Document Type : Original Article(s)
- Hamidreza Roohafza 1
- Ali Kabir 2
- Masoumeh Sadeghi 3
- Pedram Shokouh 4
- Masoud Ahmadzad-Asl 5
- Ali Akbar Khadem-Maboudi 6
- Nizal Sarrafzadegan 7
1 Assistant Professor, Department of Mental Health, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
3 Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 PhD Fellow, Department of Endocrinology and Diabetes, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
5 Assistant Professor, Mental Health Research Center, Tehran Institute of Psychiatry AND School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
6 Associate Professor, Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
7 Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
BACKGROUND: We have assessed the role of stress on compliance of patients with diabetes mellitus (DM) and hypertension (HTN) with taking prescribed medications and following dietary and exercise regimens. METHODS: A total of 9544 individuals more than 19 years of age were selected from three counties in central Iran. The presence of DM and HTN were asked from participants. We defined treatment adherence (compliance) based on agreement of individual’s self-report behavior with recommendations from a physician. RESULTS: Awareness about DM and HTN was 82.6% and 49.9%, respectively. Multivariate analysis showed that odds ratio (OR) of high to low stress level was lower than one for both “usage of medication” and “following exercise regimen” in diabetics even after adjustment for either “age and sex” or “age, sex and education”. In hypertensive patients, OR of high to low stress level was lower than one for “usage of medication” even after adjustment for either “age and sex” or “age, sex and education” and also lower than one for “following exercise regimen” only as crude index. CONCLUSION: Cases with higher stress level had lower compliance for accepting either medication or exercise as a treatment option for their DM or HTN.
- World Health Organization. Noncommunicable diseases and mental health, 2008-2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases. Geneva, Switzerland: WHO; 2008.
- Talaei M, Sarrafzadegan N, Sadeghi M, Oveisgharan S, Marshall T, Thomas GN, et al. Incidence of cardiovascular diseases in an Iranian population: the Isfahan Cohort Study. Arch Iran Med 2013; 16(3): 138-44.
- Bloom BS. Daily regimen and compliance with treatment. BMJ 2001; 323(7314): 647.
- Burnier M, Brunner HR. Impact on clinical outcomes. Compliance in healthcare and research. Monograph series. Armonk, NY: Blackwell; 2001.
- Sabate E. Adherence to long-term therapies: evidence for action. Geneva, Switzerland: World Health Organization; 2003.
- Morisky DE. Adherence or compliance behavior, encyclopedia of public health [Online]. [cited 2010]; Available from: URL: http://www.encyclopedia.com/doc/1G2-3404000026.html
- Lerman I. Adherence to treatment: the key for avoiding long-term complications of diabetes. Arch Med Res 2005; 36(3): 300-6.
- Julius RJ, Novitsky MA Jr, Dubin WR. Medication adherence: a review of the literature and implications for clinical practice. J Psychiatr Pract 2009; 15(1): 34-44.
- Ross S, Walker A, MacLeod MJ. Patient compliance in hypertension: role of illness perceptions and treatment beliefs. J Hum Hypertens 2004; 18(9): 607-13.
- Kabir M, Iliyasu Z, Abubakar LS, Jibril M. Compliance to medication among hypertensive patients in Murtala Mohammed Specialist Hospital, Kano, Nigeria. J Commun Med Prim Health Care 2004; 16(1): 16-20.
- Thrall G, Lip GY, Lane D. Compliance with pharmacological therapy in hypertension: can we do better, and how? J Hum Hypertens 2004; 18(9): 595-7.
- Tatemichi M, Hamaguchi T, Hashira M, Hayashi T, Ito M, Nakatani A, et al. Acceptability and Long-Term Compliance with Drug Treatment for Hypercholesterolemia in Japanese Male Workers: II. Long-Term Compliance with Drug Treatment. J Occup Health 2002; 44(5): 307-14.
- Stewart A, Noakes T, Eales C, Shepard K, Becker P, Veriawa Y. Adherence to cardiovascular risk factor modification in patients with hypertension. Cardiovasc J S Afr 2005; 16(2): 102-7.
- Gordillo V, del Amo J, Soriano V, Gonzalez-Lahoz J. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS 1999; 13(13): 1763-9.
- Schroeder K, Fahey T, Ebrahim S, Peters TJ. Adherence to long-term therapies: recent WHO report provides some answers but poses even more questions. J Clin Epidemiol 2004; 57(1): 2-3.
- Lehane E, McCarthy G. Medication non-adherenceexploring the conceptual mire. Int J Nurs Pract 2009; 15(1): 25-31.
- Gonzalez JS, Delahanty LM, Safren SA, Meigs JB, Grant RW. Differentiating symptoms of depression from diabetes-specific distress: relationships with self-care in type 2 diabetes. Diabetologia 2008; 51(10): 1822-5.
