The Mediating Effect of the Resilience on the Relationship between Type D Personality and Compliance in Patients with Coronary Artery Disease

Mi Yo Cheon; Jiyeon Kang

doi:10.7469/kjan.2016.28.1.61

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The Mediating Effect of the Resilience on the Relationship between Type D Personality and Compliance in Patients with Coronary Artery Disease

Mi Yo Cheon¹, Jiyeon Kang²

Korean Journal of Adult Nursing 2016;28(1):61-70.
Published online: February 29, 2016

DOI: https://doi.org/10.7469/kjan.2016.28.1.61

¹Dong-A University Medical Center, CCU, Busan

²Department of Nursing, Dong-A University, Busan, Korea

Corresponding author: Kang, Jiyeon Department of Nursing, Dong-A University, 1 Dongdaesin-dong 3-ga, Seo-gu, Busan 602-714, Korea. Tel: +82-51-240-2871, Fax: +82-51-240-2920, E-mail: jykang@dau.ac.kr

• Received: October 16, 2015 • Accepted: January 22, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
This study aimed to identify the mediating effect of the resilience on the relationship between type D personality and compliance of Coronary Artery Disease (CAD) patients.
Methods
The subjects were 236 CAD patients who visited the cardiology outpatient clinics of D University Medical Center in B City in Korea. The type D personality, resilience, and compliance of subjects were measured using structured questionnaires from July to August, 2014. The mediating effect was analyzed by a multiple hierarchical regression.
Results
The subjects with type D personality accounted for 30.9% of all study subjects. The resilience and compliance of type D subjects were significantly lower than those of non type D subjects. There was a significant correlation between resilience and compliance. The direct effect of type D personality on compliance was not significant (β=-.07, p=.243), while the indirect effect of type D personality on compliance via resilience was significant (β=.23, p<.001).
Conclusion
On the basis of above results, it can be concluded that the resilience had completely mediating effect on the relation between type D personality and compliance of CAD patients. Further studies need to be done to develop the intervention enhancing resilience of CAD patients with Type D personality.
Key Words: Coronary artery disease; Patient compliance; Type D personality; Psychological resilience

Figure 1.

Model for mediating effect of resilience between the type D personality and compliance.

Table 1.

Differences of Compliance according to the Subjects' Characteristics (N=236)

Characteristics	Categories	n (%)	M±SD	t or F	p	Post-hoc test
Gender	Female	106 (44.9)	95.37±11.09	2.30	.022
Gender	Male	130 (55.1)	91.63±13.84
Age (year)	30~49^a	23 (9.7)	82.13±16.16	12.73^†	＜.001	a＜b^‡
	50~59^a	58 (24.6)	89.47±11.92
	60~69^b	87 (36.9)	95.37±12.54
	≥70^b	68 (28.8)	97.74±9.16
Education	Elementary school	46 (19.5)	95.13±9.32	1.29	.279
	Middle school	52 (22.0)	95.17±12.57
	High school	78 (33.1)	92.58±12.83
	≥College	60 (25.4)	91.25±14.94
Living with family	Yes	210 (89.0)	93.64±12.73	1.14	.256
Living with family	No	26 (11.0)	90.62±13.23
Religion	Yes	166 (70.3)	94.51±12.29	2.23	.027
Religion	No	70 (29.7)	90.47±13.57
Occupation	Yes	105 (44.5)	90.51±13.95	3.06	.002
Occupation	No	131 (55.5)	95.55±11.34
Monthly income (10,000 won)	＜100	117 (49.6)	94.59±11.22	2.39	.069
	100~199	29 (12.3)	95.83±10.53
	200~299	32 (13.6)	92.97±14.00
	≥300	58 (24.6)	89.66±15.39
Alcohol	Yes	85 (36.0)	88.18±13.40	4.84	＜.001
Alcohol	No	151 (64.0)	96.20±11.51
Smoking	Yes	56 (23.7)	84.29±14.47	6.57	＜.001
Smoking	No	180 (76.3)	96.12±10.82
Years of follow-up	＜3^a	59 (25.0)	88.69±13.91	6.04	＜.001	a＜c^‡
	3~＜6^b	58 (24.6)	91.33±12.51
	6~＜11^c	75 (31.8)	97.01±11.99
	≥11^c	44 (18.6)	95.80±10.65
Comorbidity	Yes	225 (95.3)	93.89±12.32	3.24	.001
	Hypertension	89 (39.6)
	Dyslipidemia	50 (22.2)
	Others	86 (38.2)
	No	11 (4.7)	81.36±16.66
Familial history of heart disease	Yes	75 (31.8)	93.61±13.13	0.25	.804
Familial history of heart disease	No	161 (68.2)	93.17±12.67
Admission experience	Yes	188 (79.7)	94.26±12.53	2.27	.024
Admission experience	No	48 (20.3)	89.60±13.25
Number of admission	1	112 (59.6)	93.38±12.59	1.16	.248
Number of admission	≥2	76 (40.4)	95.54±12.41
Surgery /intervention	Yes	143 (60.6)	94.69±12.35	2.08	.038
Surgery /intervention	No	93 (39.4)	91.15±13.30
Diagnosis	Unstable angina^a	117 (49.6)	96.15±11.65	4.02	.004
	Stable angina^a	69 (29.2)	92.32±12.81
	NSTEMI^a	25 (10.6)	87.72±15.12
	STEMI^a	15 (6.4)	86.73±13.63
	Variant angina^a	10 (4.2)	90.80±10.27

