A research on the role of mentalization in chronic diseases: Investigating the relationship of mentalization to the treatment compliance in patients with Type 1 Diabetes

Chronic conditions require periodic follow-up and support as complete recovery is not possible. This situation makes treatment adherence in chronic conditions quite important. This is also the case for Type 1 diabetes, which requires daily and even hourly control and intervention. The health belief model, which reveals that people's orientation towards health behaviors is related to their perceptions about the disease, has been developed to identify these health beliefs and then increase health behaviors. Mentalizing is the ability to link one's own and others' actions, behaviors and emotions to mental processes. The aim of this study is to examine the relationship between mentalizing and health beliefs with treatment adherence in type 1 diabetes. For this purpose, 112 participants with type 1 diabetes aged 18-45 years were asked to complete the Reflective Functioning Questionnaire (RFQ-4), Diabetes Specific Health Belief Model, Warwick-Edinburg Mental Well-Being Scale, Patient-Doctor Relationship Scale, Brief Health Literacy Screening Tool and the Type 1 Diabetes Treatment Adherence Scale which is developed for this study. The data collection process was conducted online and anonymously. According to the results of the statistical analysis, the uncertainty subdimension of reflective functioning predicts treatment adherence through the mediation of the health belief model. A similar mediation relation was also found when the uncertainty sub-dimension of reflective functioning predicted individuals' well-being. On the other hand, no mediation relation was found in the relationship between reflective functioning and health belief model with patient-doctor relationship, health literacy and metabolic control. Treatment adherence has a negative relationship with the uncertainty sub-dimension of reflective functioning and metabolic control, while it has a positive relationship with the certainty sub-dimension of reflective functioning, well-being, health beliefs, patient-doctor relationship and health literacy. The results of the study confirm the hypothesis that mentalization affects treatment adherence through health beliefs. The same goes for well-being. Therefore, it can be expected that the application of mentalization-focused psychotherapies in the treatment of type 1 diabetes will both increase treatment adherence and positively affect people's well-being. Keywords Mentalization, Treatment Adherence, Health Beliefs, Type 1 Diabetes