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JRUMS 2026, 24(11): 1025-1040 |
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Ethics code: IR.SEMUMS.REC.1403.194
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Heidari Archandani Z, Rahimian-Boogar I, Eisazadeh F. The Role of Demographic Characteristics, Intrapsychic Conflicts, Defense Mechanisms, and Therapeutic Alliance in Prediction of Treatment Adherence and Glycosylated Hemoglobin in Patients with Type 2 Diabetes: A Descriptive Study. JRUMS 2026; 24 (11) :1025-1040
URL: http://journal.rums.ac.ir/article-1-7889-en.html
URL: http://journal.rums.ac.ir/article-1-7889-en.html
Semnan University
Keywords: Psychological conflicts, Defense mechanisms, Therapeutic alliance, Therapeutic adherance, HbA1c
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The Role of Demographic Characteristics, Intrapsychic Conflicts, Defense Mechanisms, and Therapeutic Alliance in Prediction of Treatment Adherence and Glycosylated Hemoglobin in Patients with Type 2 Diabetes: A Descriptive Study
Zahra Heidari Archandani[1], Isaac Rahimian-Boogar[2], Fatemeh Eisazadeh[3]
Received: 12/11/25 Sent for Revision: 06/01/26 Received Revised Manuscript: 03/02/26 Accepted: 07/02/25
Background and Objectives: Treatment adherence and glycosylated hemoglobin control are major challenges in diabetes management, influenced by various psychosocial factors. The present study aimed to determine the role of demographic characteristics and psychological factors (intrapsychic conflicts, defense mechanisms, and therapeutic alliance) in controlling these challenges.
Materials and Methods: This correlational-descriptive study was conducted on 410 patients with type 2 diabetes who had active records in the health centers of Kerman City in 2024, selected through convenience sampling. Data were collected using a demographic characteristics form, the Intrapsychic Conflicts Questionnaire Adopted to Operationalized Psychodynamic Diagnosis (Both et al.), the Defense Mechanisms Rating Scale (Di Giuseppe et al.), the Therapeutic Relationship Questionnaire (McGuire et al.), the Diabetes Mellitus Treatment Adherence Scale (Hou et al.), and the results of the latest glycosylated hemoglobin test and were analyzed using hierarchical regression analysis.
Results: Treatment adherence was predicted by intrapsychic conflicts (β=-0.22, p<0.001), immature defense mechanisms (β=-0.35, p<0.001), therapeutic alliance (β=0.11, p=0.009), and unemployment (β=-0.16, p<0.001). Glycosylated hemoglobin concentration was predicted by immature defense mechanisms (β=0.16, p<0.001), therapeutic alliance (β=-0.35, p<0.001), being married (β=-0.12, p=0.004), and having one of the diabetes complications (β=0.45, p<0.001).
Conclusion: Intrapsychic conflicts, immature defense mechanisms, and therapeutic alliance accompanied with demographic characteristics including unemployment, being married, and diabetes complications have role in treatment adherence and glycosylated hemoglobin concentration. These results provide implications for designing and administrating treatment protocols based on these factors to achieve better diabetes management.
Keywords: Psychological conflicts, Defense mechanisms, Therapeutic alliance, Therapeutic adherance, HbA1c
Funding: This study did not have any funds.
Conflict of interest: None declared.
Ethical considerations: The Ethics Committee of Semnan University of Medical Sciences approved the study (IR.SEMUMS.REC.1403.194).
Authors’ contributions:
- Conceptualization: Zahra Heidari Archandani, Isaac Rahimian-Boogar, Fatemeh Eisazadeh
- Methodology: Zahra Heidari Archandani, Isaac Rahimian-Boogar, Fatemeh Eisazadeh
- Data collection: Zahra Heidari Archandani
- Formal analysis: Zahra Heidari Archandani, Isaac Rahimian-Boogar
- Supervision: Isaac Rahimian-Boogar
- Project administration: Isaac Rahimian-Boogar
- Writing – original draft: Zahra Heidari Archandani, Isaac Rahimian-Boogar
- Writing – review & editing: Zahra Heidari Archandani, Isaac Rahimian-Boogar, Fatemeh Eisazadeh
Zahra Heidari Archandani[1], Isaac Rahimian-Boogar[2], Fatemeh Eisazadeh[3]
Received: 12/11/25 Sent for Revision: 06/01/26 Received Revised Manuscript: 03/02/26 Accepted: 07/02/25
Background and Objectives: Treatment adherence and glycosylated hemoglobin control are major challenges in diabetes management, influenced by various psychosocial factors. The present study aimed to determine the role of demographic characteristics and psychological factors (intrapsychic conflicts, defense mechanisms, and therapeutic alliance) in controlling these challenges.
