Psychiatric Symptomatology and Medication Adherence in Type 2 Diabetes: Cross-Cultural Insights from Greece

Evangelos C. Fradelos; Maria Faka; Dimitra Anagnostopoulou; Vissarion Bakalis; Elizabeth Uni; Aikaterini Toska; Konstantinos Skabardonis; Victoria Alikari; Maria Saridi

doi:10.56508/mhgcj.v9i1.371

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Psychiatric Symptomatology and Medication Adherence in Type 2 Diabetes: Cross-Cultural Insights from Greece

Mental Health: Global Challenges

Volume 9 (2026): Issue 1 (January 2026)

By: Evangelos C. Fradelos , Maria Faka, Dimitra Anagnostopoulou , Vissarion Bakalis , Elizabeth Uni , Aikaterini Toska , Konstantinos Skabardonis, Victoria Alikari and Maria Saridi

Open Access

|Aug 2026

Abstract

Introduction

Medication adherence in type 2 diabetes mellitus (T2DM) is influenced not only by clinical factors but also by psychological and interpersonal dimensions. Understanding the reasons for non-adherence is essential for designing individualized interventions.

Purpose

This study aimed to investigate medication adherence and its association with psychiatric symptomatology among community-dwelling patients with T2DM, and to translate, culturally adapt, and preliminarily evaluate the Greek version of the Medication Adherence Reasons Scale (MARS).

Methodology

A cross-sectional study was conducted with 107 adults with T2DM recruited from Primary Health Care services in Larissa, Greece. Data was collected through structured face-to-face interviews. Psychiatric symptomatology was assessed using the SCL-90-R, while medication adherence reasons were evaluated with the Greek version of the MARS. Descriptive statistics, Pearson correlations, Cronbach’s alpha, and Principal Component Analysis were performed.

Results

Participants reported generally low levels of reasons for medication non-adherence, with most MARS items concentrated at the lowest response category. PCA indicated a two-component solution explaining 51.5% of the total variance; however, the KMO value was marginally acceptable (0.50), suggesting cautious interpretation. Paranoid ideation showed the strongest and most consistent positive correlations with several MARS items. Depression, interpersonal sensitivity, phobic anxiety, and obsessive-compulsive symptoms were also significantly associated with selected non-adherence reasons, while somatization and hostility showed limited associations.

Conclusions

Medication adherence in T2DM appears to be shaped by psychological and interpersonal factors. The findings support the integration of mental health assessment into diabetes care and highlight the need for further validation of the Greek MARS in larger samples.

