Predicting Medical Adherence based on Attachment Styles by Considering the Mediating Role of Emotional Regulation in Patients with Chronic Peptic Ulcer Disease

Document Type : Research Paper

Authors

1 Department of Psychology, Torbat-e Jam Branch, Islamic Azad University, Torbat-e Jam, Iran.

2 Assistant Professor, Department of psychology, Torbat-e Jam Branch, Islamic Azad University, Torbat-e Jam, Iran.

3 Department of Psychiatry, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran.

Abstract

The purpose of this study was to investigate the prediction of medical adherence in patients with chronic peptic ulcers by examining the mediating function of emotional regulation in relation to attachment styles. The current research was fundamental in terms of its purpose and employed a correlational approach through structural equation modeling. The statistical population of the current research comprised all patients with peptic ulcers who were referred to the specialized polyclinics and personal offices of internal medicine specialists in Mashhad during the final six months of 2021. The sample consisted of 150 cases that were selected through a voluntary and intentional process. The revised version of the adult attachment scale (RAAS), Morisky medical adherence scale (MMAS), and difficulties in emotional regulation scale (DERS) were completed by the subjects. The data was analyzed using structural equation modeling. SPSS-20 and SmartPLS-3 statistical software were employed to conduct the data analysis. These findings indicated that attachment patterns have a significant indirect effect on medical adherence. Emotional regulation played a significant mediating role in this context (p<0.05). The prevalence of secure attachment styles was positively correlated with an increase in medical adherence, and individuals with higher emotional regulation reported a higher level of medical adherence. Insecure attachment styles had a significant negative effect on medical adherence; while the effect of secure attachment styles on medical adherence was direct and significant.

