Distress and health-related quality of life among people living with type 2 diabetes: An analysis of moderated mediation roles of mindfulness and social support
Restricted accessResearch articleFirst published online September, 2025
Distress and health-related quality of life among people living with type 2 diabetes: An analysis of moderated mediation roles of mindfulness and social support
Type 2 diabetes patients often experience distress that adversely impacts their health-related quality of life (HRQoL). However, studies remain scarce on the pathways explaining the poor health outcomes. This study investigated the mediating link between diabetes distress (DD) and HRQoL through mindfulness and the moderating role of social support in this link. Utilizing a cross-sectional design, 276 type 2 diabetes patients completed measures of relevant variables. Results of moderated mediation analysis showed that social support moderated the mediating effect of mindfulness in the link between DD and HRQoL. Intervention may integrate mindfulness-based therapies with targeted support enhancements to improve patients’ health.
AbdollapourMSeyedAlinaghiSAKianimoghadamAS, et al. (2024) The effectiveness of health-related quality of life (HRQOL) model in people with HIV: A cross-sectional study. Health Science Reports7(7): e2217.
2.
BajajBKhouryBSenguptaS (2022) Resilience and stress as mediators in the relationship of mindfulness and happiness. Frontiers in Psychology13: 771263.
3.
BajajBPandeN (2016) Mediating role of resilience in the impact of mindfulness on life satisfaction and affect as indices of subjective well-being. Personality and Individual Differences93: 63–67.
4.
BarreraM (1986) Distinctions between social support concepts, measures, and models. American Journal of Community Psychology14(4): 413–445.
5.
BoguschLMO’BrienWH (2019) The effects of mindfulness-based interventions on diabetes-related distress, quality of life, and metabolic control among persons with diabetes: A meta-analytic review. Behavioral Medicine45(1): 19–29.
6.
BrownKWRyanRM (2003) The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology84(4): 822–848.
7.
BrownKWRyanRMCreswellJD (2007) Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry18(4): 211–237.
8.
BurroughsTEDesikanRWatermanBM, et al. (2004) Development and validation of the diabetes quality of life brief clinical inventory. Diabetes Spectrum17(1): 41–49.
9.
CarracherAMMarathePHCloseKL (2018) International diabetes federation 2017. Journal of Diabetes10(5): 353–356.
10.
CarterNNalbantGChahalP, et al. (2024) Effectiveness and safety of self-management interventions for improving glycemic control and health-related quality of life among adults with type 2 diabetes mellitus in sub-Saharan Africa: A systematic review and meta-analysis. JBI Evidence Synthesis22(9): 1715–1788.
11.
CasselJ (1976) The contribution of the social environment to host resistance: The fourth wade hampton frost lecture. American Journal of Epidemiology104(2): 107–123.
12.
CastroRDe BoniRBLuzPM, et al. (2019) Health-related quality of life assessment among people living with HIV in Rio de Janeiro, Brazil: A cross-sectional study. Quality of Life Research28(4): 1035–1045.
13.
ChatterjeeSKhuntiKDaviesMJ (2017) Type 2 diabetes. Lancet389(10085): 2239–2251.
14.
ChenLHWuCHChangJH (2017) Gratitude and athletes’ life satisfaction: The moderating role of mindfulness. Journal of Happiness Studies18(4): 1147–1159.
15.
ChoNHShawJEKarurangaS, et al. (2018) IDF diabetes atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Research and Clinical Practice138: 271–281.
16.
CohenJ (ed.) (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd edn.Hillsdale, NJ: Lawrence Erlbaum Associates.
17.
El-AbbassyASElzyenEIELBerryK, et al. (2024) Effect of mindfulness-based intervention on alopecia distress, body image changes and health related quality of life among women with breast cancer. Egyptian Journal of Health Care15(1): 1780–1797.
18.
ElkadyA (2019) Self-care management, emotional distress and self-efficacy: Relationships with health-related quality of life among patients with type 2 diabetes. International Journal of Psycho-Educational Sciences8(2): 73–84.
19.
Erdoğan-YüceGDönerABilginA, et al. (2024) The effect of mindfulness-based interventions on caregiver burden, quality of life and psychological distress in caregivers of adults with chronic diseases: Systematic review and meta-analysis of randomized controlled trials. Worldviews on Evidence-Based Nursing21(5): 528–541.
20.
FeltonB (2018) Coping and social support in older people’s experiences of chronic illness. In: StephensMAPCrowtherJHHobfollSETennenbaumDL (eds). Stress and coping in later-life families. New York, NY: Taylor & Francis; 2018. p. 153–171.
21.
FisherLHesslerDMPolonskyWHMullanJ (2012) When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale. Diabetes Care35(2): 259–264.
22.