References

Ali, S. A., Salih, S. M., Abdelmola, A., Makeen, A. M., Solan, Y. M., Ali, M. M. M., ... Mahdi, M. (2024). Association of anxiety and depressive symptoms and treatment adherence among patients with type 2 diabetes mellitus in Jazan, Saudi Arabia: A cross-sectional study. Cureus, 16(3), e57021. https://doi.org/10.7759/cureus.57021
Search in Google Scholar Back to article
Alotaibi, R. M., Alotaibi, A. S., Alotaibi, S. M., Al-Otaibi, M. S., Alharbi, A. F., & Almutairi, K. M. (2025). Effectiveness of nurse-led educational interventions on medication adherence among patients with diabetes: A systematic review. The Review of Diabetic Studies, 21(1), 747–757. https://doi.org/10.1900/RDS.2025.21.747
Search in Google Scholar Back to article
Banday, M. Z., Sameer, A. S., & Nissar, S. (2020). Pathophysiology of diabetes: An overview. Avicenna Journal of Medicine, 10(4), 174–188. https://doi.org/10.4103/ajm.ajm_53_20
Search in Google Scholar Back to article
Dai, E., Bakalis, V., Toska, A., Saridi, M., Papagiannis, D., Albani, E., Malli, F., & Fradelos, E. C. (2023). Assessment of depression and anxiety in patients with type 2 diabetes and their correlation with adherence to the Mediterranean diet and physical activity level. Hellenic Journal of Nursing, 62(4), 99–114.
Search in Google Scholar Back to article
Derogatis, L. R. (1983). SCL-90-R: Administration, scoring and procedures manual II. Clinical Psychometric Research.
Search in Google Scholar Back to article
DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160(14), 2101–2107. https://doi.org/10.1001/archinte.160.14.2101
Search in Google Scholar Back to article
Donias, S., Karastergiou, A., & Manos, N. (1991). Standardization of the symptom checklist-90-R rating scale in a Greek population. Psychiatriki, 2, 42–48.
Search in Google Scholar Back to article
Hao, L. N., Ma, X. W., Kang, L. N., Wang, Y. Y., & Shi, H. (2025). Beyond glycemic control: A holistic perspective on psychosocial support in outpatient diabetes management. Frontiers in Endocrinology, 16, 1708620. https://doi.org/10.3389/fendo.2025.1708620
Search in Google Scholar Back to article
Hisan, U. K., Widjanarko, B., Sriatmi, A., & Shaluhiyah, Z. (2025). Association between depression and medication adherence in noncommunicable diseases: A narrative review. Korean Journal of Family Medicine, 46(4), 231–239. https://doi.org/10.4082/kjfm.25.0018
Search in Google Scholar Back to article
Kalra, S., Jena, B. N., & Yeravdekar, R. (2018). Emotional and psychological needs of people with diabetes. Indian Journal of Endocrinology and Metabolism, 22(5), 696–704. https://doi.org/10.4103/ijem.IJEM_579_17
Search in Google Scholar Back to article
Kardas, P., Bennett, B., Borah, B., Burnier, M., Daly, C., Hiligsmann, M., Menditto, E., Peterson, A. M., Slejko, J. F., Tóth, K., Unni, E., & Ágh, T. (2024). Medication non-adherence: Reflecting on two decades since WHO adherence report and setting goals for the next twenty years. Frontiers in Pharmacology, 15, 1444012. https://doi.org/10.3389/fphar.2024.1444012
Search in Google Scholar Back to article
Kwakye, A. O., Kretchy, I. A., Peprah, P., & Mensah, K. B. (2024). Factors influencing medication adherence in co-morbid hypertension and diabetes patients: A scoping review. Exploratory Research in Clinical and Social Pharmacy, 13, 100426. https://doi.org/10.1016/j.rcsop.2024.100426
Search in Google Scholar Back to article
Latkin, C. A., Edwards, C., Davey-Rothwell, M. A., & Tobin, K. E. (2017). The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland. Addictive Behaviors, 73, 133–136. https://doi.org/10.1016/j.addbeh.2017.05.005
Search in Google Scholar Back to article
Liu, J. (2025). The impact of chronic diabetes on the mental health of middle-aged and elderly people: Mechanisms and intervention strategies. Theoretical and Natural Science, 141(1), 234–238. https://doi.org/10.54254/2753-8818/2025.AU27978
Search in Google Scholar Back to article
Osborn, C. Y., & Egede, L. E. (2012). The relationship between depressive symptoms and medication nonadherence in type 2 diabetes: The role of social support. General Hospital Psychiatry, 34(3), 249–253. https://doi.org/10.1016/j.genhosppsych.2012.01.015
Search in Google Scholar Back to article
