The impact of personality traits on medication adherence and self-care in patients with type 2 diabetes mellitus: The moderating role of gender and age

Exploring the retrospective and prospective associations between the big five personality traits and clinical diagnosis of angina in middle-aged and older adults

OBJECTIVE

The goal of the present research was to test the retrospective and prospective associations between the Big Five personality traits and clinical diagnosis of angina while controlling for demographic characteristics.

METHODS

Data from middle-aged and older adults from a cohort study Understanding Society: the UK Household Longitudinal Study (UKHLS) were extracted and analyzed using binary logistic regressions (N = 10,124 for the retrospective study and N = 5485 for the prospective study). Personality was measured using a self-report 15-item version of the Big Five inventory between 2011 and 2012. Angina was measured by a self-report clinical diagnosis history question in each wave from until 2019. Covariates in our models included age, sex, income (monthly), education, and marital status.

RESULTS

Neuroticism was positively related to the likelihood of clinical angina diagnosis in both the retrospective (OR = 1.22, 95% C.I. [1.11, 1.34]) and the prospective (OR = 1.52, 95% C.I. [1.19, 1.94]) study whereas Extraversion had a positive association with odds of angina (OR = 1.52, 95% C.I. [1.17, 1.97]) in the prospective study only. The negative association between Openness and clinical angina diagnosis in the cross-sectional analysis is borderline significant (OR = 0.91, p = 0.048, 95% C.I. [0.83, 1.00]).

CONCLUSION

Our research indicated that personality traits are associated with the risk of angina. These findings emphasize the importance of considering personality traits in understanding the etiology of angina and potentially informing personalized prevention and intervention strategies.

Association of Personality Traits and Self-Care Behaviors in People With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Diabetes self-care is critical for individuals with type 2 diabetes mellitus (T2DM), and exploring the impact of personality traits on this domain remains pivotal. This study aimed to investigate the association between personality traits and various dimensions of self-care in people with T2DM. A Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA)-guided systematic review with meta-analysis was conducted. Two reviewers independently screened articles, extracted data, and assessed the risk of bias. Estimates were pooled using random-effects meta-analysis. Twenty-three studies, that met our inclusion criteria, revealed distinct associations between certain personality traits and various aspects of self-care. Notably, traits such as openness, conscientiousness, and agreeableness showed associations with improved foot care compliance (odds ratio (OR) = 2.53, 95% CI = 1.49-4.28; OR = 1.84, 95% CI = 1.10-3.08; and OR = 2.07, 95% CI = 1.23-3.48, respectively). Openness was also linked to better overall self-care behaviors (OR = 2.00, 95% CI = 1.17-3.41), while conscientiousness correlated with reduced smoking (OR = 0.96, 95% CI = 0.93-0.99), and agreeableness was associated with improved medication adherence (OR = 1.68, 95% CI = 1.34-2.31). Conversely, traits like extraversion and neuroticism showed associations with decreased medication adherence (OR = 0.77, 95% CI = 0.61-0.96 and OR = 0.51, 95% CI = 0.40-0.65, respectively), with neuroticism additionally linked to lower overall self-care behaviors (OR = 0.67, 95% CI: 0.55-0.81). This study emphasizes the intricate role of personality traits in shaping self-care practices in individuals with T2DM, underscoring the significance of factoring these traits into tailoring and improving diabetes self-care strategies. Nevertheless, establishing definitive causal relationships mandates further in-depth longitudinal investigations and broader meta-analyses to achieve a more conclusive understanding.

How is Patient Adherence Possible? A Novel Mechanistic Model of Adherence Based on Humanities

Patient non-adherence is a major contemporary medical issue because of its consequences in terms of frequency, morbidity and mortality, and health care costs. This article aims to propose a mechanistic model of adherence based on the tenet that non-adherence is the default option, as long-term adherence in chronic diseases requires sustained effort. The real question becomes, how is patient adherence possible? By focusing on adherent patients, the paper explains the mental mechanisms of adherence using concepts largely drawn from humanities, philosophy of mind, and behavioral economics and presents the findings of empirical studies supporting these hypotheses. The analysis first demonstrates the relationship between patient adherence and temporality and the influence of character traits. Further, it points out the importance of habit, which allows adherence to become non-intentional, thereby sparing patients' cognitive efforts. Finally, it points out the importance of the quality of the interaction between the person with a chronic disease and the health professional. These features explain why adherence is a syndrome (the healthy adherer phenotype), separating people into those who are safe and those who are at risk of non-adherence, non-control of diabetes, and complications. The concepts presented in this article summarize 20 years of personal clinical and philosophical reflection on patient adherence. They are mainly illustrated by examples from diabetes care but can be applied to all chronic diseases. This novel model of adherence has major practical and ethical implications, explaining the importance of patient education and shared medical decision-making in chronic disease management.

