Objective To explore the heterogeneity of hope levels and associated factors among young and middle-aged patients with diabetic retinopathy (DR), to provide a reference for stratified and precision nursing interventions.

Methods Using a convenience sampling method, young and middle-aged patients with DR who visited Zhongnan Hospital of Wuhan University, Zengdu Hospital of Suizhou City, and Dawu County People's Hospital from January 2025 to June 2025 was selected as the research subjects. Data were collected using a general information questionnaire, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Medical Coping Modes Questionnaire (MCMQ), the Social Support Rating Scale (SSRS), and the Herth Hope Index (HHI). The overall hope level was described according to the standard HHI criteria, and latent profile analysis(LPA) was conducted using the 12 HHI items as indicator variables. Multivariate Logistic regression was performed to examine factors associated with latent class membership.

Results A total of 393 young and middle-aged patients with DR were included. Three latent profiles of hope levels were identified among young and middle-aged patients with DR: the nostalgic-defensive type (32.3%), the lonely-fearful type (35.9%), and the actively maintaining type (31.8%). Multivariate Logistic regression analysis showed that sex, age, monthly per capita family income, visual impairment, glycated hemoglobin, coping style, social support, and fear of disease progression were associated with latent class membership of hope levels (P < 0.05).

Conclusion Hope levels among young and middle-aged patients with DR showed significant heterogeneity. LPA may help identify subgroups with distinct psychological characteristics that may be overlooked by traditional total-score-based stratification. The findings provide a reference for clinical nurses to identify different psychological subgroups  of young and middle-age patients with DR and implement stratified and precision nursing interventions.

1. 中华医学会眼科学分会眼底病学组, 中国医师协会眼科医师分会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2022年)-基于循证医学修订[J]. 中华眼底病杂志, 2023, 39(2): 99-124.Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association. Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China (2022)[J]. Chinese Journal of Ocular Fundus Diseases, 2023, 39(2): 99-124.

2. TeoZL, ThamYC, YuM, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and Meta-analysis[J]. Ophthalmology, 2021, 128(11): 1580-1591. doi：10.1016/j.ophtha.2021.04.027

3. HouX, WangL, ZhuD, et al. Prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy in adults with diabetes in China[J]. Nat Commun, 2023, 14(1): 4296. doi：10.1038/s41467-023-39864-w

4. MisraS, KeC, SrinivasanS, et al. Current insights and emerging trends in early-onset type 2 diabetes[J]. Lancet Diabetes Endocrinol, 2023, 11(10): 768-782. doi：10.1016/s2213-8587(23)00225-5

5. LiX, TanTE, WongTY, et al. Diabetic retinopathy in China: epidemiology, screening and treatment trends-a review[J]. Clin Exp Ophthalmol, 2023, 51(6): 607-626. doi：10.1111/ceo.14269

6. 王磊磊, 张兴, 杜伟, 等. 中青年糖尿病患者共享决策现状及影响因素的路径分析[J]. 护理学杂志, 2024, 39(10): 46-50.WangLL, ZhangX, DuW, et al. A pathway analysis of the current status of shared decision-making and the influencing factors among young and middle-aged diabetes patients[J]. Journal of Nursing Science, 2024, 39(10): 46-50.

7. TanTE, WongTY. Diabetic retinopathy: looking forward to 2030[J]. Front Endocrinol (Lausanne), 2023, 13: 1077669. doi：10.3389/fendo.2022.1077669

8. SnyderCR, HarrisC, AndersonJR, et al. The will and the ways: development and validation of an individual-differences measure of hope[J]. J Pers Soc Psychol, 1991, 60(4): 570-585. doi：10.1037/0022-3514.60.4.570