Keywords


اورکی، م.، زارع، ح.، و حسین‌زاده قاسم‌آباد، ع. (1400). اثربخشی درمان مبتنی بر پذیرش و تعهد بر تبعیت از درمان در افراد مبتلا به کبد چرب غیرالکلی. مجلۀ علمی پژوهشی دانشگاه علوم پزشکی شهید صدوقی یزد، ۲۹(۲)، ۳۴90-۳۴79. http://dx.doi.org/10.18502/ssu.v29i2.6086
دیانتی، م.، مهدوی نژاد، ب.، و تقدسی، م. (1398). بررسی تبعیت دارویی و عوامل مرتبط با آن در بیماران مبتلا به سندروم عروق کرونر در دورۀ پس از ترخیص از بیمارستان بهشتی کاشان در سال ۱۳۹۶. مجلۀ علوم پزشکی فیض، ۲۳(۲)، ۲۰8-۲۰1. http://feyz.kaums.ac.ir/article-1-3737-en.html
عسگری‌زاده، ا.، پاکدامن، ش.، هونجانی، م.، و قنبری، س. (1402). نسخۀ ایرانی مقیاس تجدیدنظر شدۀ دلبستگی بزرگسال: روایی و پایایی در جمعیت عمومی. فصلنامۀ روان‌شناسی کاربردی، 17(2)، 191-167. https://doi.org/10.48308/apsy.2023.230293.1443
نساییان، ع.، اسدی گندمانی، ر. (1397). پیش بینی تنظیم هیجان براساس سبک‌های دلبستکی و سبک‌های فرزندپروری ادراک شده در نوجوانان. مجله پرستاری کودکان، 5(1)، 1-10. http://jpen.ir/article-1-274-fa.html
نویدیان، ع.، مرادقلی، م.، کیخایی، ا. و سعیدی‌نژاد، ف. (1394). بررسی رابطۀ سبک‌های دلبستگی و رفتار خودمراقبتی در بیماران مبتلا به نارسایی قلب. حیات، ۲۱(۲)، 17-6. http://hayat.tums.ac.ir/article-1-1099-fa.html
هوایی، آ.، کاظمی، ح.، حبیب‌اللهی، ا.، و ایزدی خواه، ز. (1395). اثربخشی مداخلۀ تنظیم هیجان بر میزان تحمل پریشانی و مشکلات تنظیم هیجان در زنان مبتلا به سردرد تنشی. مجلۀ علمی پژوهشی دانشگاه علوم پزشکی شهید صدوقی یزد، ۲۴(۱۰)، ۸51-۸40. http://jssu.ssu.ac.ir/article-1-3694-fa.html
References
Abdoli, F., Madahi, M. E., & Seyrafi, M. (2021). Structural equation modeling of adherence to treatment on emotional regulation mediated by coping strategies by in women with breast cancer undergoing chemotherapy. Hormozgan Medical Journal. 25(3), 120-125. https://doi.org/10.34172/hmj.2021.15
Adams, G. C., Wrath, A. J., & Meng, X. (2018). The relationship between adult attachment and mental health care utilization: A systematic review. The Canadian Journal of Psychiatry. 63(10), 651-660. https://doi.org/10.1177/0706743718779933
Ahmed, O. A., Fahmy, U. A., Bakhaidar, R., El-Moselhy, M. A., Alfaleh, M. A., Ahmed, A. S. F., ... & Alhakamy, N. A. (2020). Pumpkin oil–based nanostructured lipid carrier system for antiulcer effect in NSAID-induced gastric ulcer model in rats. International Journal of Nanomedicine, 15, 2529-2539. https://doi.org/10.2147/IJN.S247252
Asgarizadeh, A., Pakdaman, S., Hunjani, M. & Ghanbari, S. (2000). Iranian adaptation of the revised adult attachment scale: Validity and reliability in the general population. Applied Psychology, 17(2), 167-191. https://doi.org/10.48308/apsy.2023.230293.1443 (In Persian)
Barberis, N., Cernaro, V., Costa, S., Montalto, G., Lucisano, S., Larcan, R., & Buemi, M. (2017). The relationship between coping, emotion regulation, and quality of life of patients on dialysis. The International Journal of Psychiatry in Medicine, 52(2), 111-123. https://doi.org/10.1177/0091217417720893
Belot, R. A., Bouteloup, M., Bonnet, M., Parmentier, A. L., Magnin, E., Mauny, F., & Vuillier, F. (2021). Evaluation of attachment style and social support in patients with severe migraine: Applications in doctor-patient relationships and treatment adherence. Frontiers in Neurology. 12, 706639. https://doi.org/10.3389/fneur.2021.706639
Bowlby, J. (1982). Attachment and loss: Retrospect and prospect. American Journal of Orthopsychiatry. 52(4), 664–678. https://doi.org/10.1111/j.1939-0025.1982.tb01456.x
Burgess, E., Hassmén, P., & Pumpa, K. L. (2017). Determinants of adherence to lifestyle intervention in adults with obesity: A systematic review. Clinical Obesity, 7(3), 123-135. https://doi.org/10.1111/cob.12183
Campbell, L., & Marshall, T. (2011). Anxious attachment and relationship processes: An interactionist perspective. Journal of Personality, 79(6), 1219-1250. https://doi.org/10.1111/j.1467-6494.2011.00723.x