GariepyGHonkaniemiHQuesnel-ValleeA (2016) Social support and protection from depression: Systematic review of current findings in Western countries. The British Journal of Psychiatry209(4): 284–293.
23.
GarlandELFarbNAGoldinP, et al. (2015) Mindfulness broadens awareness and builds eudaimonic meaning: A process model of mindful positive emotion regulation. Psychological Inquiry26(4): 293–314.
24.
GergesSHallitRHallitS (2023) Stressors in hospitalized patients and their associations with mental health outcomes: Testing perceived social support and spiritual well-being as moderators. BMC Psychiatry23(1): 323.
25.
GlasgowREToobertDJBarreraMJr, et al. (2005) The chronic illness resources survey: Cross-validation and sensitivity to intervention. Health Education Research20(4): 402–409.
26.
HarandiTFTaghinasabMMNayeriTD (2017) The correlation of social support with mental health: A meta-analysis. Electronic Physician9(9): 5212–5222.
27.
HaskasYSuarniantiSKadriantiE (2023) Relationship between diabetes distress and quality of life among patients with type II diabetes mellitus. Poltekita: JurnalIlmu Kesehatan17(1): 37–44.
28.
HayesAF (2018) Partial, conditional, and moderated moderated mediation: Quantification, inference, and interpretation. Communication Monographs85(1): 4–40.
29.
HeoSKangJUmeakunneE, et al. (2023) Effects of meditation intervention on self-management in adult patients with type 2 diabetes: A systematic literature review and meta-analysis. Journal of Cardiovascular Nursing38(6): 581–592.
ItzickMKaganMTal-KatzP (2018) Perceived social support as a moderator between perceived discrimination and subjective well-being among people with physical disabilities in Israel. Disability and Rehabilitation40(18): 2208–2216.
33.
JafariANaddafiFGholian-AvalM, et al. (2024) Relationship between diabetes health literacy, distress, burnout, social support, complications, self-care behaviors, and quality of life among patients with type 2 diabetes: A path analysis study. Diabetology & Metabolic Syndrome16(1): 150.
34.
KaplanRMHaysRD (2022) Health-related quality of life measurement in public health. Annual Review of Public Health43(1): 355–373.
35.
KarimiMBrazierJ (2016) Health, health-related quality of life, and quality of life: What is the difference?PharmacoEconomics34(7): 645–649.
36.
KayserJHuRXRosenscruggsD, et al. (2023) A systematic review of the impact of select mindfulness interventions on psychological outcomes among older adults with chronic health conditions. Clinical Gerontologist46(3): 302–314.
37.
KongFWangXZhaoJ (2014) Dispositional mindfulness and life satisfaction: The role of core self-evaluations. Personality and Individual Differences56: 165–169.
38.
LiangSDongMZhaoH, et al. (2022) Mindfulness and life satisfaction: The moderating effect of self-control and the moderated moderating effect of resilience. Personality and Individual Differences185: 111241.
39.
LinkEReifegersteDKlimmtC (2020) Family involvement in the context of chronic diseases: The role of social support in treatment decision-making for surgical procedures. Journal of Family Research32(1): 45–71.
40.
LiXMaLLiQ (2022) How mindfulness affects life satisfaction: based on the mindfulness-to-meaning theory. Frontiers in Psychology13: 887940.
41.
LiWWNannestadJLeowTHewardC (2024) The effectiveness of mindfulness-based stress reduction (MBSR) on depression, PTSD, and mindfulness among military veterans: A systematic review and meta-analysis. Health Psychology Open 11:20551029241302969.
42.
MadroumiRNewsonLUmehFK, et al. (2024) Identifying the key components of social support for patients living with type 2 diabetes: A protocol for a systematic review and meta-analysis of type 2 diabetes social support interventions. PLoS One19(8): e0306709. DOI: 10.1371/journal.pone.0306709.
43.
MarinoFFaillaCCarrozzaC, et al. (2021) Mindfulness-based interventions for physical and psychological wellbeing in cardiovascular diseases: A systematic review and meta-analysis. Brain Sciences11(6): 727.
44.
MegariK (2013) Quality of life in chronic disease patients. Health Psychology Research1(3): 141–148.
45.
MehrSNejatHAkbariH, et al. (2023) Comparing the efficacy of mindfulness-based stress reduction training and compassion-focused training on stress coping styles in patients with coronary heart disease. Journal of Fundamentals of Mental Health25(3): 169–178.
46.
MihevcMPotočnikTZavrnik, et al. (2024) Beyond diagnosis: Investigating factors influencing health-related quality of life in older people with type 2 diabetes in Slovenia. Primary Care Diabetes18(2): 157–162.
47.
Newton-JohnTRVenturaADMoselyK, et al. (2017) ‘Are you sure you’re going to have another one of those?’: A qualitative analysis of the social control and social support models in type 2 diabetes. Journal of Health Psychology22(14): 1819–1829.
