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

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: ,  ,  ,  ,  ,  ,  ,   and    
Open Access
|Aug 2026
Figures & tables

Figures & Tables

Table 1

Sample Sociodemographic Characteristics and Clinical Features (N = 107)

VariableCategoryn (%)
GenderMale53 (49.5%)
GenderFemale54 (50.5%)
Occupational StatusHousework1 (0.9%)
Occupational StatusFull-time employment30 (28.0%)
Occupational StatusPart-time employment10 (9.3%)
Occupational StatusRetired66 (61.7%)
Educational LevelPrimary school59 (55.1%)
Educational LevelSecondary school22 (20.6%)
Educational LevelHigh school20 (18.7%)
Educational LevelUniversity/College6 (5.6%)
Marital StatusMarried82 (76.6%)
Marital StatusDivorced4 (3.7%)
Marital StatusWidowed21 (19.6%)
Living ArrangementLiving alone16 (15.0%)
Living ArrangementWith 1 person15 (14.0%)
Living ArrangementWith 2 persons35 (32.7%)
Living ArrangementWith >2 persons41 (38.3%)
ComorbiditiesHypertension52 (48.6%)
ComorbiditiesCoronary artery disease22 (20.6%)
ComorbiditiesStroke2 (1.9%)
ComorbiditiesOther31 (29.0%)
PolydipsiaNo63 (58.9%)
PolydipsiaYes44 (41.1%)
SleepinessNo78 (72.9%)
SleepinessYes29 (27.1%)
Nausea/Abdominal painNo101 (94.4%)
Nausea/Abdominal painYes6 (5.6%)
PolyuriaNo37 (34.6%)
PolyuriaYes70 (65.4%)
Blurred visionNo63 (58.9%)
Blurred visionYes44 (41.1%)
DizzinessNo95 (88.8%)
DizzinessYes12 (11.2%)
Anxiety/NervousnessNo49 (45.8%)
Anxiety/NervousnessYes58 (54.2%)
TachycardiaNo53 (49.5%)
TachycardiaYes54 (50.5%)
Sweating (cold sweat)No96 (89.7%)
Sweating (cold sweat)Yes11 (10.3%)
Fatigue/WeaknessNo76 (71.0%)
Fatigue/WeaknessYes29 (27.1%)
Fatigue/WeaknessOther2 (1.9%)
HungerNo103 (96.3%)
HungerYes4 (3.7%)
Behavioral changesNo99 (92.5%)
Behavioral changesYes8 (7.5%)
Diabetes ComplicationsDiabetic retinopathy16 (15.0%)
Diabetes ComplicationsDiabetic nephropathy1 (0.9%)
Diabetes ComplicationsErectile dysfunction4 (3.7%)
Diabetes ComplicationsOther86 (80.4%)
Treatment TypeDiet1 (0.9%)
Treatment TypeOral medication27 (25.2%)
Treatment TypeInsulin13 (12.1%)
Treatment TypeCombination66 (61.7%)
Diabetes Diet AdherenceNo26 (24.3%)
Diabetes Diet AdherenceYes81 (75.7%)

[i] Note. N = 107. n represents the frequency count, and % represents the percentage of the total sample.

Table 2

Frequencies and Percentages of Medication Adherence Reasons Scale (MARS) Items in Standardized APA Style

Variable01234567
1. I had side effects from the medication.102 (95.3 %)5 (4.7 %)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
2. I did not have enough money to pay for the medication.94 (87.9 %)5 (4.7 %)8 (7.5 %)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
3. I did not feel comfortable taking it for personal reasons (e.g., I was tired of taking medications, I was very ill, or because of my religious beliefs).102 (95.3 %)5 (4.7 %)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
4. I did not feel comfortable taking it for social reasons (e.g., I was with friends).99 (92.5 %)5 (4.7 %)3 (2.8 %)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
5. I do not think I need the medication anymore.100 (93.5 %)2 (1.9 %)0 (0%)0 (0%)5 (4.7 %)0 (0%)0 (0%)0 (0%)
6. I do not think the medication is effective for me.96 (89.7 %)5 (4.7 %)3 (2.8 %)3 (2.8 %)0 (0%)0 (0%)0 (0%)0 (0%)
7. Sometimes I skip a dose or doses of the medication to see if I still need it.90 (84.1 %)6 (5.6 %)3 (2.8 %)3 (2.8 %)0 (0%)0 (0%)0 (0%)5 (4.7 %)
8. I am concerned about the possible side effects of the medication.101 (94.4 %)6 (5.6 %)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
9. I am concerned about the long-term side effects of the medication.96 (89.7 %)11 (10.3 %)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
10. I had difficulty opening the vial or preparing the injection (e.g., opening the package, mixing the components, or drawing up the medication).105 (98.1 %)2 (1.9 %)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
11. I had difficulty swallowing the medication, applying the medication, inhaling the medication, or administering the injection (e.g., I am afraid of needles, or I have physical or sensory impairments).102 (95.3 %)5 (4.7 %)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
12. I did not have the medication because the pharmacist did not have it available, I had run out of supply, or my online order did not arrive on time.73 (68.2 %)19 (17.8 %)14 (13.1 %)1 (0.9 %)0 (0%)0 (0%)0 (0%)0 (0%)
13. I did not have the medication because I had no way to get to the pharmacy.91 (85.0 %)13 (12.1 %)1 (0.9 %)2 (1.9 %)0 (0%)0 (0%)0 (0%)0 (0%)
14. I am not sure how to take this medication.105 (98.1 %)2 (1.9 %)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
15. I have difficulty organizing all the medications I need to take.103 (96.3 %)4 (3.7 %)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
16. I would take it, but I have difficulty remembering things in my daily life.100 (93.5 %)1 (0.9 %)5 (4.7 %)1 (0.9 %)0 (0%)0 (0%)0 (0%)0 (0%)
17. I would take it, but I missed it because of a change in my daily routine..92 (86.0 %)12 (11.2 %)2 (1.9 %)1 (0.9 %)0 (0%)0 (0%)0 (0%)0 (0%)
18. I would take it, but I simply forgot.76 (71.0 %)18 (16.8 %)12 (11.2 %)1 (0.9 %)0 (0%)0 (0%)0 (0%)0 (0%)
19. Taking the medication is not a high priority in my daily life.106 (99.1 %)0 (0%)0 (0%)1 (0.9 %)0 (0%)0 (0%)0 (0%)0 (0%)
20. How many days were you able to take your medication(s) as prescribed?4 (3.7 %)0 (0%)0 (0%)3 (2.8 %)5 (4.7 %)6 (5.6 %)18 (16.8 %)71 (66.4 %)
Table 3 A.