Materials and Methods: This correlational-descriptive study was conducted on 410 patients with type 2 diabetes who had active records in the health centers of Kerman City in 2024, selected through convenience sampling. Data were collected using a demographic characteristics form, the Intrapsychic Conflicts Questionnaire Adopted to Operationalized Psychodynamic Diagnosis (Both et al.), the Defense Mechanisms Rating Scale (Di Giuseppe et al.), the Therapeutic Relationship Questionnaire (McGuire et al.), the Diabetes Mellitus Treatment Adherence Scale (Hou et al.), and the results of the latest glycosylated hemoglobin test and were analyzed using hierarchical regression analysis.
Results: Treatment adherence was predicted by intrapsychic conflicts (β=-0.22, p<0.001), immature defense mechanisms (β=-0.35, p<0.001), therapeutic alliance (β=0.11, p=0.009), and unemployment (β=-0.16, p<0.001). Glycosylated hemoglobin concentration was predicted by immature defense mechanisms (β=0.16, p<0.001), therapeutic alliance (β=-0.35, p<0.001), being married (β=-0.12, p=0.004), and having one of the diabetes complications (β=0.45, p<0.001).
Conclusion: Intrapsychic conflicts, immature defense mechanisms, and therapeutic alliance accompanied with demographic characteristics including unemployment, being married, and diabetes complications have role in treatment adherence and glycosylated hemoglobin concentration. These results provide implications for designing and administrating treatment protocols based on these factors to achieve better diabetes management.
Keywords: Psychological conflicts, Defense mechanisms, Therapeutic alliance, Therapeutic adherance, HbA1c
Funding: This study did not have any funds.
Conflict of interest: None declared.
Ethical considerations: The Ethics Committee of Semnan University of Medical Sciences approved the study (IR.SEMUMS.REC.1403.194).
Authors’ contributions:
- Conceptualization: Zahra Heidari Archandani, Isaac Rahimian-Boogar, Fatemeh Eisazadeh
- Methodology: Zahra Heidari Archandani, Isaac Rahimian-Boogar, Fatemeh Eisazadeh
- Data collection: Zahra Heidari Archandani
- Formal analysis: Zahra Heidari Archandani, Isaac Rahimian-Boogar
- Supervision: Isaac Rahimian-Boogar
- Project administration: Isaac Rahimian-Boogar
- Writing – original draft: Zahra Heidari Archandani, Isaac Rahimian-Boogar
- Writing – review & editing: Zahra Heidari Archandani, Isaac Rahimian-Boogar, Fatemeh Eisazadeh
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Citation: Heidari Archandani Z, Rahimian-Boogar I, Eisazadeh F. The Role of Demographic Characteristics, Intrapsychic Conflicts, Defense Mechanisms, and Therapeutic Alliance in Prediction of Treatment Adherence and Glycosylated Hemoglobin in Patients with Type 2 Diabetes: A Descriptive Study. J Rafsanjan Univ Med Sci 2026; 24 (11): 1025-40. [Farsi]
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[1]- MSc Student in Clinical Psychology, Dept.of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
[2]- Associate Prof., Dept. of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
ORCID: 0000-0003-3029-9050
(Corresponding Author) Tel: (023) 31533066, E-mail: i_rahimian@semnan.ac.ir
ORCID: 0000-0003-3029-9050
(Corresponding Author) Tel: (023) 31533066, E-mail: i_rahimian@semnan.ac.ir
[3]- PhD in Health Psychology and Postdoctoral Researcher, Dept. of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
Type of Study: Research |
Subject:
Psychiatry
Received: 2025/11/12 | Accepted: 2026/02/7 | Published: 2026/05/20
Received: 2025/11/12 | Accepted: 2026/02/7 | Published: 2026/05/20
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