- Gonzalez JS, Peyrot M, McCarl LA, Collins EM, Serpa L, Mimiaga MJ, et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 2008; 31(12): 2398-403.
- DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160(14): 2101-7.
- Gonzalez JS, Safren SA, Cagliero E, Wexler DJ, Delahanty L, Wittenberg E, et al. Depression, selfcare, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity. Diabetes Care 2007; 30(9): 2222-7.
- Nau DP, Aikens JE, Pacholski AM. Effects of gender and depression on oral medication adherence in persons with type 2 diabetes mellitus. Gend Med 2007; 4(3): 205-13.
- Surwit RS, Schneider MS. Role of stress in the etiology and treatment of diabetes mellitus. Psychosom Med 1993; 55(4): 380-93.
- Fisher L, Skaff MM, Mullan JT, Arean P, Mohr D, Masharani U, et al. Clinical depression versus distress among patients with type 2 diabetes: not just a question of semantics. Diabetes Care 2007; 30(3): 542-8.
- Thorpe JM, Kalinowski CT, Patterson ME, Sleath BL. Psychological distress as a barrier to preventive care in community-dwelling elderly in the United States. Med Care 2006; 44(2): 187-91.
- Roohafza H, Sadeghi M, Talaei M, Pourmoghaddas Z, Sarrafzadegan N. Psychological status and quality of life in relation to the metabolic syndrome: Isfahan Cohort Study. Int J Endocrinol 2012; 2012: 380902.
- Sarrafzadegan N, Baghaei AM, Kelishadi R. First annual evaluation of Isfahan Healthy Heart Program (IHHP) [Online]. [cited 2004]; Available from: URL: http://www.ihhp.ir/ihhp/sounds/1497/First_annual_evaluation_of_IHHP.pdf
- Sarrafzadegan N, Baghaei A, Sadri G, Kelishadi R, Malekafzali H, Boshtam M, et al. Isfahan healthy heart program: Evaluation of comprehensive, community-based interventions for noncommunicable disease prevention. Prev Control 2006; 2(2): 73-84.
- Sarraf-Zadegan N, Sadri G, Malek AH, Baghaei M, Mohammadi FN, Shahrokhi S, et al. Isfahan Healthy Heart Programme: a comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol 2003; 58(4): 309-20.
- Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979; 9(1): 139-45.
- Montazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi M, Fateh A. The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version. Health Qual Life Outcomes 2003; 1: 66.
- Khosravi A, Kiani Mehr G, Kelishadi R, Shirani S, Gharipour M, Tavassoli A, et al. The impact of a 6- year comprehensive community trial on the awareness, treatment and control rates of hypertension in Iran: experiences from the Isfahan healthy heart program. BMC Cardiovascular Disorders 2010; 10: 61.
- Rabiei K, Kelishadi R, Sarrafzadegan N, Abedi HA, Alavi M, Heidari K, et al. Process evaluation of a community-based program for prevention and control of non-communicable disease in a developing country: The Isfahan Healthy Heart Program, Iran. BMC Public Health 2009; 9: 57.
- Charney DS. Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am Psychiatry 2004; 161(2): 195-216.
- Dantzer R. Cytokine-induced sickness behavior: mechanisms and implications. Ann N Y Acad Sci 2001; 933: 222-34.
- Talbot F, Nouwen A. A review of the relationship between depression and diabetes in adults: is there a link? Diabetes Care 2000; 23(10): 1556-62.
- Shirani S, Kelishadi R, Sarrafzadegan N, Khosravi A, Sadri G, Amani A, et al. Awareness, treatment and control of hypertension, dyslipidaemia and diabetes mellitus in an Iranian population: the IHHP study. East Mediterr Health J 2009; 15(6): 1455-63.
- Roohafza H, Sadeghi M, Sarraf-Zadegan N, Baghaei A, Kelishadi R, Mahvash M, et al. Relation between stress and other life style factors. Stress and Health 2007; 23(1): 23-9.
- Nabi H, Vahtera J, Singh-Manoux A, Pentti J, Oksanen T, Gimeno D, et al. Do psychological attributes matter for adherence to antihypertensive medication? The Finnish Public Sector Cohor Study. J Hypertens 2008; 26(11): 2236-43.
- Hashmi SK, Afridi MB, Abbas K, Sajwani RA, Saleheen D, Frossard PM, et al. Factors associated with adherence to anti-hypertensive treatment in Pakistan. PLoS One 2007; 2(3): e280.
- Luyster FS, Hughes JW, Gunstad J. Depression and anxiety symptoms are associated with reduced dietary adherence in heart failure patients treated with an implantable cardioverter defibrillator. J Cardiovasc Nurs 2009; 24(1): 10-7.
- Bogner HR, de Vries HF. Integration of depression and hypertension treatment: a pilot, randomized controlled trial. Ann Fam Med 2008; 6(4): 295-301.