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Vol 17, No 3 (2020)
Research paper
Published online: 2020-07-13

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The relationship between medication adherence and affective temperaments in patients with congestive heart failure

Alireza Shamsi1, Hooria Yavarmanesh2, Hani Harati3, Shiva Eiliaei1, Majid Sadeghian1
Psychiatria 2020;17(3):115-120.


Introduction: Congestive heart failure (CHF) is a serious condition and lack of medication adherence is one of the
most common problems in the treatment of patients with CHF. This study aimed to determine the relationship between
medication adherence and affective temperaments in patients with CHF.

Material and methods: This cross-sectional study was performed on 150 patients, who were referred to the cardiology
clinic of Ali Ibn Abi Talib Hospital of Zahedan, Iran in 2017–2018. Morisky Medication Adherence Scale (MMAS-8),
Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto questionnaire (TEMPS-A), and Beck Depression
Inventory-II (BDI-II) were used to collect data. For statistical analysis, SPSS-18 was used. Logistic regression was done for
modeling the relationship between medication adherence.

Results: Generally, 54% of the patients were euthymic, while 16%, 23.33%, and 6.66% of them suffered from mild,
moderate, and severe depression, respectively. The medication adherence was high, moderate, and low in 30.66%,
46%, and 23.33% of the patients, respectively. There was a significant relationship between medication adherence and
depressive (P = 0.049), cyclothymic (P = 0.01), and irritable (P = 0.01) affective temperaments. Only BDI-II score (P =
0.018) was identified as predictors of drug adherence.

Conclusions: Despite the statistically significant relationship between depressive, cyclothymic, and irritable temperaments
and adherence, affective temperaments cannot be considered as a predictor of adherence in patients with CHF.