48.
NganHYChongYYChienWT (2021) Effects of mindfulness- and acceptance-based interventions on diabetes distress and glycaemic level in people with type 2 diabetes: Systematic review and meta-analysis. Diabetic Medicine38(4): e14525.
49.
NicolucciAKovacs BurnsKHoltRI, et al. (2013) Diabetes attitudes, wishes and needs second study (DAWN2™): Cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabetic Medicine30(7): 767–777.
50.
NwakobiM (2014) Diabetes Mellitus (Type 2) Associated Psychological Stress of Patients in Nigeria. Minneapolis: Walden University.
51.
OnuDUIfeagwaziCMOnyedibeMCC (2021) Enacted support matters in the relationship between psychological distress and health-related quality of life among type 2 diabetes patients in Nigeria. Psychology Health & Medicine26(8): 947–954.
52.
OnuDUIfeagwaziCMPrinceOA (2022) Social support buffers the impacts of diabetes distress on health-related quality of life among type 2 diabetic patients. Journal of Health Psychology27(10): 2305–2317.
53.
OnudoOrjiakorT (2024) Does social support buffer the impact of stress on health among people living with sickle cell disease: A cross-sectional study. Technical report, Department of Psychology, University of Nigeria.
54.
PanCWSunHPZhouHJ, et al. (2016) Valuing health-related quality of life in type 2 diabetes patients in China. Medical Decision Making36(2): 234–241.
55.
PatraSPatroBKPadhyS, et al. (2023) Relationship of mindfulness with depression, self-management, and quality of life in type 2 diabetes mellitus: Mindfulness is a predictor of quality of life. Indian Journal of Social Psychiatry39(1): 70–76.
56.
PearsonSWillsKWoodsM, et al. (2018) Effects of mindfulness on psychological distress and HbA1c in people with diabetes. Mindfulness9(5): 1615–1626.
57.
PhamTNguyenTTruongH, et al. (2020) Effects of diabetic complications on health-related quality of life impairment in Vietnamese patients with type 2 diabetes. Journal of Diabetes Research2020(1): 4360804.
58.
PolonskyWHFisherLEarlesJet al. (2005) Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care28(3):626–31. DOI: 10.2337/diacare.28.3.626
59.
QianXZhangJ (2024) Mindfulness-based interventions on psychological comorbidities in patients with inflammatory bowel disease: A systematic review and meta-analysis. Actas Españolas de Psiquiatría52(4): 571–582.
60.
RockwoodNHayesA (2017) MLmed: An SPSS macro for multilevel mediation and conditional process analysis. In: Poster presented at the annual meeting of the association of psychological science (APS), Boston, MA.
61.
ShettyAAfrozAAliL, et al. (2021) Health-related quality of life among people with type 2 diabetes mellitus – A multicentre study in Bangladesh. Diabetes & Metabolic Syndrome Clinical Research & Reviews15(5): 102255.
62.
ShoresW (2023) Mindful Management: A Mindfulness-Based Stress Reduction Manual for Adolescents With Type 1 Diabetes. Connecticut: University of Hartford.
63.
SkinnerTCJoensenLParkinT (2020) Twenty-five years of diabetes distress research. Diabetic Medicine37(3): 393–400.
64.
Svedbo-EngströmMLeksellJJohanssonU, et al. (2019) Health-related quality of life and glycaemic control among adults with type 1 and type 2 diabetes: A nationwide cross-sectional study. Health and Quality of Life Outcomes17(8): 1–11.
65.
TanJYangWMaH, et al. (2016) Adolescents’ core self-evaluations as mediators of the effect of mindfulness on life satisfaction. Social Behavior and Personality44(7): 1115–1122.
66.
TianXYiLJLiangCS, et al. (2022) The impact of mindfulness-based stress reduction (MBSR) on psychological outcomes and quality of life in patients with lung cancer: A meta-analysis. Frontiers in Psychology13: 901247.
67.
WanEYFungCSWongCK, et al. (2017) Effectiveness of a multidisciplinary risk assessment and management programme-diabetes mellitus (RAMP-DM) on patient-reported outcomes. Endocrine55(2): 416–426.
68.
YapJMTantonoNWuVX, et al. (2024) Effectiveness of technology-based psychosocial interventions on diabetes distress and health-relevant outcomes among type 2 diabetes mellitus: A systematic review and meta-analysis. Journal of Telemedicine and Telecare30(2): 262–284.
69.
ZhangDLeeEKPMakECW, et al. (2021) Mindfulness-based interventions: An overall review. British Medical Bulletin138(1): 41–57.
70.
ZimetGDDahlemNWZimetSG, et al. (1988) The multidimensional scale of perceived social support. Journal of Personality Assessment52(1): 30–41.
