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

Abstract

Background: The COVID-19 pandemic significantly impacted individuals with type 2 diabetes (T2D), especially in China, where stringent public health measures disrupted healthcare access and heightened psychological stress. The long-term associations of pandemic-related post-traumatic stress disorder (PTSD) symptoms with self-care behaviors, fear of hypoglycemia (FoH), and depressive symptoms in T2D patients remain underexplored. This study examines these associations in Chinese adults with T2D in the post-pandemic period. Methods: We conducted a cross-sectional study with 242 adults with T2D at community health centers in Huai’an, China. Data on PTSD symptoms (Impact of Event Scale-Revised), self-care behaviors (Summary of Diabetes Self-Care Activities-6), FoH (Hypoglycemia Fear Survey II-Worry Scale), and depressive symptoms (Patient Health Questionnaire-9) were collected. Generalized linear models adjusted for demographic and clinical factors analyzed associations between PTSD symptoms and self-care, FoH, and depressive symptoms. Results: The prevalence of PTSD in the sample was 10.33% (n = 25). Higher PTSD scores were significantly associated with poorer dietary adherence (β = -0.0036, 95% CI: -0.0066 to -0.0005) and foot care (β = -0.0365, 95% CI: -0.0494 to -0.0235), as well as increased FoH (β = 0.0171, 95% CI: 0.0055 to 0.0287) and depressive symptoms (β = 0.0148, 95% CI: 0.0076 to 0.0220). No significant associations were found with physical activity, blood glucose testing, or medication adherence (all P > 0.05). Conclusions: COVID pandemic-related PTSD symptoms may be associated with certain worsened self-care behaviors, heightened FoH, and increased depressive symptoms among patients with T2D. These findings suggest that addressing mental health by integrating psychological support into chronic-care models could help improve diabetes outcomes, particularly for vulnerable groups facing future public health challenges.