{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T04:02:45Z","timestamp":1769832165908,"version":"3.49.0"},"reference-count":46,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Key R&D and Promotion Special Project of Henan Province, China","award":["252102310176"],"award-info":[{"award-number":["252102310176"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Objective: This study aimed to examine the association between family cohesion and disease identity in adolescents and young adults (AYAs) with type 1 diabetes mellitus (T1DM) and to test the mediating role of perceived social support in this relationship. Methods: From January 2025 to June 2025, a total of 222 AYA patients with T1DM were recruited from the Department of Endocrinology and Department of Pediatrics of four tertiary-level hospitals in Zhengzhou, Henan Province, China. The Disease Identity Questionnaire for AYA patients with T1DM, Family Cohesion Scale, and Perceived Social Support Scale were used. Results: Family cohesion was positively correlated with perceived social support and disease identity, and perceived social support was positively correlated with disease identity. Perceived social support played a partial mediating role in the association between family cohesion and disease identity (\u03b2 = 0.391, p &lt; 0.001), accounting for 63.6% of the total effect. Conclusions: Family cohesion is positively associated with perceived social support and disease identity in AYA patients with T1DM, with perceived social support playing a partial mediating role. This indicates that family cohesion shows both direct and indirect associations with patients\u2019 disease identity. The study suggests that interventions aimed at enhancing family cohesion and perceived social support may inform strategies to improve patients\u2019 disease identity, thereby potentially facilitating their psychosocial adaptation.<\/jats:p>","DOI":"10.3390\/nursrep16020048","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T14:35:46Z","timestamp":1769783746000},"page":"48","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Mediating Role of Perceived Social Support in Family Cohesion and Disease Identity Among Chinese Adolescents and Young Adults with Type 1 Diabetes Mellitus: A Cross-Sectional Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6131-7358","authenticated-orcid":false,"given":"Xiao","family":"Yang","sequence":"first","affiliation":[{"name":"School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaofan","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunhui","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6446-6366","authenticated-orcid":false,"given":"Xian","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e075681","DOI":"10.1136\/bmj-2023-075681","article-title":"New advances in type 1 diabetes","volume":"384","author":"Subramanian","year":"2024","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"112277","DOI":"10.1016\/j.diabres.2025.112277","article-title":"Global type 1 diabetes prevalence, incidence, and mortality estimates 2025: Results from the International Diabetes Federation Atlas, 11th Edition, and the T1D Index Version 3.0","volume":"225","author":"Ogle","year":"2025","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1038\/s41390-024-03107-5","article-title":"Global, regional, and national burden of type 1 diabetes in adolescents and young adults","volume":"97","author":"Gong","year":"2024","journal-title":"Pediatr. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"j5295","DOI":"10.1136\/bmj.j5295","article-title":"Incidence of type 1 diabetes in China, 2010\u20132013: Population based study","volume":"360","author":"Weng","year":"2018","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s13300-023-01367-8","article-title":"Incidence of Childhood Type 1 Diabetes in Beijing During 2011\u20132020 and Predicted Incidence for 2025\u20132035: A Multicenter, Hospitalization-Based Study","volume":"14","author":"Li","year":"2023","journal-title":"Diabetes Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.adolescence.2016.02.007","article-title":"Brief report: Benefit finding and identity processes in type 1 diabetes: Prospective associations throughout adolescence","volume":"49","author":"Luyckx","year":"2016","journal-title":"J. Adolesc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s00431-012-1725-5","article-title":"Adolescent views on transition in diabetes and nephrology","volume":"172","author":"Tong","year":"2013","journal-title":"Eur. J. Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.jadohealth.2008.04.005","article-title":"Identity development, coping, and adjustment in emerging adults with a chronic illness: The sample case of type 1 diabetes","volume":"43","author":"Luyckx","year":"2008","journal-title":"J. Adolesc. Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jcjd.2022.08.007","article-title":"Assessing Incorporation of Type 1 Diabetes Into Identity: Validation of the Accepting Diabetes and Personal Treatment (ADAPT) Survey in Teens and Young Adults","volume":"47","author":"Commissariat","year":"2023","journal-title":"Can. J. Diabetes"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1177\/1049732320966582","article-title":"Integrating Illness Management into Identity Verification Processes","volume":"31","author":"Maietta","year":"2021","journal-title":"Qual. Health Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s10964-019-01180-2","article-title":"The Social Context and Illness Identity in Youth with Type 1 Diabetes: A Three-Wave Longitudinal Study","volume":"49","author":"Raymaekers","year":"2020","journal-title":"J. Youth Adolesc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1111\/pedi.13022","article-title":"The role of parental support for emerging adults with type 1 diabetes: A scoping review","volume":"21","author":"Johansen","year":"2020","journal-title":"Pediatr. Diabetes"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1002\/nur.21913","article-title":"\u201cAnxiety and Type 1 diabetes are like cousins\u201d: The experience of anxiety symptoms in youth with Type 1 diabetes","volume":"41","author":"Rechenberg","year":"2018","journal-title":"Res. Nurs. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.2196\/jmir.9432","article-title":"Stigma and Its Association With Glycemic Control and Hypoglycemia in Adolescents and Young Adults with Type 1 Diabetes: Cross-Sectional Study","volume":"20","author":"Brazeau","year":"2018","journal-title":"J. Med. Internet Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"757","DOI":"10.2337\/dc15-2559","article-title":"Illness Identity in Adolescents and Emerging Adults with Type 1 Diabetes: Introducing the Illness Identity Questionnaire","volume":"39","author":"Oris","year":"2016","journal-title":"Diabetes Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1177\/26350106241304424","article-title":"Parent-Adolescent Communication, Self-Efficacy, and Self-Management of Type 1 Diabetes in Adolescents","volume":"51","author":"Tuohy","year":"2025","journal-title":"Sci. Diabetes Self Manag. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1111\/nhs.13042","article-title":"Metabolic control and quality of life in type 1 diabetes: Do adherence, family support, and school support matter?","volume":"25","author":"Almeida","year":"2023","journal-title":"Nurs. Health Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4478","DOI":"10.1111\/jocn.15033","article-title":"The effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes","volume":"28","author":"Luo","year":"2019","journal-title":"J. Clin. Nurs."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1097\/jnr.0000000000000234","article-title":"Adolescent Perceptions of Peer Responses to Diabetes Self-Management: A Qualitative Study","volume":"26","author":"Yang","year":"2018","journal-title":"J. Nurs. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1037\/0022-006X.54.4.416","article-title":"Social support as coping assistance","volume":"54","author":"Thoits","year":"1986","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"N\u00fa\u00f1ez-Baila, M.D.L.\u00c1., G\u00f3mez-Arag\u00f3n, A., and Gonz\u00e1lez-L\u00f3pez, J.R. (2021). Social Support and Peer Group Integration of Adolescents with Diabetes. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18042064"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1093\/jpepsy\/jsab052","article-title":"Systematic Review: Diabetes Family Conflict in Young People With Type 1 Diabetes","volume":"46","author":"Hickling","year":"2021","journal-title":"J. Pediatr. Psychol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1748362","DOI":"10.1080\/17482631.2020.1748362","article-title":"Emergence of a butterfly: The life experiences of type 1 diabetes Taiwanese patients during the 16-25 years old transition period","volume":"15","author":"Chiang","year":"2020","journal-title":"Int. J. Qual. Stud. Health Well-Being"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1080\/02739615.2015.1124777","article-title":"Intrinsic Motivation in Ethnic Minority Youth with Type 1 Diabetes","volume":"46","author":"Delamater","year":"2017","journal-title":"Child. Health Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/s10826-013-9758-6","article-title":"Family Cohesion and Health-Related Quality of Life of Children with Type 1 Diabetes: The Mediating Role of Parental Adjustment","volume":"23","author":"Moreira","year":"2013","journal-title":"J. Child Fam. Stud."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1037\/0033-2909.98.2.310","article-title":"Stress, social support, and the buffering hypothesis","volume":"98","author":"Cohen","year":"1985","journal-title":"Psychol. Bull."},{"key":"ref_27","unstructured":"Chinese Society of Diabetes, Chinese Association of Endocrinologists, Chinese Society of Endocrinology, and Chinese Society of Pediatrics (2022). Guidelines for the diagnosis and treatment of type 1 diabetes in China (2021 edition). Chin. J. Diabetes, 14, 1143\u20131250."},{"key":"ref_28","unstructured":"World Health Organization (2017). Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation, World Health Organization."