Associations of different types of child maltreatment and diabetes in adulthood - the mediating effect of personality functioning: Findings from a population-based representative German sample

PURPOSE

This study aimed to examine the role of personality functioning in the association between various types of child maltreatment (CM) (sexual, physical, and emotional abuse as well as physical and emotional neglect) and diabetes in adulthood.

METHODS

Analyses are based on representative data of the German population (N = 5,041) from 2016 to 2019. Self-report questionnaires assessed diagnosis of diabetes, child maltreatment (CTQ), personality functioning (OPD-SQS), and symptoms of depression/anxiety (PHQ-4). Odd ratios were calculated to examine the association between CM and diabetes, and mediation analyses including PHQ-4 as covariate were conducted to examine the role of personality functioning.

RESULTS

All CM types significantly elevated the odds of having diabetes in adulthood. Personality functioning mediated the association between abuse and diabetes (sexual: b = 0.012, 95% CI [.002, 0.022], P_M = 25.0%, physical: b = 0.009, 95% CI [.001, 0.017], P_M = 12.0%, and emotional: b = 0.013, 95% CI [.002, 0.024], P_M = 59.8%), but not between neglect and diabetes.

CONCLUSIONS

CM is associated with an increased risk of diabetes, with personality functioning being a relevant mediator for CM abuse types. Hence, by focusing on CM prevention and considering impaired personality functioning in diabetes treatment, diabetes self-management and health behavior could be improved.

Association between the Big Five personality traits and medication adherence in patients with cardiovascular disease: A cross-sectional study

The correlation between personality traits and health outcomes of primary prevention has been examined. However, there is a lack of evidence on the association between the assessment of personality traits and medication adherence for secondary prevention of cardiovascular disease. Thus, this study aimed to explore the association between personality traits and medication adherence, including compliance to prescribed medications and attitudes toward taking medications among patients with cardiovascular disease. This cross-sectional study included patients hospitalized for cardiovascular disease. We assessed the Big Five personality traits (conscientiousness, neuroticism, openness, extraversion, and agreeableness) of each patient at discharge using the Ten-Item Personality Inventory. In addition, we evaluated four aspects of medication adherence using a 12-item version of the medication adherence scale: medication compliance, collaboration with health care providers, willingness to access and use information on medication, and acceptance to take medication. Logistic regression analysis was performed to assess the correlation between the level of each medication adherence domain and each personality trait. The data of 128 patients with cardiovascular disease were analyzed. Higher conscientiousness score was significantly associated with a high compliance score (odds ratio per 1 point increase, 1.90; 95% confidence interval, 1.30-2.79; p = 0.001), high collaboration score (1.90; 1.31-2.76; p = 0.001), and high willingness score (1.74; 1.19-2.54; p = 0.004) after adjustment for potential confounders. Other combinations of personality traits and medication adherence showed no statistically significant correlations in multivariate analyses. The findings of this study suggest that assessment of personality traits, especially conscientiousness, may facilitate patient-medical staff communication for the improvement of medication adherence in patients with cardiovascular disease.

Personality and weight management in adults with type 2 diabetes: A systematic review

Aims

Managing weight in the context of type 2 diabetes presents unique hormonal, medicinal, behavioural and psychological challenges. The relationship between weight management and personality has previously been reviewed for general and cardiovascular disease populations but is less well understood in diabetes. This systematic review investigated the relationship between personality constructs and weight management outcomes and behaviours among adults with type 2 diabetes.

Methods

Medline, PubMed, Embase, PsycINFO and SPORTDiscus databases were searched to July 2021. Eligibility: empirical quantitative studies; English language; adults with type 2 diabetes; investigation of personality-weight management association. Search terms included variants of: diabetes, physical activity, diet, body mass index (BMI), adiposity, personality constructs and validated scales. A narrative synthesis, with quality assessment, was conducted.

