Structural Relationships between Anxiety and Diabetes Self-Management in Adolescents with Type 1 Diabetes: The Mediating Role of Perceived Stress

Abstract

Objective: Adolescents with type 1 diabetes often face psychological challenges that may interfere with effective disease management. This study aimed to examine the structural links between anxiety and diabetes self-management, with perceived stress tested as a potential mediator.

Materials and Methods: This descriptive correlational study was conducted among adolescents with type 1 diabetes attending diabetes treatment centers in Tehran, Iran, in 2024. A convenience sample of 310 participants completed the Diabetes Self-Management Questionnaire, the Perceived Stress Scale, and the Beck Anxiety Inventory. Path analysis was conducted using AMOS version 24. The adequacy of the proposed model was evaluated through standard goodness-of-fit indices, and the mediating effect of perceived stress was tested using bootstrap confidence intervals.

Results: The structural model showed an acceptable fit to the observed data. Anxiety had a significant positive effect on perceived stress, β= .33, t= 4.61,P< 0.001, and a significant negative effect on diabetes self- management, β= −0.28, t= −3.90, P< 0.001. Perceived stress was also negatively associated with diabetes self- management, β= −0.46, t= −6.20, P< 0.001. Bootstrap analysis confirmed the significant indirect effect of anxiety on diabetes self-management via perceived stress, 95% CI [-0.28, -0.11]. The final model explained 48% of the variance in diabetes self-management.

Conclusion: Anxiety appears to compromise diabetes self-management among adolescents with type 1 diabetes, partly through heightened perceived stress. Integrating anxiety- and stress-focused psychological interventions into routine diabetes care may improve self-management outcomes in this vulnerable population