NSTEMI=Non ST segment elevation myocardial infarction; STEMI=ST segment elevation myocardial infarction;

^†Welch's ANOVA due to unmet homogeneity assumption;

^‡Scheffé test.

Table 2.

Type D Personality, Resilience, and Compliance of Study Subjects (N=236)

Variables	Categories	n (%)	Range	M±SD	Negative affectivity	Social inhibition
Variables	Categories	n (%)	Range	M±SD	M±SD	M±SD
Personality	Type D	73 (30.9)			15.77±3.81	14.88±3.81
	Non-type D	163 (69.1)			5.79±5.25	3.94±4.02
	Total	236 (100.0)			8.87±6.70	7.32±6.42
Resilience			25~175	130.14±23.24
Compliance	Medication		5~25	21.77±2.84
	Daily activities		5~25	19.50±3.89
	Exercise & stress management		5~25	17.59±3.82
	Diet		5~25	17.44±3.62
	Risk factor management		5~25	17.01±4.05
	Total		25~125	93.31±12.79

Table 3.

Differences of Resilience and Compliance according to the Type D Personality (N=236)

Variables	Type D (n=73)	Non-type D (n=163)	t	p
Variables	M±SD	M±SD	t	p
Resilience	122.18±25.02	133.71±21.54	3.61	＜.001
Compliance	90.74±12.54	94.46±12.77	2.08	.039

Table 4.

Mediating Effect of Resilience on the Relationship between the D Type Personality and Compliance (N=236)

Step		Path		B	SE	_β	Adjusted R²	p
Step 1	D type personality	→	Compliance	-3.50	1.72	-.13	.18	.043
Step 2	D type personality	→	Resilience	-11.38	3.21	-.23	.08	.001
Step 3	Resilience	→	Compliance	0.14	0.03	.25	.22	＜.001
Step 4	D type personality	→	Compliance	-2.02	1.72	-.07	.22	.243
	Resilience			0.13	0.04	.23		＜.001

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The Mediating Effect of the Resilience on the Relationship between Type D Personality and Compliance in Patients with Coronary Artery Disease

Korean J Adult Nurs. 2016;28(1):61-70. Published online February 29, 2016

DOI: https://doi.org/10.7475/kjan.2016.28.1.61

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The Mediating Effect of the Resilience on the Relationship between Type D Personality and Compliance in Patients with Coronary Artery Disease

Korean J Adult Nurs. 2016;28(1):61-70. Published online February 29, 2016

DOI: https://doi.org/10.7475/kjan.2016.28.1.61

Figure

The Mediating Effect of the Resilience on the Relationship between Type D Personality and Compliance in Patients with Coronary Artery Disease

Figure 1. Model for mediating effect of resilience between the type D personality and compliance.

Figure 1.

The Mediating Effect of the Resilience on the Relationship between Type D Personality and Compliance in Patients with Coronary Artery Disease

Table 1.

Differences of Compliance according to the Subjects' Characteristics (N=236)