Results

Seventeen studies were identified: nine cross-sectional, six cohort and two randomised controlled trials (N=6,672 participants, range: 30-1,553). Three studies had a low risk of bias. Personality measurement varied. The Big Five and Type D personality constructs were the most common measures. Higher emotional instability (neuroticism, negative affect, anxiety, unmitigated communion and external locus of control) was negatively associated with healthy diet and physical activity, and positively associated with BMI. Conscientiousness had positive associations with healthy diet and physical activity and negative associations with BMI and anthropometric indices.

Conclusions

Among adults with type 2 diabetes, evidence exists of a relationship between weight management and personality, specifically, negative emotionality and conscientiousness. Consideration of personality may be important for optimising weight management and further research is warranted.

Systematic review registration

www.crd.york.ac.uk/prospero/, identifier CRD42019111002.

The Big Five personality traits and regularity of lifetime dental visit attendance: evidence of the Survey of Health, Ageing, and Retirement in Europe (SHARE)

Background

Regular dental visits are essential for the prevention, early detection and treatment of worldwide highly prevalent oral diseases. Personality traits were previously associated with treatment compliance, medication adherence and regular doctor visits, however, the link between personality traits and regular dental visit attendance remains largely unexplored. Thus, the objective of this study is to clarify this link.

Methods

Data (wave 7) of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used, focusing on Germany (n = 2822). Personality was assessed using the 10-item Big Five Inventory (BFI-10). Regular dental visits were assessed. Multiple logistic regressions were used, adjusting for various covariates.

Results

Majority of the participants (84%) reported to attend regular dental visits during lifetime. Regularity of lifetime dental visit attendance was positively and significantly associated with increased extraversion [OR 1.13, 95% CI (1.01–1.26)], increased conscientiousness [OR 1.26, 95% CI (1.10–1.44)], and increased openness to experience [OR 1.12, 95% CI (1.01–1.26)]. However, there was a lack of association with agreeableness and neuroticism. Moreover, the outcome measure was positively associated with younger age, being female, born in Germany, being married, higher education, being retired (compared to being homemaker), whereas it was not associated with obesity or chronic diseases.

Conclusions

Identification of personality traits that are associated with regular dental visits can support prevention, screening and clinical management of oral diseases. Further research in this field may facilitate the development and increase the incorporation of individualized concepts to enhance patient compliance and attendance, and thus the provision of oral and dental care services.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-02051-2.

Treatment self-regulation questionnaire across three self-care behaviours: An instrument validation study in Iranian patients with type 2 diabetes mellitus

Aim

The study aimed at testing the validity and reliability of the Persian version of the treatment self‐regulation questionnaire (TSRQ‐15) across healthy diet, exercise and medication‐use/glucose‐monitoring among Iranian people with type‐2 diabetes.

Design

Cross‐sectional design.

Methods

Content validity was investigated by 16 experts. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed. Construct validity, convergent/discriminant validity and internal consistency were examined. Concurrent validity was assessed using Spearman's rho correlation across different behaviours.

Results

Content validity was confirmed for Persian TSRQ‐15. A three‐factor structure was revealed, in which external regulation and introjected regulations were validated, while amotivation and autonomous failed to show discriminant validity. Internal consistency was sound, and concurrent validity was approved. The Persian version of TSRQ‐15 was shown to be a valid and reliable tool for assessing motivation behind the practice of healthy diet, exercise and medication‐use/glucose‐monitoring in people with type 2 diabetes.

Personality Traits and Self-Care Behaviors in Adults with Type 2 Diabetes Mellitus

PURPOSE

Personality traits are an important factor in health behaviors. However, personality traits and self-care in T2DM in the Mexican population are not yet explored due to this; the purpose of this work was to explore the relationship of personality traits with self-care in Mexican adults with type 2 diabetes mellitus.

PATIENTS AND METHODS

A cross-sectional study was carried out in a sample of 197 T2DM patients from a primary care center in Oaxaca, Mexico. The Big Five Inventory and the Summary of Diabetes Self-care Activities (SDSCA) were the tools used. Correlation models and multiple linear regression models were used for the analysis.

RESULTS

Most of the study participants were women (74.6%). The mean age was 53.1 years (SD = 8.4). The average years of schooling of the participants were 5.7 (SD = 4.3). The number of years lived with T2DM was 9.0 (SD = 6.5). The waist circumference was 96.3 (SD = 14.2), and the BMI was 27.5 kg/m2 (SD = 4.1). The traits of conscientiousness (r = 0.283) and openness (r = 0.259) were positively correlated with self-care activities, while neuroticism was inversely correlated (r = -0.144). In the multiple linear regression models, only the conscientiousness and openness traits were predictors of self-care; they explained 19% of the variance.

