In the aftermath of the COVID-19 pandemic, a growing body of research is shedding light on its sustained impact on individuals with chronic illnesses, especially type 2 diabetes (T2D). Recent findings published in BMC Psychiatry reveal intricate links between pandemic-related post-traumatic stress disorder (PTSD) symptoms and critical aspects of diabetes management among Chinese adults. This study highlights how psychological sequelae from the pandemic continue to exert a deleterious influence on self-care behaviors, fear of hypoglycemia (FoH), and depressive symptoms well into the post-pandemic era.
The COVID-19 pandemic’s profound disruption to healthcare systems worldwide has been well-documented, but the long-term psychological repercussions on patients managing chronic conditions like T2D remain less understood. In China, stringent public health policies, including lockdowns and quarantines, severely curtailed routine healthcare access, exacerbating stress and anxiety for vulnerable populations. This study addresses a critical gap by examining how PTSD symptoms linked to the pandemic correlate with diabetes self-management behaviors and mental health indicators months after pandemic restrictions eased.
Utilizing a cross-sectional design, researchers evaluated 242 adults diagnosed with T2D in Huai’an, Jiangsu Province, gathering comprehensive psychological and behavioral data through validated instruments. The Impact of Event Scale-Revised (IES-R) measured PTSD symptoms specific to the COVID crisis, while self-care behaviors were quantified using the Summary of Diabetes Self-Care Activities (SDSCA-6). Additionally, the Hypoglycemia Fear Survey II-Worry Scale assessed FoH, and the Patient Health Questionnaire-9 (PHQ-9) gauged depressive symptom severity. This battery of tools allowed for nuanced assessment of how trauma-related stress influences diabetes management tasks.
Analysis revealed that approximately 10.33% of participants met the threshold for PTSD symptoms attributable to the pandemic experience, signaling a significant mental health burden amidst this cohort. Crucially, higher PTSD scores were statistically linked to poorer dietary adherence and diminished foot care routines, two self-care behaviors essential for effective diabetes control and complication prevention. These associations underscore the pervasive influence of unresolved trauma on health behaviors requiring consistent attention and effort.
Interestingly, the study found no significant linkage between PTSD symptoms and other common self-care measures such as physical activity, blood glucose monitoring frequency, or medication adherence. This delineation suggests that while trauma-related stress selectively impairs certain self-management activities, others might remain resilient or influenced by different psychosocial determinants. Such specificity highlights the complex interplay between psychological distress and health behavior patterns in chronic illness contexts.
Elevated PTSD symptoms also correlated positively with increased fear of hypoglycemia, an often debilitating anxiety that can lead to erratic eating patterns and avoidance of optimal glycemic control. FoH adds a layer of complication by driving behavioral adaptations rooted in fear rather than clinical guidance, negatively impacting overall diabetes stability. The association found here suggests that pandemic-induced trauma may sensitize individuals to hypoglycemic threat perceptions, further compromising metabolic management.
Moreover, depressive symptoms—a common comorbidity in diabetes—were likewise elevated with worsening PTSD scores. This dual burden of PTSD and depression creates a reinforcing cycle of psychological distress and self-care difficulties, complicating treatment adherence and prognosis. Recognizing and intervening in this intertwined mental health challenge is vital for optimizing long-term diabetes outcomes in the aftermath of widespread crises like the COVID-19 pandemic.
The study’s use of generalized linear models allowed for rigorous adjustment of demographic and clinical confounders, lending robustness to findings. Such methodical statistical scrutiny provides confidence that observed associations stem substantially from pandemic-related PTSD rather than unrelated variables. This methodological strength enhances the study’s credibility and relevance for public health policy and clinical practice.
These insights carry pivotal implications for diabetes care frameworks moving forward. The data advocate for integrating psychological screening and support into routine diabetes management, particularly focusing on trauma-informed interventions. By addressing mental health facets such as PTSD and depression, healthcare providers may bolster patients’ capacity to maintain critical self-care regimens, ultimately improving clinical outcomes and quality of life.
In broader context, the findings serve as a potent reminder of the pandemic’s lingering shadow on chronic disease populations, long after viral transmission rates decline. The psychological fallout has real, measurable consequences for disease control, demanding sustained attention and resources. This study thus reinforces calls for a holistic reimagining of healthcare models to encompass mental health as a fundamental pillar, especially in post-crisis recovery phases.
Future research directions could elaborate on longitudinal trajectories of PTSD and related symptoms in T2D patients, exploring intervention efficacy and identifying resilience factors. Understanding how trauma interacts dynamically with diabetes self-care over time will inform more tailored, patient-centered approaches. The evolving pandemic landscape necessitates adaptive strategies that remain vigilant to the intricate psychosocial dimensions of chronic illness management.
In sum, this pioneering investigation by Li, Pan, Su, and colleagues unpacks the nuanced psychological aftermath of COVID-19 among Chinese T2D patients, unveiling critical pathways by which pandemic-induced PTSD impairs self-care behaviors and exacerbates fear and depression. These revelations underscore the urgent need for integrated mental and physical healthcare paradigms, delivering comprehensive support to those carrying the dual burdens of chronic disease and pandemic trauma. As global health systems emerge from crisis, such evidence-based insights will be instrumental in shaping resilient, compassionate care for vulnerable populations.
Subject of Research: Long-term psychological impacts of COVID-19-related PTSD symptoms on diabetes self-care, fear of hypoglycemia, and depressive symptoms in Chinese adults with type 2 diabetes.
Article Title: Associations between COVID pandemic-related post-traumatic stress disorder symptoms and self-care behaviors, fear of hypoglycemia, and depressive symptoms among Chinese adults with type 2 diabetes in the post-pandemic era
Article References:
Li, D., Pan, E., Su, M. et al. Associations between COVID pandemic-related post-traumatic stress disorder symptoms and self-care behaviors, fear of hypoglycemia, and depressive symptoms among Chinese adults with type 2 diabetes in the post-pandemic era. BMC Psychiatry 25, 892 (2025). https://doi.org/10.1186/s12888-025-07324-y
Image Credits: AI Generated
DOI: https://doi.org/10.1186/s12888-025-07324-y
