The Mediating Role of Perceived Social Support in the Association Between Perceived Stress and Self-Management Behaviors Among Patients with Type 2 Diabetes Mellitus and Metabolic Dysfunction-Associated Steatotic Liver Disease.

Abstract

Objective: To examine whether perceived social support mediates the relationship between perceived stress and self-management behaviors in patients with type 2 diabetes mellitus (T2DM) complicated by metabolic dysfunction-associated steatotic liver disease (MASLD), and to provide a theoretical basis for targeted psychosocial interventions in clinical practice.

Methods: By convenience sampling, patients with T2DM and MASLD were recruited from a tertiary hospital in Changsha between April 2024 and September 2025. Data were collected using a general information questionnaire, the Chinese Perceived Stress Scale, the Perceived Social Support Scale, and the Chronic Disease Self-Management Behavior Measurement Scale.

Results: The mean scores for perceived stress, perceived social support, and self-management behaviors were 25.66 ± 8.02, 56.05 ± 10.28, and 27.63 ± 8.62, respectively. Pearson correlation analysis indicated that dimensions such as loss of control and tension were significantly associated with both social support and self-management behaviors (all P < 0.01). Perceived stress was negatively correlated with perceived social support (r = -0.534, P < 0.01) and self-management behaviors (r = -0.391, P < 0.01), whereas perceived social support showed a positive correlation with self-management behaviors (r = 0.471, P < 0.01). Mediation analysis demonstrated that perceived social support partially mediated the association between perceived stress and self-management behaviors, accounting for 50.2% of the total effect.

Conclusion: Perceived social support functions as a key mediator linking perceived stress and self-management behaviors in patients with T2DM and MASLD. These findings highlight the importance of integrating psychological assessment into routine nursing care. Interventions such as family-involved nursing care, peer support groups, and the utilization of community-based healthcare resources may help establish a coordinated support system that connects the hospital, family, and society. The proposed approach could mitigate the adverse impact of stress on self-management behaviors and ultimately improve patient outcomes.