Caruso, A., Grolnick, W., Rabner, J., & Lebel, A. (2021). Parenting, self-regulation, and treatment adherence in pediatric chronic headache: A self-determination theory perspective. Journal of Health Psychology. 26(10), 1637-1650. https://doi.org/10.1177/1359105319884596
Ciechanowski, P. S., Katon, W. J., & Russo, J. E. (2005). The association of depression and perceptions of interpersonal relationships in patients with diabetes. Journal of Psychosomatic Research, 58(2), 139-144. https://doi.org/10.1016/j.jpsychores.2004.07.009.
Collins, N. L., & Read, S. J. (1990). Adult attachment, working models, and relationship quality in dating couples. Journal of Personality and Social Psychology, 58(4), 644. https://doi.org/10.1037/0022-3514.58.4.644
Compare, A., Zarbo, C., Shonin, E., Van Gordon, W., & Marconi, C. (2014). Emotional regulation and depression: A potential mediator between heart and mind. Cardiovascular Psychiatry and Neurology, 2014(1), 324374. https://doi.org/10.1155/2014/324374
Dianati, M., Mahdavinejad, B., & Taghadosi, M. (2019). Medication adherence rate and related factors in patients with acute coronary syndrome after discharge from Shahid Beheshti Hospital in Kashan during 2017-2018. Feyz Medical Sciences Journal; 23(2), 201-208. http://feyz.kaums.ac.ir/article-1-3737-en.html (In Persian)
Dynyak, A. (2020). Peptic ulcer disease: Can a behavioral factor be implicated?. Jurnal Profesi Medika: Jurnal Kedokteran Dan Kesehatan, 14(2), 118-121. https://doi.org/10.33533/jpm.v14i2.1948.
Escobar, D. F. S. S., Noll, P. R. E. S., Jesus, T. F. d., & Noll, M. (2020). Assessing the mental health of brazilian students involved in risky behaviors. International Journal of Environmental Research and Public Health, 17(10), 3647. https://doi.org/10.3390/ijerph17103647.
Eshraghian, A. (2014). Epidemiology of helicobacter pylori infection among the healthy population in Iran and countries of the Eastern Mediterranean Region: A systematic review of prevalence and risk factors. World Journal of Gastroenterology: WJG20(46), 17618. http://dx.doi.org/10.3748/wjg.v20.i46.17618
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment. 26, 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Havaiy, A., Kazemi, H., Habibollahi, A., & Izadikhah, Z.(2016). The effect of emotion regulation on the amount of tension tolerance and emotion regulation difficulties in women with tension -type headaches . Journal of Shahid Sadoughi University of Medical Science, 24(10), 840-851. https://www.sid.ir/paper/36691/en (In persian)
Hazan, C., & Shaver, P. (2017). Romantic love conceptualized as an attachment process. In R. Zukauskiene, (Ed.), Interpersonal development (pp. 283-296). London: Routledge. https://doi.org/10.4324/9781351153683
Hendrickson, S. B., Simske, N. M., DaSilva, K. A., & Vallier, H. A. (2020). Improvement in outpatient follow-up with a postdischarge phone call intervention. The Journal of the American Academy of Orthopaedic Surgeons, 28(18), e815-e822. https://doi.org/10.5435/JAAOS-D-19-00132
Inwood, E., & Ferrari, M. (2018). Mechanisms of change in the relationship between self‐compassion, emotion regulation, and mental health: A systematic review. Applied Psychology: Health and Well‐Being, 10(2), 215-235. https://doi.org/10.1111/aphw.12127.
Jimenez, X. F. (2017). Attachment in medical care: A review of the interpersonal model in chronic disease management. Chronic Illness, 13(1), 14-27. https://doi.org/10.1177/1742395316653454
Johnson, H. D. (1965). Gastric ulcer: Classification, blood group characteristics, secretion patterns and pathogenesis. Annals of Surgery, 162(6), 996-1004. https://doi.org/10.1097/00000658-196512000-00005
