CORRELATES OF MENTAL HEALTH, ACCEPTANCE, AND COMMITMENT TO THERAPY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) requires treatment and self-management. Psychological distress and illness acceptance may influence medication adherence, yet their interrelationships remain insufficiently examined in Palestine.

Aim: To examine mental health distress, illness acceptance, and commitment to therapy among patients with T2DM from a clinical pharmacy perspective.

Methods: A cross-sectional correlational study included 350 adults with T2DM. Data collection was completed in 2026 using a demographic questionnaire, the Depression Anxiety Stress Scale-21, Acceptance of Illness Scale, and Medication Adherence Report Scale-5. Descriptive statistics, Pearson correlations, and multiple linear regression were performed.

Results: Participants had a mean age of 53.4 ± 14.8 years, diabetes duration of 13.9 ± 10.9 years, and HbA1c of 8.5 ± 1.3%. Anxiety was the most prominent psychological problem, with 54.0% classified as extremely severe. Illness acceptance was moderate (24.0 ± 8.5), while medication adherence was high (19.7 ± 4.4); 57.4% demonstrated high adherence. Mental health distress was negatively correlated with commitment to therapy (r = −0.355, p < 0.001) and illness acceptance (r = −0.808, p < 0.001). Illness acceptance was positively correlated with commitment to therapy (r = 0.487, p < 0.001). Illness acceptance (β = 0.39), physician follow-up (β = 0.33), family support (β = 0.15), and exercise (β = 0.15) independently predicted commitment to therapy, whereas mental health distress did not (β = −0.02, p = 0.824).

Conclusion: Illness acceptance showed the strongest independent association with commitment to therapy among the variables included in the regression model. Physician follow-up, family support, and exercise were also positively associated with commitment to therapy. These findings support consideration of psychological and adherence-related factors within multidisciplinary diabetes care; however, the cross-sectional design does not permit causal inference.

Keywords: Type 2 Diabetes Mellitus; Mental Health; Illness Acceptance; Medication Adherence; Clinical Pharmacy; Palestine.