认为有缺陷（b6）	1.82±1.05
		公众不公平假设（b7）	1.94±1.08
	抱怨评论	误解需要胰岛素的原因（c1）	1.92±1.09
		与糖相关的指责（c2）	2.65±1.40
		管理不佳被说不负责（c3）	2.45±1.31
		误解自身错误导致糖尿病（c4）	2.28±1.31
		误解生来有糖尿病（c5）	2.13±1.20
	父母过度关心	父母过度保护自己（d1）	2.55±1.22
		父母过度担心糖尿病（d2）	3.00±1.26
		父母表现得好像糖尿病是他们的疾病（d3）	2.55±1.34
心理韧性	自我照护信心（Y1）	—	13.00±3.62
	家庭资源（Y2）	—	14.17±3.32
	寻求帮助（Y3）	—	11.07±3.88

图1 基于多源病耻感的心理韧性复杂网络注：边的粗细代表节点间相关性的强弱，蓝色实线代表正相关，红色虚线代表负相关。节点周围的白色圆圈代表可预测性；a1=低血糖尴尬，a2=担心他人不好的反应，a3=对糖尿病设备不自在，a4=隐瞒糖尿病，a5=公共管理尴尬，b1=他人社交排斥，b2=他人期望低，b3=在学校受到歧视，b4=他人不信任，b5=他人排挤，b6=被认为有缺陷，b7=公众不公平假设，c1=误解需要胰岛素的原因，c2=与糖相关的指责，c3=管理不佳被说不负责，c4=误解自身错误导致糖尿病，c5=误解生来有糖尿病，d1=父母过度保护自己，d2=父母过度担心糖尿病，d3=父母表现得好像糖尿病是他们的疾病，Y1=自我照护信心，Y2=家庭资源，Y3=寻求帮助。

Figure 1 Complex network of resilience based on multi-source stigma

图2 复杂网络节点的预期影响注：EI=预期影响。

Figure 2 Expected influence of nodes in complex network

图3 青春期前后组复杂网络节点的预期影响注：图A表示青春期前期组，图B表示青春期后期组。

Figure 3 Expected influence of nodes in complex network in pre- and post-pubertal groups

图4 复杂网络预期影响的稳定性注：图A表示针对总样本的分析，图B表示针对青春期前期组的分析，图C表示针对青春期后期组的分析。

Figure 4 The stability of expected influence in complex network

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基于多源病耻感的青少年1型糖尿病患者心理韧性复杂网络研究

Complex Network Analysis of Resilience in Adolescents with Type 1 Diabetes Mellitus Based on Multi-sourced Stigma

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