CONCLUSION

People with greater openness and conscientiousness were associated with greater compliance with self-care. Conversely, neuroticism was inversely associated with self-care in patients with T2DM.

An Unsafe/Safe Typology in People with Type 2 Diabetes: Bridging Patients' Expectations, Personality Traits, Medication Adherence, and Clinical Outcomes

BACKGROUND

Support programs are provided to people with diabetes to help them manage their disease. However, adherence to and persistence in support programs are often low, making it difficult to demonstrate their effectiveness.

AIM

To identify the determinants of patients' perceived interest in diabetes support programs because it may be a powerful determinant of effective participation in such programs.

PATIENTS AND METHODS

An online study conducted in April 2021 in metropolitan France on 600 people with diabetes recruited from a consumer panel. A 64-item psychosocial questionnaire including a question asking to evaluate the helpfulness of a support program was used. Univariate, multivariate, and multiple correspondence analyses were performed.

RESULTS

The existence of a typology, known as Unsafe/Safe, was discovered, in which patients with type 2 diabetes respond in two distinct ways. Type U (unsafe) patients, who believe that a support program would be helpful, are more likely to be nonadherent to their treatment, have high hemoglobin A1c levels, have at least one diabetic complication, lack information regarding their disease and treatment, rate the burden of their disease and impairment of their quality of life as high, worry about their future, and are pessimistic. Type S (safe) patients have the opposite characteristics. Type U patients can be dichotomized into two broad classes: one in which they lack information regarding disease and treatment and the other in which alterations in the quality of life and burden of the disease predominate. Insulin-treated patients give more importance to the lack of information, whereas noninsulin-treated patients complain primarily about the burden of the disease and impairment of quality of life.

CONCLUSION

This study describes this new U/S typology, proposes a simple method based on a nine-item questionnaire to identify type U patients by calculating a Program Helpfulness Score described herein, and clarifies the nature of the intervention to be provided to them. This novel approach could be applied to other chronic diseases.

Medication Adherence and Associated Factors in Patients With Type 2 Diabetes: A Structural Equation Model

Background: The number of patients with type 2 diabetes (T2D) is increasing. Medication treatment is of great importance to stabilize blood glucose. Previous studies have reported that neuroticism, self-efficacy, and social support are factors associated with medication adherence, but few studies have fully investigated the mechanisms between these factors and medication adherence in patients with T2D. Purpose: To explore the prevalence of medication adherence and the factors associated with medication adherence in patients with T2D. Methods: A cross-sectional study consisting of 483 patients with T2D was conducted from July to December 2020. Questionnaires containing sociodemographic and clinical characteristics, the Morisky Medication Adherence Scale-8 (MMAS-8), the neuroticism subscale of the Eysenck Personality Questionnaire-Revised Short Scale (EPQ-RS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Diabetes Management Self-efficacy Scale (DMSES) were used to collect data. The structural equation model (SEM) was used to test the hypotheses. Results: This study included 305 (63.1%) medication adherence and 178 (36.9%) medication non-adherence patients with T2D. Social support directly influenced medication adherence (β = 0.115, P = 0.029) and indirectly influenced medication adherence through self-efficacy (β = 0.044, P = 0.016). Self-efficacy directly influenced medication adherence (β = 0.139, P = 0.023). Neuroticism indirectly affected medication adherence through social support (β = -0.027, P = 0.023) and self-efficacy (β = -0.019, P = 0.014). Moreover, there was a sequential mediating effect of social support and self-efficacy on the relationship between neuroticism and medication adherence (β = -0.010, P = 0.012). After controlling for age and gender, similar results were obtained. The model fit indices showed a good fit. Conclusions: The medication adherence of patients with T2D needs to be improved. Neuroticism, social support, and self-efficacy had direct or indirect effects on medication adherence in patients with T2D. Healthcare providers should comprehensively develop intervention programs based on neuroticism, social support, and self-efficacy to improve medication adherence in patients with T2D.

Genetic and Environmental Contributions to Mental Illness With Implications for Evaluation and Treatment

From the outside looking in, it may appear that nurse practitioner practice in mental health care is relatively easy compared to other nurse practitioner population care. The current article presents a brief overview of recent theories on the etiology of mental disorders, specifically major depressive disorder, bipolar disorder, and schizophrenia, with implications for practice. Pharmacological treatments targeting important stress response and immune and inflammatory targets lag behind the science. A practical framework for psychiatric evaluation, formulation, and treatment planning that combines four distinctive ways of viewing patients' concerns is presented as a useful method for providing person-centered mental health care. [Journal of Psychosocial Nursing and Mental Health Services, 59(1), 9-13.].