Sahoo, J., Mohanty, S., Kundu, A., & Epari, V. (2022). Medication adherence among patients of type II diabetes mellitus and its associated risk factors: A cross-sectional study in a tertiary care hospital of Eastern India. Cureus, 14(12), e33074. https://doi.org/10.7759/cureus.33074
Search in Google Scholar Back to article
Sebastian, M. J., Khan, S. K., Pappachan, J. M., & Jeeyavudeen, M. S. (2023). Diabetes and cognitive function: An evidence-based current perspective. World Journal of Diabetes, 14(2), 92–109. https://doi.org/10.4239/wjd.v14.i2.92
Search in Google Scholar Back to article
Seghatoleslam, T., Ardakani, A., Habil, H., & Rashid, R. (2022). Comorbidity of mental disorder in patients with chronic disease: A comparative study of heroin dependence patients and diabetes mellitus patients. Iranian Journal of Public Health, 51(1), 142–150. https://doi.org/10.18502/ijph.v51i1.8305
Search in Google Scholar Back to article
Shukla, M., Schilt-Solberg, M., & Gibson-Scipio, W. (2025). Medical mistrust: A concept analysis. Nursing Reports (Pavia, Italy), 15(3), 103. https://doi.org/10.3390/nursrep15030103
Search in Google Scholar Back to article
Stewart, S. J. F., Moon, Z., & Horne, R. (2023). Medication nonadherence: Health impact, prevalence, correlates and interventions. Psychology & Health, 38(6), 726–765. https://doi.org/10.1080/08870446.2022.2144923
Search in Google Scholar Back to article
Unni, E. J., & Farris, K. B. (2015). Development of a new scale to measure self-reported medication nonadherence. Research in Social & Administrative Pharmacy: RSAP, 11(3), e133–e143. https://doi.org/10.1016/j.sapharm.2009.06.005
Search in Google Scholar Back to article
Unni, E. J., Olson, J. L., & Farris, K. B. (2014). Revision and validation of Medication Adherence Reasons Scale (MAR-Scale). Current Medical Research and Opinion, 30(2), 211–221. https://doi.org/10.1185/03007995.2013.851075
Search in Google Scholar Back to article
Unni, E. J., Sternbach, N., & Goren, A. (2019). Using the Medication Adherence Reasons Scale (MAR-Scale) to identify the reasons for non-adherence across multiple disease conditions. Patient Preference and Adherence, 13, 993–1004. https://doi.org/10.2147/PPA.S205359
Search in Google Scholar Back to article
Xu, H., & Chen, Q. (2025). The bidirectional influence between type 2 diabetes mellitus and the state of depression and anxiety. Journal of Affective Disorders, 386, 119467. https://doi.org/10.1016/j.jad.2025.119467
Search in Google Scholar Back to article
Yang, H., Wu, F., Gui, M., et al. (2023). The role of medication adherence in the association between depressive symptoms and quality of life in older adults with type 2 diabetes mellitus. BMC Geriatrics, 23, 196. https://doi.org/10.1186/s12877-023-03929-8
Search in Google Scholar Back to article
Yang, K., Fang, Y., He, J., & Li, J. (2025). Prevalence and risk factors of depression in patients with diabetes mellitus: A systematic review and meta-analysis. Frontiers in Endocrinology, 16, 1660478. https://doi.org/10.3389/fendo.2025.1660478
Search in Google Scholar Back to article
Zolnierek, K. B., & DiMatteo, M. R. (2009). Physician communication and patient adherence to treatment: A meta-analysis. Medical Care, 47(8), 826–834. https://doi.org/10.1097/MLR.0b013e31819a5acc
Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.56508/mhgcj.v9i1.371 | Journal eISSN: 2612-2138

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Language: English

Page range: 155 - 178

Submitted on: May 24, 2026

Accepted on: Aug 1, 2026

Published on: Aug 5, 2026

Published by: International Platform on Mental Health

In partnership with: Paradigm Publishing Services

Publication frequency: Volume open

Keywords:

Mental Health,

Type 2 Diabetes Mellitus,

Medication Adherence,

Medication Adherence Reasons Scale (MARS),

Psychiatric Symptomatology,

Primary Health Care,

Psychometric Validation

Related subjects:

Business and economics,

Psychiatry, psychotherapy,

Social sciences,

Psychology,

Psychology, other

© 2026 Evangelos C. Fradelos, Maria Faka, Dimitra Anagnostopoulou, Vissarion Bakalis, Elizabeth Uni, Aikaterini Toska, Konstantinos Skabardonis, Victoria Alikari, Maria Saridi, published by International Platform on Mental Health
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 9 (2026): Issue 1 (January 2026)