Can Personality Traits be Related to Medical Adherence
in Patients with Myocardial Infarction?

Brazaitiene MA; Adomaitiene V; Gustiene O

Research Article

J Fam Med. 2021; 8(5): 1258.

Can Personality Traits be Related to Medical Adherence in Patients with Myocardial Infarction?

Brazaitiene MA¹*, Adomaitiene V¹ and Gustiene O²

¹Department of Psychiatry, Lithuanian University of Health Sciences, Lithuania

²Department of Cardiology, Lithuanian University of Health Sciences, Lithuania

*Corresponding author: Marija Audrone Brazaitiene, Department of Psychiatry, Lithuanian University of Health Sciences, 2 Eiveniu St, 50161, Lithuania

Received: May 08, 2021; Accepted: June 23, 2021; Published: June 30, 2021

Abstract

Background: For myocardial infarction survivors, long-term pharmacotherapy is an important element of a complex treatment and a better prognosis may be achieved through better medication adherence.

Aim: The purpose of this study is to find out whether it is possible to predict medication adherence of the patients who survived myocardial infarction via assessing their personality.

Design and Setting: Analytic cross-sectional study.

Methods: The study was held in Hospital of Lithuanian University of Health Sciences Kaunas clinics (HLUHS KK) department of cardiology. Patients with ST-segment elevation myocardial infarction were randomly included and completed questionnaire before discharge from Cardiology unit. We recruited 198 patients with myocardial infarction who completed questionnaire (ICD-10 diagnoses I21.0, I21.1 or I21.2). Medical adherence association with personality was assessed with Morisky-Green medical adherence scale (MMAS-8) and the Big-Five inventory.

Results: Medical adherence was associated with conscientiousness, agreeableness, neuroticism and extraversion. There was no significant association with openness to experiences. Neuroticism negatively affected medical adherence. It was determined, that conscientiousness, agreeableness and extraversion positively affected medical adherence.

Conclusion: This study demonstrated that good medical adherence in patients with ST-segment elevation myocardial infarction was associated with higher scores in conscientiousness and agreeableness personality traits and lower scores in neuroticism.

Keywords: Personality; Medical adherence; Treatment; Myocardial infarction

Introduction

In 2019, incidence of acute or subsequent myocardial infarction (ICD-10-AM codes I21-I22) was 3,55 per 1000 residents of Lithuania (4,6 for men and 2,63 for women) [1] and mortality from acute myocardial infarction (ICD-10-AM code I21) was 40,76 per 100 000 residents of Lithuania (46,31 for men and 35,95 for women) [2]. For myocardial infarction survivors, long-term pharmacotherapy is an important element of a complex treatment and a better prognosis may be achieved through better medication adherence [3], however, the data suggest that adherence of a number of patients is not sufficient [4-6]. In order to utilize the most effective measures to optimize treatment and achieve best results, it is crucial for both healthcare specialists and the patients themselves to firstly discover the factors that could possibly contribute to poor adherence. Studies that investigated influences on medication adherence in patients after myocardial infarction focused on such variables as demographic, economic, psychosocial (depressive symptoms, stress), patient (gender, age) and health belief-related factors, medical comorbidities were also considered [5,7]. It is of note that these studies did not include patient‘s personality, which is an important patient factor [8], thus its role as a risk factor for poor adherence after myocardial infarction is yet to be explored.

The key concept of personality, as the Five Factor Model describes it, can be assessed through evaluation of the following personality domains: agreeableness, conscientiousness, neuroticism, extraversion and openness to experience [9,10]. Agreeableness describes motivation to maintain positive relations with others, it is related to such facets as cooperation, understanding and pleasantness. Conscientiousness depicts orderliness, efficiency and dutifulness. Neuroticism defines the inverse of toughness, happiness and stability. Openness to experience is associated with intellect, reflection and ingenuity. Extraversion represents gregariousness and assertiveness.

Among the literature exploring the role of personality on adherence, there is a study by Iakovleva et al. [11] that confirms the need for research on various patient factors. The data were collected from 100 people who suffered from coronary heart disease and underwent coronary artery bypass grafting. Statistical analysis revealed that when the patients were divided into three groups (according to adherence), the adherent group scored significantly higher on conscientiousness and lower on neuroticism compared to non-adherent group. There was also a tendency to score higher on agreeableness and there was no statistical significance for extraversion and openness as well as for the differences between the partial-adherence group.

There are also many other studies that reveal the associations between personality traits of the Five Factor Model and adherence to treatment in patients suffering from various conditions. Ko et al. [12] demonstrate that a high level of conscientiousness were associated with better medication adherence in rheumatoid arthritis patients. Hazrati-Meimaneh et al. [13] found that neuroticism indicated a negative association with medication adherence. Positive associations were found between medication adherence and personality traits, including extraversion, agreeableness, and conscientiousness in patients with type 2 diabetes. Skinner et al. [14] proposed that even though the independent association between conscientiousness and glycated hemoglobin was not found, this personality trait was still important for patients with type 2 diabetes as it was related to lower body mass index, being less likely to smoke and more likely to perform beneficial self-care behaviours as blood glucose measurements and appropriate medication taking. The positive link between conscientiousness and medication adherence is also confirmed in the meta-analysis by Molloy et al. [15]. Toelle et al. [16] found that high neuroticism scores and a previous asthma hospital admission were associated with non-adherence to prescribed daily inhaled corticosteroid in asthma patients. All this research reveals the importance of personality on adherence to treatment and implements the idea of a possibility to interfere and improve the situation when a simple evaluation of the patient‘s personality results in prediction that adherence will not be sufficient. Therefore, further studies are required to better understand the role of personality on patient‘s beneficial health-related behaviours.