Principal Component Analysis Factor Loadings for the MARS Items (N = 107)

ItemComponent 1Component 2Uniqueness
MARS10.98—0.04
MARS30.98—0.04
MARS110.98—0.04
MARS50.97—0.06
MARS70.95—0.06
MARS80.91—0.17
MARS90.74—0.44
MARS40.58—0.65
MARS120.53—0.42
MARS170.49—0.75
MARS190.48—0.76
MARS18—0.740.45
MARS13—0.730.46
MARS20—−0.710.49
MARS15—0.570.67
MARS2—0.530.72
MARS16—0.470.78
MARS6—0.390.75

[i] Note. Factor loadings < 0.35 are suppressed and represented as “—”. Items with very low communalities were excluded from the final model: MARS10 (uniqueness = 0.97) and MARS14 (uniqueness = 0.99).

Table 3 B.

Principal Component Analysis Model Fit Statistics and Total Variance Explained

MeasureValue
KMO (Overall)0.50
Bartlett’s Testχ2(190) = 4038.945, p < .001
Eigenvalue (Component 1)7.28
Eigenvalue (Component 2)3.02
Variance Explained (%)51.5%
Table 4A

Correlations Between SCL-90-R Symptomatology Scales and MARS Items (M1 to M10)

VariableM1M2M3M4M5M6M7M8M9M10
Somatization−.02.09−.02.13.03.14−.06−.04.04−.04
Obsessive-compulsive.05−.01.05.18.10.20*.00.01.10−.03
Interpersonal sensitivity.26**−.03.26**.21*.30**−.04.20*.21*.27**−.05
Depression.13.13.13.20*.16.23*.06.08.15.02
Anxiety.04.12.04−.07.08.13.02.02.13.00
Hostility.01.19.01−.02.04.05.09.02.08−.05
Phobic anxiety.22*.00.22*.14.27**.33***.16.17.25*.04
Paranoid ideation.52***−.08.52***.20*.54***.13.46***.47***.46***−.02
Psychoticism.06.06.06.12.10−.01.03.03.17−.02
GSI.13.07.13.15.17.16.08.09.17.09
PST.08.15.08.08.12.17.07.05.17−.04
PSI.22*.01.22*.30**.25*.19.14.17.18.08

Note. Values are Pearson correlation coefficients (r) between SCL-90-R psychiatric symptomatology scales and MARS items. M1 to M20 correspond to the items of the Medication Adherence Reasons Scale. GSI = Global Severity Index; PST = Positive Symptom Total; PSI = Positive Symptom Distress Index.

* p < .05,

** p < .01,

*** p < .001.

Table 4B

Correlations Between SCL-90-R Symptomatology Scales and MARS Items (M11 to M20)

VariableM11M12M13M14M15M16M17M18M19M20
Somatization−.02−.07.14−.06−.04.28**.03.17−.04.17
Obsessive-compulsive.05−.04.12−.12−.03.33***.07.19−.02.13
Interpersonal sensitivity.26**.12.15−.09−.03.18.09−.09.11.18
Depression.13.08.17−.12−.05.35***.07.24*.02.16
Anxiety.04.01.15−.08−.08.29**−.15.10−.02.13
Hostility.01.08.19*−.02−.05.08.02.02.02−.03
Phobic anxiety.22*.04.06−.11−.04.40***−.03.17.07.05
Paranoid ideation.52***.27**.08−.08.01.16.11−.04.22*.13
Psychoticism.06.06.17−.09.04.21*.03.06−.01.17
GSI.13.04.15−.11−.05.31**.02.14.03.07
PST.08.11.20*−.09−.01.28**−.02.17.01.12
PSI.22*.02.10−.10−.07.29**.19.15.08.13

Note. Values are Pearson correlation coefficients (r) between SCL-90-R psychiatric symptomatology scales and MARS items. M1 to M20 correspond to the items of the Medication Adherence Reasons Scale. GSI = Global Severity Index; PST = Positive Symptom Total; PSI = Positive Symptom Distress Index.

* p < .05,

** p < .01,

*** p < .001.

DOI: https://doi.org/10.56508/mhgcj.v9i1.371 | Journal eISSN: 2612-2138
Journal RSS Feed
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,
Business management,
Industries,
Health care,
Medicine,
Clinical medicine,
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.

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