{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T20:13:34Z","timestamp":1793218414419,"version":"4.5.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Current empirical literature demonstrates a paucity of evidence elucidating the intricate network relationships among personality traits, emotion states, self-management behaviors, and quality of life (QOL) in patients with type 2 diabetes mellitus (T2DM). This cross-sectional study aimed to investigate these relationships using structural equation modeling (SEM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cohort of 839 T2DM patients was systematically recruited from 69 community health service centers in Hangzhou, China, between 2016 and 2020. Standardized instruments were administered to assess demographic characteristics, personality traits (Chinese Big Five Personality Inventory-15, CBF-PI-15), emotional states (Self-Rating Anxiety Scale [SAS] and Self-Rating Depression Scale [SDS]), self-management behaviors (Type 2 Diabetes Self-Care Scale, 2-DSCS), and QOL (MOS 36-Item Short-Form Health Survey, SF-36). Data analyses were performed using SPSS 26.0 and AMOS 21.0.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Descriptive statistics revealed the highest mean score for agreeableness (13.58\u202f\u00b1\u202f2.55), whereas self-management subdomains exhibited comparatively lower scores (blood glucose monitoring: 12.17\u202f\u00b1\u202f4.10; regular exercise: 12.35\u202f\u00b1\u202f4.89). Significant anxiety and depressive symptoms were present in 20.4 and 28.6% of participants, respectively. Bivariate correlations showed significant positive associations between self-management behaviors and both psychological\/physiological QOL dimensions, alongside negative correlations with anxiety, depression, and neuroticism. The SEM analysis yielded excellent model fit indices (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\/df\u202f=\u202f3.556, AGFI\u202f=\u202f0.946, GFI\u202f=\u202f0.967, CFI\u202f=\u202f0.957, IFI\u202f=\u202f0.957, RMSEA\u202f=\u202f0.055), with anxiety emerging as the most robust predictor of QOL (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f\u22120.542), followed by depression (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f\u22120.360) and self-management behaviors (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.342). Mediation analysis confirmed the significant intermediary roles of anxiety and depression in pathway linking self-management behaviors to QOL (indirect effects accounting for 33.70%, 30.33% of total variance).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings elucidate the complex psychobehavioral mechanisms underlying QOL in T2DM patients, highlighting the critical mediating role of emotional states between self-management and QOL. The results underscore the imperative for integrated interventions targeting both emotional regulation and behavioral modification in diabetes care protocols.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyg.2025.1629825","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T11:15:48Z","timestamp":1756466148000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Associations among personality traits, emotional states, and self-management behaviors with quality of life in type 2 diabetes: a structural equation modeling approach examining emotional mediation"],"prefix":"10.3389","volume":"16","author":[{"given":"Wen","family":"Fu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jue","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caixia","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shijun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1080\/08164622.2022.2075253","article-title":"Associations between personality traits and adherence to treatment in patients with primary open-angle glaucoma in an African population","volume":"106","author":"Abu","year":"2023","journal-title":"Clin. Exp. Optom."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1159\/000484929","article-title":"Exploring factors associated with depression and anxiety among hospitalized patients with type 2 diabetes mellitus","volume":"26","author":"AlBekairy","year":"2017","journal-title":"Med. Princ. Pract."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S38","DOI":"10.2337\/dc18-S004","article-title":"Lifestyle management: standards of medical care in diabetes-2018","volume":"41","year":"2018","journal-title":"Diabetes Care"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"449","DOI":"10.4093\/dmj.2017.41.6.449","article-title":"Association of self-care behaviors and quality of life among patients with type 2 diabetes mellitus: Chaldoran County, Iran","volume":"41","author":"Babazadeh","year":"2017","journal-title":"Diabetes Metab. J."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"4226","DOI":"10.3390\/nu15194226","article-title":"Exploring the interrelationships between diabetes, nutrition, anxiety, and depression: implications for treatment and prevention strategies","volume":"15","author":"Basiri","year":"2023","journal-title":"Nutrients"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"335","DOI":"10.22088\/cjim.13.2.3","article-title":"Depression and quality of life in patients with type 2 diabetes mellitus","volume":"13","author":"Bayani","year":"2022","journal-title":"Caspian J. Intern. Med."