Illness acceptance and early self-management in older adults with prediabetes: the mediating role of depression.

BACKGROUND

Early self-management is essential for preventing the progression from prediabetes to diabetes, particularly among older adults who often experience difficulties maintaining stable health behaviors during the early adaptation stage. Illness acceptance represents an important cognitive response to disease-related stress, while depression reflects a common emotional reaction during early disease awareness. However, the psychological mechanisms linking illness acceptance and early self-management in older adults with prediabetes remain insufficiently understood.

OBJECTIVE

This study aimed to examine the relationships among illness acceptance, depression, and early self-management in older adults with prediabetes, and to investigate the mediating role of depression within the stress-cognitive appraisal-coping framework.

METHODS

A cross-sectional study was conducted among 400 older adults with prediabetes recruited from multiple hospitals in Zhejiang Province, China, between June and December 2025. Participants completed validated measures assessing illness acceptance (Acceptance of Illness Scale), depressive symptoms (PHQ-3), and self-management behaviors (Self-Management Scale). Pearson correlation analysis was used to assess associations among variables. Mediation analysis was conducted using PROCESS Model 4 with bias-corrected bootstrapping after adjustment for demographic and clinical covariates.

RESULTS

Illness acceptance was positively associated with depressive symptoms (r = 0.38, p < 0.001) and self-management behaviors (r = 0.36, p < 0.001). Depressive symptoms were also positively associated with self-management (r = 0.67, p < 0.001). Mediation analysis demonstrated that depression partially mediated the relationship between illness acceptance and self-management, accounting for approximately 68.57% of the total effect. The indirect effect was statistically significant based on bootstrap confidence intervals. Structural equation modeling indicated acceptable model fit.

CONCLUSION

Illness acceptance was positively associated with early self-management among older adults with prediabetes, both directly and indirectly through emotional pathways. The findings suggest that emotional responses accompanying early disease awareness may influence behavioral engagement during disease adaptation. Integrating acceptance-based education with emotional support strategies may enhance early self-management interventions for older adults with prediabetes.