{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T15:01:50Z","timestamp":1785769310254,"version":"3.56.0"},"reference-count":54,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"CUHK Direct Grant","award":["2022.024"],"award-info":[{"award-number":["2022.024"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["West J Nurs Res"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Psychological flexibility is the concept and focus of Acceptance and Commitment Therapy. It has been demonstrated to benefit self-efficacy and depressive symptoms. However, its role in diabetes self-management (DSM) and the potential mechanisms remain unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>This study aimed to investigate the association between psychological flexibility and self-management and to explore the mediating effect of depressive symptoms and self-efficacy among people with diabetes in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Using a cross-sectional study design, 249 people with type 2 diabetes in China were recruited from February 1, 2024, to April 30, 2024, and completed a structured online questionnaire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Psychological flexibility and DSM showed a moderate correlation (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.45,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Path analysis showed significant associations between the 3 subscales of psychological flexibility and depressive symptoms and self-efficacy. In addition, depressive symptoms partially mediated the relationship between the valued action subscale of psychological flexibility and DSM, while the mediation role of self-efficacy was not significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The findings highlight the potential mechanisms of how higher levels of psychological flexibility may affect depressive symptoms reduction and self-management promotion. Acceptance and Commitment Therapy that particularly aims to enhance valued action may be effective for alleviating depressive symptoms and enhancing self-management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/01939459251336042","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T02:28:23Z","timestamp":1747362503000},"page":"698-707","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Psychological Flexibility and Diabetes Self-Management: The Mediating Roles of Depressive Symptoms and Self-Efficacy"],"prefix":"10.1177","volume":"47","author":[{"given":"Chang","family":"Wang","sequence":"first","affiliation":[{"name":"Faculty of Medicine, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalin","family":"Zheng","sequence":"additional","affiliation":[{"name":"Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese Medicine, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaonian","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Fengtai District Chinese Medicine Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muzi","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese Medicine, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7892-2994","authenticated-orcid":false,"given":"Xue","family":"Yang","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.4103\/2468-8827.184853"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2017.12.019"},{"key":"e_1_3_2_4_2","volume-title":"IDF Diabetes Atlas","author":"International Diabetes Federation","unstructured":"International Diabetes Federation. 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