Khan, F. (2024). Effect of attachment style on emotional regulation and psychological wellbeing among adults. Advanced International Journal of Multidisciplinary Research, 2(3). https://doi.org/10.62127/aijmr.2024.v02i03.1046.
Kobylińska, D. & Kusev, P. (2019). Flexible emotion regulation: how situational demands and individual differences influence the effectiveness of regulatory strategies. Frontiers in Psychology, 1o, 00072. https://doi.org/10.3389/fpsyg.2019.00072
Kubica, A., Gruchała, M., Jaguszewski, M., Jankowski, P., Świeczkowski, D., Merks, P., & Uchmanowicz, I. (2017). Adherence to treatment—a pivotal issue in long-term treatment of patients with cardiovascular diseases. An expert standpoint. Medical Research Journal, 2(4), 123-127. https://doi.org/10.5603/MRJ.2017.0016
Lee, S. P., Sung, I. K., Kim, J. H., Lee, S. Y., Park, H. S., & Shim, C. S. (2017). Risk factors for the presence of symptoms in peptic ulcer disease. Clinical Endoscopy, 50(6), 578-584. https://doi.org/10.5946/ce.2016.129
Leung, S. E., Wnuk, S., Jackson, T., Cassin, S. E., Hawa, R., & Sockalingam, S. (2019). Prospective study of attachment as a predictor of binge eating, emotional eating and weight loss two years after bariatric surgery. Nutrients, 11(7), 16-25. https://doi.org/10.3390/nu11071625
Liu, J., Zhu, X., Yan, J., Gong, L., Wu, X., Liu, M., & Mao, P. (2021). Association between regulatory emotional self-efficacy and immunosuppressive medication adherence in renal transplant recipients: Does medication belief act as a mediator? Frontiers in Pharmacology, 12, 559368. https://doi.org/10.3389/fphar.2021.559368
Maheswari, B., Devi, P. R., Ajith, K., VedPrakash, P., & SeshaSai Gayatri, K. (2020). Evaluation of antiulcer activity of ethanol extract of leaves of lactuca sativa. Journal of Drug Delivery and Therapeutics, 10(4), 196-199. https://doi.org/10.22270/jddt.v10i4.4190
Malaeb, D., Sacre, H., Mansour, S., Haddad, C., Sarray El Dine, A., Fleihan, T., ... & Hosseini, H. (2023). Assessment of medication adherence among Lebanese adult patients with non-communicable diseases during COVID-19 lockdown: A cross-sectional study. Frontiers in Public Health, 11, 1145016. https://doi.org/10.3389/fpubh.2023.1145016
McWilliams, L. A. (2018). Relationships between adult attachment dimensions and patient-physician relationship quality. Journal of Relationships Research, 9, e15. https://doi.org/10.1017/jrr.2018.13
Middleton, K. R., Anton S. D., & Perri M. G. (2013). Long-term adherence to health behavior change. American Journal of Lifestyle Medicine,7(6), 395-404. https://doi.org/10.1177/1559827613488867
Mikulincer, M., & Shaver, P. R. (2020). Broaden-and-build effects of contextually boosting the sense of attachment security in adulthood. Current Directions in Psychological Science, 29(1), 22-26. https://doi.org/10.1177/0963721419885997.
Moosazadeh, M., Lankarani, K. B., & Afshari, M. (2016). Meta-analysis of the prevalence of helicobacter pylori infection among children and adults of Iran. International Journal of Preventive Medicine, 7(1), 48. https://doi.org/10.4103/2008-7802.177893
Morisky, D. E., Ang, A., Krousel‐Wood, M., & Ward, H. J. (2008). Predictive validity of a medication adherence measure in an outpatient setting. The Journal of Clinical Hypertension, 10(5), 348-354. https://doi.org/10.1111/j.1751-7176.2008.07572.x
Navidian, A., Moradgholi, M., Kykhaee, A., & Saeedinegad, F. (2015). Relationship between attachment styles and self-care behaviors in patients with heart failure. Journal of Hayat, 21(2) :6-17. http://hayat.tums.ac.ir/article-1-1099-en.html (In Persian)
Nesayan, A., & Asadi gandomani, R. (2018). Prediction of emotion regulation based on attachment styles and perceived parenting styles in adolescents. Journal of Pediatric Nursing, 5(1), 1-10