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  1. Mendis S, Puska P, Norrving B. Global atlas on cardiovascular disease prevention and control: World Health Organization; 2011.
  2. Khoshtarash M, Momeni M, Ghanbari A, et al. Self-care behaviors and related factors in patients with heart failure reffering to‎ medical & educational center of heart in Rasht. Holistic Nursing and Midwifery Journal. 2013; 23(1): 22–9.
  3. Labarthe DR. Epidemiology and prevention of cardiovascular diseases: a global challenge. Jones & Bartlett Publishers 2010.
  4. Lloyd-Jones D, Adams RJ, Brown TM, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee, WRITING GROUP MEMBERS, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. 2010; 121(7): e46–e4e215.
  5. Bennett SJ, Lane KA, Welch J, et al. Medication and dietary compliance beliefs in heart failure. West J Nurs Res. 2005; 27(8): 977– 994.
  6. Venner GH, Seelbinder JS. Team management of congestive heart failure across the continuum. J Cardiovasc Nurs. 1996; 10(2): 71–84.
  7. Kapfhammer HP. [The relationship between depression, anxiety and heart disease - a psychosomatic challenge]. Psychiatr Danub. 2011; 23(4): 412–424.
  8. Philbin EF, DiSalvo TG. Influence of race and gender on care process, resource use, and hospital-based outcomes in congestive heart failure. Am J Cardiol. 1998; 82(1): 76–81.
  9. Moser DK, Dickson V, Jaarsma T, et al. Role of self-care in the patient with heart failure. Curr Cardiol Rep. 2012; 14(3): 265–275.
  10. González B, Lupón J, Herreros J, et al. Patient's education by nurse: what we really do achieve? Eur J Cardiovasc Nurs. 2005; 4(2): 107–111.
  11. Lloyd G, Guthrie E. Handbook of liaison psychiatry. Cambridge University Press 2007.
  12. McMurray J. Why we need new strategies in CHF management. J Renin Angiotensin Aldosterone Syst. 2000; 1 Suppl 1: 12–16.
  13. Rosenström T, Jokela M, Cloninger CR, et al. Associations between dimensional personality measures and preclinical atherosclerosis: the cardiovascular risk in Young Finns study. J Psychosom Res. 2012; 72(5): 336–343.
  14. Nefs G, Speight J, Pouwer F, et al. DS14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosom Med. 2005; 67(1): 89–97.
  15. Kring A, Davison G, Johnson S. Abnormal Psychology (Psychology of Abnormality). Shamsi Pour H(Persian translator. 2010; 2: 241–68.
  16. Gois C, Barbosa A, Ferro A, et al. The role of affective temperaments in metabolic control in patients with type 2 diabetes. J Affect Disord. 2011; 134(1-3): 52–58.
  17. Shamsi A, Khodaifar F, Arzaghi SM, et al. Is there any relationship between medication compliance and affective temperaments in patients with type 2 diabetes? J Diabetes Metab Disord. 2014; 13(1): 96.
  18. Morisky DE, Ang A, Krousel-Wood M, et al. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008; 10(5): 348–354.
  19. Granger BB, Ekman I, Hernandez AF, et al. Results of the Chronic Heart Failure Intervention to Improve MEdication Adherence study: A randomized intervention in high-risk patients. Am Heart J. 2015; 169(4): 539–548.
  20. Moharamzad Y, Saadat H, Nakhjavan Shahraki B, et al. Validation of the Persian Version of the 8-Item Morisky Medication Adherence Scale (MMAS-8) in Iranian Hypertensive Patients. Glob J Health Sci. 2015; 7(4): 173–183.
  21. Yoda N, Yamashita T, Wada Y, et al. Classification of adult patients with type 2 diabetes using the Temperament and Character Inventory. Psychiatry Clin Neurosci. 2008; 62(3): 279–285.
  22. Khalili N, Panjalizadeh M, Jahani Y, et al. Validation of the Brief Persian Version of the Affective Temperament Auto-Questionnaire TEMPS-A. Iranian Journal of Psychiatry and Clinical Psychology. 2018; 24(1): 92–107.
  23. Ghassemzadeh H, Mojtabai R, Karamghadiri N, et al. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety. 2005; 21(4): 185–192.
  24. Abbasi M, Salemi S, Fatemi NS, et al. Hypertensive patients, their compliance level and its’ relation to their health beliefs. Iran Journal of Nursing. 2005; 18(41): 61–8.
  25. Monane M, Bohn RL, Gurwitz JH, et al. Noncompliance with congestive heart failure therapy in the elderly. Arch Intern Med. 1994; 154(4): 433–437.
  26. Lennie TA. Nutrition self-care in heart failure: state of the science. J Cardiovasc Nurs. 2008; 23(3): 197–204.
  27. Ghali JK, Kadakia S, Cooper R, et al. Precipitating factors leading to decompensation of heart failure. Traits among urban blacks. Arch Intern Med. 1988; 148(9): 2013–2016.
  28. Parsa-Yekta Z, Zakeri Mo, Mehran A, et al. Study of medication compliance of patients with coronary heart diseases and associated factors. Journal of hayat. 2004; 9(4): 34–43.
  29. Jahanpour F, Rafiei Z, Ravanipour M, et al. Assessment of Medication Adherence in Elderly Patients With Cardiovascular Diseases Based on Demographic Factors in Bushehr City in the Year 2013. Jundishapur Journal of Chronic Disease Care. 2015; 4(3).
  30. Hadian K, Mokhbery V. Assessment and Identification of Precipitating Factors of Heart Failure in 140 patients In Immam Khomeini Hospital of Sari in 1376-77. Journal of Mazandaran University of Medical Sciences. 1999; 9(24): 24–31.
  31. Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006; 166(17): 1836–1841.
  32. Pugh MJo, Anderson J, Pogach LM, et al. Differential adoption of pharmacotherapy recommendations for type 2 diabetes by generalists and specialists. Med Care Res Rev. 2003; 60(2): 178–200.
  33. Hall PA, Rodin GM, Vallis TM, et al. The consequences of anxious temperament for disease detection, self-management behavior, and quality of life in Type 2 diabetes mellitus. J Psychosom Res. 2009; 67(4): 297–305.