9. 吕雨梅, 郭玉成, 周郁秋. 脑卒中患者康复锻炼依从性发展轨迹及其潜在类别预测因素分析[J]. 中华护理杂志, 2023, 58(17): 2103-2111. doi：10.3761/j.issn.0254-1769.2023.17.008LyuYM, GuoYC, ZhouYQ. Research on the developmental trajectory of rehabilitation exercise adherence and its potential classes predictors in stroke patients[J]. Chinese Journal of Nursing, 2023, 58(17): 2103-2111. doi：10.3761/j.issn.0254-1769.2023.17.008

10. PeduzziP, ConcatoJ, KemperE, et al. A simulation study of the number of events per variable in logistic regression analysis[J]. J Clin Epidemiol, 1996, 49(12): 1373-1379. doi：10.1016/s0895-4356(96)00236-3

11. 中华医学会糖尿病学分会. 中国糖尿病防治指南(2024版)[J]. 中华糖尿病杂志, 2025, 17(1): 16-139. doi：10.3760/cma.j.cn115791-20241203-00705Chinese Diabetes Society. Guideline for the prevention and treatment of diabetes mellitus in China (2024 edition)[J]. Chinese Journal of Diabetes, 2025, 17(1): 16-139. doi：10.3760/cma.j.cn115791-20241203-00705

12. 国家重点研发计划2020YFC2008200项目组, 中华医学会眼科学分会眼视光学组, 中国医师协会眼科医师分会眼视光专业委员会. 中国低视力康复临床指南(2021)[J]. 中华眼视光学与视觉科学杂志, 2021, 23(3): 161-170.Research Panel of the National Key R&D Project 2020YFC2008200, Chinese Optometric Association of Chinese Ophthalmological Society, Optometry Committee of Chinese Ophthalmologists Association. Chinese Low Vision Rehabilitation Clinical Guideline (2021)[J]. Chinese Journal of Optometry and Visual Science, 2021, 23(3): 161-170.

13. MehnertA, HerschbachP, BergP, et al. Fear of progression in breast cancer patients--validation of the short form of the Fear of Progression Questionnaire (FoP-Q-SF)[J]. Z Psychosom Med Psychother, 2006, 52(3): 274-288. doi：10.13109/zptm.2006.52.3.274

14. 吴奇云, 叶志霞, 李丽, 等. 癌症患者恐惧疾病进展简化量表的汉化及信效度分析[J]. 中华护理杂志, 2015, 50(12): 1515-1519. doi：10.3761/j.issn.0254-1769.2015.12.021WuQY, YeZX, LiL, et al. Reliability and validity of Chinese version of Fear of Progression Questionnaire-Short Form for cancer patients[J]. Chinese Journal of Nursing, 2015, 50(12): 1515-1519. doi：10.3761/j.issn.0254-1769.2015.12.021

15. FeifelH, StrackS, NagyVT. Coping strategies and associated features of medically ill patients[J]. Psychosom Med, 1987, 49(6): 616-625. doi：10.1097/00006842-198711000-00007

16. 沈晓红, 姜乾金. 医学应对方式问卷中文版701例测试报告[J]. 中国行为医学科学, 2000, 9(1): 18.ShenXH, JiangQJ. Report on the testing of the Chinese version of the Medical Coping Modes Questionnaire with 701 cases[J]. Chinese Journal of Behavioral Medicine and Brain Science, 2000, 9(1): 18.

17. 肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994, 4(2): 98-100.XiaoSY. Theoretical basis and research applications of the Social Support Rating Scale[J]. Chinese Journal of Clinical Psychiatry, 1994, 4(2): 98-100.

18. HerthK. Development and refinement of an instrument to measure hope[J]. Sch Inq Nurs Pract, 1991, 5(1): 39-51.

19. 赵海平, 王健. 血液透析患者的社会支持和希望[J]. 中华护理杂志, 2000, 35(5): 306-308.ZhaoHP, WangJ. Social support and hope in hemodialysis patients[J]. Chinese Journal of Nursing, 2000, 35(5): 306-308.