},{"key":"ref_29","unstructured":"Xiao, S. (2010). Guide to Nursing Research Practice and Paper Writing, Peking University Medical Press."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1545-5300.1979.00003.x","article-title":"Circumplex model of marital and family system: I. Cohesion and adaptability dimensions, family types, and clinical applications","volume":"18","author":"Olson","year":"1979","journal-title":"Fam. Process"},{"key":"ref_31","first-page":"198","article-title":"Preliminary evaluation of the \u201cFamily Cohesion and Adaptability Scale\u201d and the \u201cFamily Environment Scale\u201d: A comparative study of normal families and families of individuals with schizophrenia","volume":"5","author":"Zheng","year":"1991","journal-title":"Chin. Ment. Health J."},{"key":"ref_32","unstructured":"Jiang, Q. (1999). Perceived Social Support Scale (PSSS). Handbook of Mental Health Assessment Scales, Chinese Mental Health Journal Press."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1207\/s15327752jpa5503&4_17","article-title":"Psychometric characteristics of the Multidimensional Scale of Perceived Social Support","volume":"55","author":"Zimet","year":"1990","journal-title":"J. Pers. Assess."},{"key":"ref_34","first-page":"29","article-title":"Applicability of the Perceived Social Support Scale among adolescent groups","volume":"11","author":"Ye","year":"2022","journal-title":"Educ. Obs."},{"key":"ref_35","unstructured":"Kline, R.B. (2015). Principles and Practice of Structural Equation Modeling, Guilford Publications. [4th ed.]."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s10459-010-9222-y","article-title":"Likert scales, levels of measurement and the \u201claws\u201d of statistics","volume":"15","author":"Norman","year":"2010","journal-title":"Adv. Health Sci. Educ."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Rubio, P., Mart\u00edn-\u00c1vila, J., Rodr\u00edguez-Jim\u00e9nez, E., Valero-Moreno, S., Montoya-Castilla, I., and P\u00e9rez-Mar\u00edn, M. (2025). Emotional Contagion Among Adolescents with Type 1 Diabetes Mellitus (T1DM) and Their Primary Caregivers: Benefits of Psychological Support for Family Systems in Pilot Study. Children, 12.","DOI":"10.3390\/children12020151"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"66","DOI":"10.31372\/20190402.1028","article-title":"Family Support towards Resilience in Adolescents with Type I Diabetes: A Preliminary Study in Indonesia","volume":"4","author":"Agustini","year":"2019","journal-title":"Asian Pac. Isl. Nurs. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.dr.2017.09.001","article-title":"Developmental Model of Parent-Child Coordination for Self-Regulation Across Childhood and Into Emerging Adulthood: Type 1 Diabetes Management as an Example","volume":"46","author":"Berg","year":"2017","journal-title":"Dev. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"239","DOI":"10.2174\/1573399811666150421114957","article-title":"Type 1 Diabetes in Young Adulthood","volume":"11","author":"Monaghan","year":"2015","journal-title":"Curr. Diabetes Rev."},{"key":"ref_41","first-page":"102","article-title":"Research progress on parental support for adolescents with type 1 diabetes","volume":"31","author":"Liu","year":"2016","journal-title":"J. Nurs. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1111\/dme.12067","article-title":"Characterizing the Transition from Paediatric to Adult Care among Emerging Adults with Type 1 Diabetes","volume":"30","author":"Helgeson","year":"2013","journal-title":"Diabet. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3611","DOI":"10.2147\/PRBM.S474339","article-title":"The Associating Factors of Parent-Teen and Peer Relationships Among Chinese Adolescents with Type 1 Diabetes Mellitus","volume":"17","author":"Luo","year":"2024","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1111\/dme.14056","article-title":"Diabetes-specific self-esteem, self-care and glycaemic control among adolescents with Type 1 diabetes","volume":"37","author":"Kenowitz","year":"2020","journal-title":"Diabet. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/scs.13214","article-title":"Experiences of young people living with type 1 diabetes in transition to adulthood: The importance of care provider familiarity and support","volume":"38","author":"Laursen","year":"2024","journal-title":"Scand. J. Caring Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s11892-018-0995-3","article-title":"Self- and Social-Regulation in Type 1 Diabetes Management During Late Adolescence and Emerging Adulthood","volume":"18","author":"Wiebe","year":"2018","journal-title":"Curr. Diabetes Rep."}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/2\/48\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T14:50:12Z","timestamp":1769784612000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/2\/48"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,30]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["nursrep16020048"],"URL":"https:\/\/doi.org\/10.3390\/nursrep16020048","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,30]]}}}