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e059336","DOI":"10.1136\/bmjopen-2021-059336","article-title":"ACTonDiabetes: study protocol of a pragmatic randomised controlled trial for the evaluation of an acceptance and commitment-based internet-based and mobile-based intervention for adults living with type 1 or type 2 diabetes","volume":"12","author":"Bendig","year":"2022","journal-title":"BMJ Open"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1001\/jama.2016.19720","article-title":"Association between diabetes and cause-specific mortality in rural and urban areas of China","volume":"317","author":"Bragg","year":"2017","journal-title":"JAMA"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"5","DOI":"10.11606\/s1518-8787.2019053000608","article-title":"Association between diabetes mellitus and depressive symptoms in the Brazilian population","volume":"53","author":"Briganti","year":"2018","journal-title":"Rev. Saude Publica"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"315","DOI":"10.3760\/cma.j.cn115791-20210221-00095","article-title":"Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)","volume":"13","year":"2021","journal-title":"Chin. J. Diabetes Mellitus"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"831","DOI":"10.3389\/fpsyg.2017.00831","article-title":"Negative affectivity predicts lower quality of life and metabolic control in type 2 diabetes patients: a structural equation modeling approach","volume":"8","author":"Conti","year":"2017","journal-title":"Front. Psychol."},{"key":"ref1002","doi-asserted-by":"publisher","first-page":"1210691","DOI":"10.3389\/fpsyg.2023.1210691","article-title":"Intertemporal decision-making as a mediator between personality traits and self-management in type 2 diabetes: a cross-sectional study","volume":"28","author":"Deng","year":"2023","journal-title":"Front. Psychol."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1030911","DOI":"10.3389\/fpsyg.2022.1030911","article-title":"The relationship between personality profile and self-care among patients with type 2 diabetes","volume":"13","author":"Dadras","year":"2022","journal-title":"Front. Psychol."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"284","DOI":"10.4103\/0253-7176.119502","article-title":"Prevalence of depression in patients with type II diabetes mellitus and its impact on quality of life","volume":"35","author":"Das","year":"2013","journal-title":"Indian J. Psychol. Med."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2174","DOI":"10.2337\/dc16-1145","article-title":"Lifetime duration of depressive disorders in patients with type 2 diabetes","volume":"39","author":"De Groot","year":"2016","journal-title":"Diabetes Care"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1186\/s12955-020-01613-8","article-title":"Impact of health literacy and self-care behaviors on health-related quality of life in Iranians with type 2 diabetes: a cross-sectional study","volume":"18","author":"Gaffari-Fam","year":"2020","journal-title":"Health Qual. Life Outcomes"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"816","DOI":"10.3969\/j.issn.1674-4748.2018.07.020","article-title":"Analysis of self-management behaviors and influencing factors in elderly patients with type 2 diabetes","volume":"16","author":"Gao","year":"2018","journal-title":"Chin. Genl. Pract. Nurs."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/j.jpsychores.2009.05.015","article-title":"The consequences of anxious temperament for disease detection, self-management behavior, and quality of life in type 2 diabetes mellitus","volume":"67","author":"Hall","year":"2009","journal-title":"J. Psychosom. Res."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1646","DOI":"10.1016\/j.jrp.2008.07.005","article-title":"Delay discounting: interactions between personality and cognitive ability","volume":"42","author":"Hirsh","year":"2008","journal-title":"J. Res. Pers."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e47198","DOI":"10.2196\/47198","article-title":"User engagement clusters of an 8-week digital mental health intervention guided by a relational agent (Woebot): exploratory study","volume":"25","author":"Hoffman","year":"2023","journal-title":"J. Med. Internet Res."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1037\/emo0000644","article-title":"Personality traits and emotion regulation: a targeted review and recommendations","volume":"20","author":"Hughes","year":"2020","journal-title":"Emotion"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"997","DOI":"10.2147\/PPA.S507666","article-title":"The relationship between personality and self-management behavior in Chinese young and middle-aged people with chronic illness: the chain mediating role of family health and health literacy","volume":"19","author":"Lang","year":"2025","journal-title":"Patient Prefer. Adherence"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"506","DOI":"10.19723\/j.issn.1671-167X.2020.03.017","article-title":"Relationship between the five-factor model of personality traits and self-management attitude of patients with type 2 diabetes","volume":"52","author":"Li","year":"2020","journal-title":"Beijing Da Xue Xue Bao"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.16766\/j.cnki.issn.1674-4152.002004","article-title":"Anxiety and depression in patients with type 2 diabetes mellitus and their influencing factors","volume":"19","author":"Li","year":"2021","journal-title":"Chin. J. Gen. Pract."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"8307","DOI":"10.1038\/s41598-020-57647-x","article-title":"Anxiety and depression in diabetes care: longitudinal associations with health-related quality of life","volume":"10","author":"Liu","year":"2020","journal-title":"Sci. Rep."