20. 杨丽娜, 杨珍. 癌症病人希望水平评估工具的研究进展[J]. 护理研究, 2022, 36(14): 2519-2522.YangLN, YangZ. Research progress of hope level assessment tools for cancer patients[J]. Chinese Nursing Research, 2022, 36(14): 2519-2522.

21. 陈刚, 王禹涵, 李腾, 等. 糖尿病视网膜病变患者心盛现状及影响因素分析[J]. 护理学杂志, 2025, 40(11): 82-85, 101.ChenG, WangYH, LiT, et al. Status of flourishing among patients with diabetic retinopathy and its influencing factors[J]. Journal of Nursing Science, 2025, 40(11): 82-85, 101.

22. FenwickEK, ReesG, PesudovsK, et al. Social and emotional impact of diabetic retinopathy: a review[J]. Clin Exp Ophthalmol, 2012, 40(1): 27-38. doi：10.1111/j.1442-9071.2011.02599.x

23. KhooK, ManREK, ReesG, et al. The relationship between diabetic retinopathy and psychosocial functioning: a systematic review[J]. Qual Life Res, 2019, 28(8): 2017-2039. doi：10.1007/s11136-019-02165-1

24. XiongM, YaoH, ChengY, et al. Attributes and influencing factors of hope levels in breast cancer patients: a latent profile analysis[J]. Br J Health Psychol, 2025, 30(1): e12773. doi：10.1111/bjhp.12773

25. LiD, XiJ, XuY, et al. Relatedness needs satisfaction or ego depletion? The effect of leisure nostalgia on life satisfaction[J]. Front Psychol, 2025, 16: 1645603. doi：10.3389/fpsyg.2025.1645603

26. WildschutT, SedikidesC, ArndtJ, et al. Nostalgia: content, triggers, functions[J]. J Pers Soc Psychol, 2006, 91(5): 975-993. doi：10.1037/0022-3514.91.5.975

27. LiY, XiaoT, LiaoH, et al. Fear of progression, loneliness, and hope in patients with gastrointestinal cancer: a cross-sectional relational study[J]. Front Psychol, 2023, 14: 1279561. doi：10.3389/fpsyg.2023.1279561

28. McCoyMA, TheekeLA. A systematic review of the relationships among psychosocial factors and coping in adults with type 2 diabetes mellitus[J]. Int J Nurs Sci, 2019, 6(4): 468-477. doi：10.1016/j.ijnss.2019.09.003

29. ChewBH, VosRC, MetzendorfMI, et al. Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus[J]. Cochrane Database Syst Rev, 2017, 9(9): CD011469.

30. GaoS, LiuX. Analysis of anxiety and depression status and their influencing factors in patients with diabetic retinopathy[J]. World J Psychiatry, 2024, 14(12): 1905-1917. doi：10.5498/wjp.v14.i12.1905

31. XuL, ChenS, XuK, et al. Prevalence and associated factors of depression and anxiety among Chinese diabetic retinopathy patients: a cross-sectional study[J]. PLoS One, 2022, 17(4): e0267848. doi：10.1371/journal.pone.0267848

32. SturrockBA, ReesG, LamoureuxEL, et al. Individuals' perspectives on coping with vision loss from diabetic retinopathy[J]. Optom Vis Sci, 2018, 95(4): 362-372. doi：10.1097/opx.0000000000001209

33. CooperOAE, TaylorDJ, CrabbDP, et al. Psychological, social and everyday visual impact of diabetic macular oedema and diabetic retinopathy: a systematic review[J]. Diabet Med, 2020, 37(6): 924-933. doi：10.1111/dme.14125

34. Hernández-MorenoL, SenraH, MacedoAF. Is perceived social support more important than visual acuity for clinical depression and anxiety in patients with age-related macular degeneration and diabetic retinopathy?[J]. Clin Rehabil, 2021, 35(9): 1341-1347. doi：10.1177/0269215521997991