Self-Disclosure and Fear of Progression in Younger and Middle-Aged Adults with Diabetes: Chain-Mediating Roles of Social Support and Illness Perception

Background: Among younger and middle-aged adults with diabetes, fear of progression (Fop) is a prominent psychological burden that is associated with impaired self-management and poorer long-term treatment adherence. Although self-disclosure has shown benefits in alleviating Fop in other chronic conditions, its role in younger and middle-aged adults with diabetes, and the pathways through which it might relate to Fop remain unclear. Purpose: To examine the effect of self-disclosure on FoP among younger and middle-aged adults with diabetes and to test the chain-mediating roles of social support and illness perception using a cross-sectional design. Patients and Methods: A survey was conducted in a tertiary hospital in Nanjing, China, from March 2023 to August 2024. Standardized scales were used to assess self-disclosure, social support, illness perception, and FoP. A multiple mediation model was tested using the PROCESS macro for SPSS (v22.0). Results: A total of 193 participants were included. Self-disclosure exhibited a substantial direct impact on FoP. It also exerted indirect effects through two pathways: (1) the independent mediation of illness perception and (2) the serial mediation of social support followed by illness perception. Conclusion: Self-disclosure is a meaningful and modifiable psychosocial factor associated with reduced FoP among younger and middle-aged adults with diabetes. Interventions aimed at facilitating disclosure, enhancing supportive communication, and reshaping maladaptive illness perceptions may help reduce FoP and support long-term self-management and adherence.