Abstract: Background Resilience can effectively improve health outcomes and enhance the quality of life for adolescents with Type 1 Diabetes（T1D）. 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 T1D，and identify the core sources of stigma. Methods From July 2022 to July 2024，a total of 364 adolescents with T1D 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前期=10.47，GS后期=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 T1D. 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

摘要： 背景 心理韧性可有效改善青少年1型糖尿病（T1D）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T1D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名青少年T1D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 T1D 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