Health Perception Based Physical Activity and Anxiety Management Strategies for Alleviating Depression in Diabetes Patients

다국어 초록 (Multilingual Abstract)

Purpose – This study aimed to investigate the effect of health perception on depression in diabetic patients and to verify the sequential multiple mediating effects of physical activity and generalized anxiety disorder in this relationship using structural equation modeling (SEM).
Design/Methodology/Approach – Data were drawn from the 2022 Korea National Health and Nutrition Examination Survey (KNHANES). A total of 738 adults aged 19 years or older with diabetes were identified, and 668 respondents with complete PHQ-9 data were included in the analysis. Health perception (6 indicators), Physical activity (12 indicators), GAD (GAD-7), and depression (PHQ-9) were specified as latent variables. Confirmatory factor analysis and SEM were conducted using AMOS 29.0. Serial multiple mediation effects were tested via bootstrap procedures and phantom variable analysis.
Findings – Sociodemographic analyses indicated significantly higher depressive scores among women, unmarried individuals, low-income groups, and recipients of medical aid. Health perception did not show a significant direct effect on depressive symptoms. However, it had a significant indirect effect through physical activity. Specifically, higher health perception was associated with increased physical activity, which in turn reduced GAD, while GAD was positively associated with depression. The serial mediation pathway (health perception → physical activity → GAD → depressive symptoms) was statistically significant, and the indirect effect through physical activity alone was also confirmed. In contrast, the direct pathway between health perception and GAD was not significant.
Research Implications – These findings suggest a cognitive-behavioral-emotional pathway through which health perception indirectly alleviates depressive symptoms by promoting physical activity and reducing anxiety. A stepwise intervention strategy (enhancing health perception, promoting physical activity, reducing anxiety, and preventing depression) should be incorporated into integrated mental health programs for patients with diabetes beyond glucosecentered management.