http://jpen.ir/article-1-274-en.html
Nielsen, S. K. K., Lønfeldt, N., Wolitzky-Taylor, K. B., Hageman, I., Vangkilde, S., & Daniel, S. I. F. (2017). Adult attachment style and anxiety: The mediating role of emotion regulation. Journal of Affective Disorders. 218, 253-259. https://doi.org/10.1016/j.jad.2017.04.047
Ogedegbe, G., Schoenthaler, A., Richardson, T., Lewis, L., Belue, R., Espinosa, E., & Charlson, M. E. (2007). An RCT of the effect of motivational interviewing on medication adherence in hypertensive African Americans: Rationale and design. Contemporary Clinical Trials. 28(2), 169-181. https://doi.org/10.1016/j.cct.2006.04.002
Oraki, M., Zare, H., & Hosseinzadeh Ghasemabad, A. (2021). Effectiveness of acceptance and commitment therapy on treatment  adherence  in people with non-alcoholic fatty liver disease. Journal of Shahid Sadoughi University of Medical Science, 29(2), 3479-3490. http://dx.doi.org/10.18502/ssu.v29i2.6086 (In Persian)
Paik, K. Y., Seok, H. E., & Chung, J. H. (2020). The analysis of risk for peptic ulcer disease using Korean national health and nutrition examination survey: A cross-sectional analysis of a national survey sample. Annals of Translational Medicine, 8(7), 460. https://doi.org/10.21037/atm.2020.03.126
Robson, B. L., Preece, D. A., & Dickson, J. M. (2023). Goal motives in depression and anxiety: The mediating role of emotion regulation difficulties. Australian Psychologist, 58(4), 284-293. https://doi.org/10.1080/00050067.2022.2162809
Scheel, J. F., Schieber, K., Reber, S., Stoessel, L., Waldmann, E., Jank, S., Eckardt, K.-U., …, & Erim, Y. (2018). Psychosocial variables associated with immunosuppressive medication non-adherence after renal transplantation. Frontiers in Psychiatry, 9, 00023. https://doi.org/10.3389/fpsyt.2018.00023.
Sivakumar, A., & Stubbs, B. (2021). Peptic ulcer disease. InnovAiT, 14(6), 372-378. https://doi.org/10.1177/17557380211005791
Srivastav, Y., Kumar, V., Srivastava, Y., & Kumar, M. (2023). Peptic Ulcer Disease (PUD), diagnosis, and current medication-based management options: Schematic overview. Journal of Advances in Medical and Pharmaceutical Sciences, 25(11), 14–27. https://doi.org/10.9734/jamps/2023/v25i11651
Talia, A., Miller-Bottome, M., Wyner, R., Lilliengren, P., & Bate, J. (2019). Patients’ adult attachment interview classification and their experience of the therapeutic relationship: Are they associated? Research in Psychotherapy: Psychopathology, Process, and Outcome, 22(2). https://doi.org/10.4081/ripppo.2019.361
Wang, Y., Zhang, P., Han, Y., Nelson, R. S., McLeod, H. L., Tao, K., ... & Zhou, H. (2020). Adherence to adjuvant imatinib therapy in patients with gastrointestinal stromal tumor in clinical practice: A cross-sectional study. Chemotherapy, 64(4), 197-204. https://doi.org/10.1159/000505177
Waters, S. F., Karnilowicz, H. R., West, T. V., & Mendes, W. B. (2020). Keep it to yourself? Parent emotion suppression influences physiological linkage and interaction behavior. Journal of Family Psychology, 34(7), 784–793. https://doi.org/10.1037/fam0000664
Xie, X., Ren, K., Zhou, Z., Dang, C., & Zhang, H. (2022). The global, regional and national burden of peptic ulcer disease from 1990 to 2019: A population-based study. BMC Gastroenterology. 22(1), 58. https://doi.org/10.1186/s12876-022-02130-2
Zahid, R., Akram, M., Riaz, M., Munir, N., & Shehzad, M. (2020). Phytotherapeutic modalities for the management of Helicobacter pylori associated peptic ulcer. European Journal of Inflammation, 18. https://doi.org/10.1177/2058739220968308
Volume 16, Issue 2
March 2025
Pages 97-111
  • Receive Date: 12 February 2023
  • Revise Date: 28 April 2023
  • Accept Date: 07 June 2023
  • First Publish Date: 22 January 2025
  • Publish Date: 22 June 2025