Risk perception, treatment adherence, and personality during COVID-19 pandemic: An international study on cancer patients

Objective

To explore the role of personality traits in moderating the relation between COVID‐19 risk perception and treatment adherence, and between risk perception and psychosocial distress in patients diagnosed with cancer.

Methods

An online survey (n = 1281) was conducted worldwide in seven countries (Austria, Germany, Hong Kong, Italy, Spain, Sweden, and Turkey). Inclusion criteria were to be 18 years of age or older, have received a cancer diagnosis, and be in treatment or follow‐up. A few moderated regression models were performed with both personality traits and Hierarchical Taxonomy of Psychopathology super‐spectra as moderators.

Results

Detachment, negative affectivity, psychoticism and all the super‐spectra significantly moderated the relation between coronavirus risk perception and psychosocial distress, after the adjusting effect of confidence in safeguards. Only negative affectivity moderated the association between coronavirus risk perception and treatment adherence.

Conclusions

Personality traits may foster the understanding of how a patient might adjust to cancer treatment and, more generically, to highly stressful events such as the COVID‐19 pandemic. Further research is needed to confirm the results in different cancer stages and types.

[To explore medication adherence of patients with type 2 diabetes mellitus using the latent profile analysis based on the Big Five personality theory]

OBJECTIVE

To explore the personality portraits of patients with type 2 diabetes mellitus (T2DM), its relationship with medication adherence and the influencing factors of medication adherence.

METHODS

T2DM patients from 22 community health service stations of 4 community health service centers in Tongzhou district and Shunyi district in Beijing were selected as the research objects. A self-designed questionnaire was used to collect demographic information. The short version of Big Five personality scale was used to collect personality information, and latent profile analysis was used to explore their personality portraits. The medication adherence was evaluated by medication adherence scale, and the difference of medication adherence among the different personality portraits was explored by analysis of variance. The influencing factors of medication adherence were explored by the ordinal Logistic regression model.

RESULTS

In the study, 751 T2DM patients were included. Latent profile analysis showed that the T2DM patients in this study could be divided into four types of personality portraits, including introverted and stable type (42.7%), negative type (12.7%), anxiety type (15.3%) and active and responsible type (29.3%). Among them, 75 patients said that they did not use medicine or insulin, 5 patients were lack of data, and finally 671 patients with T2DM were included in the analysis about medication adherence. The analysis of variance showed that there was no significant difference in medication adherence between anxiety type (5.55±1.65) and negative type (5.94±1.53, P=0.089), but the medication adherence score of anxiety type was significantly lower than that of introverted and stable type (6.17±1.46, P=0.001) and active and responsible type (6.09±1.65, P=0.004). Anxiety type and negative type were seen as a whole in the ordinal Logistic regression model named anxiety and negative type. The results showed that compared with anxiety and negative type, the active and responsible type or introverted and stable type was the protective factor for good medication adherence (OR=1.567, 95%CI: 1.096-2.237; OR=1.774, 95%CI: 1.214-2.591), and the education level also affected the medication adherence.

CONCLUSION

T2DM can be classified into four types of personality portraits based on Big Five personality theory. The anxiety and negative type after the combination of anxiety type and negative type is the independent risk factor for poor medication adherence. In addition, education level is also the influencing factor of medication compliance.

Personality Traits and Cardiotoxicity Arising From Cancer Treatments: An Hypothesized Relationship

Thanks to the evolution in medical and pharmaceutical research, to date, the number of cancer treatments is increasingly on the rise. Despite this, several side effects related to cancer treatments can exacerbate patients’ physical and psychological conditions, such as cardiotoxicity. Over the years, researchers have explored the possible relationship between psychological variables and physical diseases. Even though some authors examined the relationship between personality and specific diseases, no scientific attention has been paid to the role of personality in the development of cardiotoxicity arising from cancer treatments. Yet this is an important objective, given that determining whether personality influences cardiac toxicity of anticancer treatments could inform the processes by which stable psychological factors influence health. This contribution summarizes and analyzes the available scientific evidence about the association between personality and main cardiotoxicity-related-diseases of anticancer therapies, including cancer and cardiovascular diseases, in order to sketch a hypothetical model of the relationship between personality traits and cardiotoxicity.