Characteristics	Categories	n (%)	M±SD	t or F	p	Post-hoc test
Gender	Female	106 (44.9)	95.37±11.09	2.30	.022
Gender	Male	130 (55.1)	91.63±13.84
Age (year)	30~49^a	23 (9.7)	82.13±16.16	12.73^†	＜.001	a＜b^‡
	50~59^a	58 (24.6)	89.47±11.92
	60~69^b	87 (36.9)	95.37±12.54
	≥70^b	68 (28.8)	97.74±9.16
Education	Elementary school	46 (19.5)	95.13±9.32	1.29	.279
	Middle school	52 (22.0)	95.17±12.57
	High school	78 (33.1)	92.58±12.83
	≥College	60 (25.4)	91.25±14.94
Living with family	Yes	210 (89.0)	93.64±12.73	1.14	.256
Living with family	No	26 (11.0)	90.62±13.23
Religion	Yes	166 (70.3)	94.51±12.29	2.23	.027
Religion	No	70 (29.7)	90.47±13.57
Occupation	Yes	105 (44.5)	90.51±13.95	3.06	.002
Occupation	No	131 (55.5)	95.55±11.34
Monthly income (10,000 won)	＜100	117 (49.6)	94.59±11.22	2.39	.069
	100~199	29 (12.3)	95.83±10.53
	200~299	32 (13.6)	92.97±14.00
	≥300	58 (24.6)	89.66±15.39
Alcohol	Yes	85 (36.0)	88.18±13.40	4.84	＜.001
Alcohol	No	151 (64.0)	96.20±11.51
Smoking	Yes	56 (23.7)	84.29±14.47	6.57	＜.001
Smoking	No	180 (76.3)	96.12±10.82
Years of follow-up	＜3^a	59 (25.0)	88.69±13.91	6.04	＜.001	a＜c^‡
	3~＜6^b	58 (24.6)	91.33±12.51
	6~＜11^c	75 (31.8)	97.01±11.99
	≥11^c	44 (18.6)	95.80±10.65
Comorbidity	Yes	225 (95.3)	93.89±12.32	3.24	.001
	Hypertension	89 (39.6)
	Dyslipidemia	50 (22.2)
	Others	86 (38.2)
	No	11 (4.7)	81.36±16.66
Familial history of heart disease	Yes	75 (31.8)	93.61±13.13	0.25	.804
Familial history of heart disease	No	161 (68.2)	93.17±12.67
Admission experience	Yes	188 (79.7)	94.26±12.53	2.27	.024
Admission experience	No	48 (20.3)	89.60±13.25
Number of admission	1	112 (59.6)	93.38±12.59	1.16	.248
Number of admission	≥2	76 (40.4)	95.54±12.41
Surgery /intervention	Yes	143 (60.6)	94.69±12.35	2.08	.038
Surgery /intervention	No	93 (39.4)	91.15±13.30
Diagnosis	Unstable angina^a	117 (49.6)	96.15±11.65	4.02	.004
	Stable angina^a	69 (29.2)	92.32±12.81
	NSTEMI^a	25 (10.6)	87.72±15.12
	STEMI^a	15 (6.4)	86.73±13.63
	Variant angina^a	10 (4.2)	90.80±10.27

NSTEMI=Non ST segment elevation myocardial infarction; STEMI=ST segment elevation myocardial infarction;

^†Welch's ANOVA due to unmet homogeneity assumption;

^‡Scheffé test.

Table 2.

Type D Personality, Resilience, and Compliance of Study Subjects (N=236)

Variables	Categories	n (%)	Range	M±SD	Negative affectivity	Social inhibition
Variables	Categories	n (%)	Range	M±SD	M±SD	M±SD
Personality	Type D	73 (30.9)			15.77±3.81	14.88±3.81
	Non-type D	163 (69.1)			5.79±5.25	3.94±4.02
	Total	236 (100.0)			8.87±6.70	7.32±6.42
Resilience			25~175	130.14±23.24
Compliance	Medication		5~25	21.77±2.84
	Daily activities		5~25	19.50±3.89
	Exercise & stress management		5~25	17.59±3.82
	Diet		5~25	17.44±3.62
	Risk factor management		5~25	17.01±4.05
	Total		25~125	93.31±12.79

Table 3.

Differences of Resilience and Compliance according to the Type D Personality (N=236)

Variables	Type D (n=73)	Non-type D (n=163)	t	p
Variables	M±SD	M±SD	t	p
Resilience	122.18±25.02	133.71±21.54	3.61	＜.001
Compliance	90.74±12.54	94.46±12.77	2.08	.039

Table 4.

Mediating Effect of Resilience on the Relationship between the D Type Personality and Compliance (N=236)

Step		Path		B	SE	_β	Adjusted R²	p
Step 1	D type personality	→	Compliance	-3.50	1.72	-.13	.18	.043
Step 2	D type personality	→	Resilience	-11.38	3.21	-.23	.08	.001
Step 3	Resilience	→	Compliance	0.14	0.03	.25	.22	＜.001
Step 4	D type personality	→	Compliance	-2.02	1.72	-.07	.22	.243
	Resilience			0.13	0.04	.23		＜.001

Table 1. Differences of Compliance according to the Subjects' Characteristics (N=236)

NSTEMI=Non ST segment elevation myocardial infarction; STEMI=ST segment elevation myocardial infarction;

†

Welch's ANOVA due to unmet homogeneity assumption;

‡

Scheffé test.

Table 2. Type D Personality, Resilience, and Compliance of Study Subjects (N=236)

Table 3. Differences of Resilience and Compliance according to the Type D Personality (N=236)

Table 4. Mediating Effect of Resilience on the Relationship between the D Type Personality and Compliance (N=236)

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