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Original Article

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

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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

Copyright © 2016 Korean Society of Adult Nursing

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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  • 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.
kjan-28-61f1.jpg
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  
Male 130 (55.1) 91.63±13.84      
Age (year) 30~49a 23 (9.7) 82.13±16.16 12.73† ＜.001 a＜b‡
50~59a 58 (24.6) 89.47±11.92    
60~69b 87 (36.9) 95.37±12.54    
≥70b 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
No 26 (11.0) 90.62±13.23    
Religion Yes 166 (70.3) 94.51±12.29 2.23 .027
No 70 (29.7) 90.47±13.57    
Occupation Yes 105 (44.5) 90.51±13.95 3.06 .002
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
No 151 (64.0) 96.20±11.51    
Smoking Yes 56 (23.7) 84.29±14.47 6.57 ＜.001
No 180 (76.3) 96.12±10.82    
Years of follow-up ＜3a 59 (25.0) 88.69±13.91 6.04 ＜.001 a＜c‡
3~＜6b 58 (24.6) 91.33±12.51    
6~＜11c 75 (31.8) 97.01±11.99    
≥11c 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
No 161 (68.2) 93.17±12.67    
Admission experience Yes 188 (79.7) 94.26±12.53 2.27 .024
No 48 (20.3) 89.60±13.25    
Number of admission 1 112 (59.6) 93.38±12.59 1.16 .248
≥2 76 (40.4) 95.54±12.41    
Surgery /intervention Yes 143 (60.6) 94.69±12.35 2.08 .038
No 93 (39.4) 91.15±13.30    
Diagnosis Unstable anginaa 117 (49.6) 96.15±11.65 4.02 .004
Stable anginaa 69 (29.2) 92.32±12.81    
NSTEMIa 25 (10.6) 87.72±15.12    
STEMIa 15 (6.4) 86.73±13.63    
Variant anginaa 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
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
M±SD M±SD
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
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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
    Image
    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

    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  
    Male 130 (55.1) 91.63±13.84      
    Age (year) 30~49a 23 (9.7) 82.13±16.16 12.73† ＜.001 a＜b‡
    50~59a 58 (24.6) 89.47±11.92    
    60~69b 87 (36.9) 95.37±12.54    
    ≥70b 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
    No 26 (11.0) 90.62±13.23    
    Religion Yes 166 (70.3) 94.51±12.29 2.23 .027
    No 70 (29.7) 90.47±13.57    
    Occupation Yes 105 (44.5) 90.51±13.95 3.06 .002
    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
    No 151 (64.0) 96.20±11.51    
    Smoking Yes 56 (23.7) 84.29±14.47 6.57 ＜.001
    No 180 (76.3) 96.12±10.82    
    Years of follow-up ＜3a 59 (25.0) 88.69±13.91 6.04 ＜.001 a＜c‡
    3~＜6b 58 (24.6) 91.33±12.51    
    6~＜11c 75 (31.8) 97.01±11.99    
    ≥11c 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
    No 161 (68.2) 93.17±12.67    
    Admission experience Yes 188 (79.7) 94.26±12.53 2.27 .024
    No 48 (20.3) 89.60±13.25    
    Number of admission 1 112 (59.6) 93.38±12.59 1.16 .248
    ≥2 76 (40.4) 95.54±12.41    
    Surgery /intervention Yes 143 (60.6) 94.69±12.35 2.08 .038
    No 93 (39.4) 91.15±13.30    
    Diagnosis Unstable anginaa 117 (49.6) 96.15±11.65 4.02 .004
    Stable anginaa 69 (29.2) 92.32±12.81    
    NSTEMIa 25 (10.6) 87.72±15.12    
    STEMIa 15 (6.4) 86.73±13.63    
    Variant anginaa 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.

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

    Variables Categories n (%) Range M±SD Negative affectivity Social inhibition
    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    

    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
    M±SD M±SD
    Resilience 122.18±25.02 133.71±21.54 3.61 ＜.001
    Compliance 90.74±12.54 94.46±12.77 2.08 .039

    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)

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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