},{"key":"ref25","volume-title":"Report on nutrition and chronic diseases of Chinese residents (2020)","year":"2021"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1111\/aphw.12087","article-title":"Does personality matter in diabetes adherence? Exploring the pathways between neuroticism and patient adherence in couples with type 2 diabetes","volume":"9","author":"Novak","year":"2017","journal-title":"Appl. Psychol. Health Well Being"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1543298","DOI":"10.3389\/fpubh.2025.1543298","article-title":"Comparative effectiveness of diabetes self-management education and support intervention strategies among adults with type 2 diabetes in Texas","volume":"13","author":"Ory","year":"2025","journal-title":"Front. Public Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"775","DOI":"10.4103\/njcp.njcp_523_19","article-title":"Anxiety levels, quality of life and related socio-demographic factors in patients with type 2 diabetes","volume":"23","author":"Ozdemir","year":"2020","journal-title":"Niger. J. Clin. Pract."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e0232752","DOI":"10.1371\/journal.pone.0232752","article-title":"Patient-reported outcomes predict return to work and health-related quality of life six months after cardiac rehabilitation: results from a German multi-Centre registry (OutCaRe)","volume":"15","author":"Salzwedel","year":"2020","journal-title":"PLoS One"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.paid.2018.01.050","article-title":"Coping with sadness: how personality and emotion regulation strategies differentially predict the experience of induced emotions","volume":"136","author":"Schindler","year":"2019","journal-title":"Pers. Individ. Differ."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1111\/dme.14196","article-title":"Assessing the impact of diabetes on quality of life: what have the past 25 years taught us?","volume":"37","author":"Speight","year":"2020","journal-title":"Diabet. Med."},{"key":"ref32","volume-title":"Anxiety and depressive disorders in diabetes","author":"Stevanovic","year":"2019"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"9119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1016\/s2213-8587(13)70139-6","article-title":"Depression and type 2 diabetes: a causal association?","volume":"2","author":"Tab\u00e1k","year":"2014","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.pcd.2020.05.012","article-title":"Multidisciplinary team approach to diabetes. An outlook on providers\u2019 and patients\u2019 perspectives","volume":"14","author":"Tan","year":"2020","journal-title":"Prim. Care Diabetes"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"23779608231185921","DOI":"10.1177\/23779608231185921","article-title":"Predicting factors of health-related quality of life among adults with type 2 diabetes: a systematic review","volume":"9","author":"Teli","year":"2023","journal-title":"SAGE Open Nurs."},{"key":"ref37","volume-title":"Chapter 5-personality and type 2 diabetes: an overview of the epidemiological evidence","author":"van der Feltz-Cornelis","year":"2018"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e55483","DOI":"10.2196\/55483","article-title":"Economic evaluation of a web application implemented in primary Care for the Treatment of depression in patients with type 2 diabetes mellitus: multicenter randomized controlled trial","volume":"12","author":"Varela-Moreno","year":"2024","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"kaae075","DOI":"10.1093\/abm\/kaae075","article-title":"A blended mindfulness-based stress reduction program to improve diabetes self-management among people with type 2 diabetes mellitus: a mediation effect analysis","volume":"59","author":"Wang","year":"2025","journal-title":"Ann. Behav. Med."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med. Care"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"165","DOI":"10.3760\/cma.j.issn.1674-0815.2019.02.016","article-title":"Comprehensive evaluation and self-management of diabetes care for the elderly","volume":"13","author":"Wen","year":"2019","journal-title":"Chin. J. Health Manage."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1177\/0013164413495237","article-title":"Sample size requirements for structural equation models: an evaluation of power, Bias, and solution propriety","volume":"76","author":"Wolf","year":"2013","journal-title":"Educ. Psychol. Meas."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1007\/s10484-024-09666-x","article-title":"Effect of heart rate variability biofeedback on cardiac autonomic activation and diabetes self-care in patients with type II diabetes mellitus","volume":"50","author":"Wu","year":"2024","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.3760\/cma.j.issn.1674-2907.2016.08.012","article-title":"Investigation and analysis of depression and anxiety in patients with diabetes mellitus","volume":"22","author":"Yan","year":"2016","journal-title":"Chin. J. Mod. Nurs."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e0221621","DOI":"10.1371\/journal.pone.0221621","article-title":"The development and psychometric evaluation of the Chinese big five personality Inventory-15","volume":"14","author":"Zhang","year":"2019","journal-title":"PLoS One"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1001\/archpsyc.1965.01720310065008","article-title":"A self-rating depression scale","volume":"12","author":"Zung","year":"1965","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/s0033-3182(71)71479-0","article-title":"A rating instrument for anxiety disorders","volume":"12","author":"Zung","year":"1971","journal-title":"Psychosomatics"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2025.1629825\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T11:15:53Z","timestamp":1756466153000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2025.1629825\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":49,"alternative-id":["10.3389\/fpsyg.2025.1629825"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2025.1629825","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]},"article-number":"1629825"}}