The aim of this study was to find out whether it is possible to predict medication adherence of the patients who survived myocardial infarction via assessing their personality in accordance to the Five Factor Model. The differences in adherence and personality dimensions regarding gender were also inspected.

Methods

Study design and population

The study was held in Hospital of Lithuanian University of Health Sciences Kaunas clinics (HLUHS KK) department of cardiology. Patients with ST-segment elevation myocardial infarction were randomly included and completed questionnaire between January 2017 and November 2018 before discharge from Cardiology unit. Patients with diagnosis of ST-segment elevation myocardial infarction completed questionnaire (ICD-10 diagnoses I21.0, I21.1 or I21.2). Patients with self-reported history of psychiatric illness were eliminated. Patients had to be capable to understand study design and sign informed consent.

Variables

Medical adherence association with personality was assessed with: Morisky-Green Medical Adherence Scale (MMAS-8) and the Big-Five inventory. The MMAS-8 questionnaire consists of 8 items, which are rated by the patient. A higher score means a better medical adherence. Patients scored less than 6 points were assigned as having low medical adherence, from 6 to less than 8-medium and 8-high. The Big-Five inventory evaluated personality dimensions: extraversion, consciousness, agreeableness, neuroticism and openness to experiences.

Statistical analysis

Categorical variables describing sociodemographic characteristics are presented as percentages. Quantitative scores are presented as means and Standard Deviations (SD). Parametrical Student’s t test was applied to compare quantitative variables between two groups and analysis of variances (ANOVA) was applied to compare among more than two groups. The results were considering as statistically significant if p<0.05. Data analysis was performed using the statistical analysis program IBM SPSS, version 21.

Results

The initial population was 200, of which 2 were eliminated. We recruited 198 patients with myocardial infarction (Table 1), whose sociodemographic characteristics were: male gender 73,7%, mostly aged 65 years or more 52,5%, had more than 11year of education 64,1%, lived with partner 72,8%, were unemployed 56,6% and lived in the city 67,2%.

Table 1: Sociodemographic characteristics of patients with myocardial infarction.




  
    Characteristic 
    n (%) 
  
  
    Sex
  
  
    Male
    146 (73,7) 
  
  
    Female
    52 (26,3) 
  
  
    Age (years)
  
  
    <65
    94 (47,5) 
  
  
    =65
    104 (52,5) 
  
  
    Education level (years)
  
  
    =11
    71 (35,9) 
  
  
    >11
    127 (64,1) 
  
  
    Family type
  
  
    Live in pair
    144 (72,8) 
  
  
    Single
    54 (27,2) 
  
  
    Livelyhood
  
  
    Employed
    86 (43,4) 
  
  
    Unemployed
    112 (56,6) 
  
  
    Residence
  
  
    City
    133 (67,2) 
  
  
    Countryside
    65 (32,8)



Table 1: Sociodemographic characteristics of patients with myocardial infarction.

The difference between mean age of male and female was not statistically significant (p=0.082). There were no association determined between adherence to medication, extraversion, neuroticism, openness to experiences and the sex of the subjects (Table 2). However, female scored higher on conscientiousness and agreeableness compared to male (28,60 (5,24) vs 25,96 (4,85)).

Table 2: Adherence to treatment and personality traits according to gender.




  
    
    Male 

      Mean (SD) 
    Female 

      Mean (SD) 
    P 
  
  
    Medical adherence 
    5,78 (1,92) 
    5,84 (1,70) 
    0,983 
  
  
    Extraversion 
    24,14 (4,36) 
    23,44 (5,50) 
    0,503 
  
  
    Conscientiousness 
    25,96    (4,85) 
    28,60    (5,24) 
    0,001 
  
  
    Agreeableness 
    25,68    (5,11) 
    28,17    (6,03) 
    0,001 
  
  
    Neuroticism 
    15,88 (4,87) 
    17,38 (6,15) 
    0,087 
  
  
    Openness to experiences 
    19,46 (4,69) 
    18,69 (5,83) 
    0,223



Table 2: Adherence to treatment and personality traits according to gender.

It turns out that almost every second subject of our study had poor medical adherence (48%), every third (31%) regular and every fifth (21%) good medical adherence.

We determined, that low Morisky-Green scores was significantly related to low conscientiousness, agreeableness and high neuroticism, which indicates that individuals who rated low conscientiousnes and agreeablenes personality traits were more disposed to a non adherent behaviour and indivicuals with high neuroticism scores were prone to poor medical adherence. Meanwhile good medical adherence was related to high conscientiousness, agreeableness and low neuroticism. There was no significant associations between MMAS-8 scores and extraversion or openness to experiences (Table 3).

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Citation:Brazaitiene MA, Adomaitiene V and Gustiene O. Can Personality Traits be Related to Medical Adherence in Patients with Myocardial Infarction?. J Fam Med. 2021; 8(5): 1258.

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		Poor Mean (SD)	Regular Mean (SD)	Good Mean (SD)	P
Personality traits	Extraversion	23,52 (3,87)	23,92 (5,45)	25,00 (5,06)	0,221
	Conscientiousness	24,77 (4,93)	28,45 (4,37)	28,21 (4,96)	<0,001
	Agreeableness	24,43 (5,41)	27,77 (5,27)	28,48 (4,41)	<0,001
	Neuroticism	17,49 (4,41)	14,98 (5,75)	15,48 (5,74)	0,007
	Openness to experiences	19,64 (4,65)	18,84 (5,77)	19,02 (4,62)	0,244