Volume 18, Issue 1 (2-2026)                   IJDO 2026, 18(1): 30-40 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Azimi Ghahveh Moghadam N, Noori R. Predicting Psychological Distress based on Mindfulness and Resilience with the Mediation of Cognitive Flexibility in Diabetic Patients. IJDO 2026; 18 (1) :30-40
URL: http://ijdo.ssu.ac.ir/article-1-1015-en.html
MSC in Psychology, Department of Psychology, Torbat Jam Branch, Islamic Azad University, Torbat Jam, Iran.
Abstract:   (41 Views)
Objective: The present study aimed to predict psychological distress based on mindfulness and resilience with the mediation of cognitive flexibility in diabetic patients.
Materials and Methods: This study is descriptive-correlational in nature and was conducted using structural equation modeling. The statistical population consisted of all diabetic patients visiting hospitals in Mashhad city. Using purposive and volunteer sampling methods, 115 individuals were selected as the sample. Participants completed The Kessler Psychological Distress Scale (K10), The Five Facet Mindfulness Questionnaire (FFMQ), The Connor-Davidson Resilience Scale (CD-RISC), and Cognitive Flexibility Inventory (CFI). Inferential statistics were employed, utilizing structural equation modeling (SEM), while inferential analysis evaluated hypotheses and assessed the structural relationships using SPSS version 22 and LISREL version 3.
Results: The descriptive results indicated the following scores for the study variables: psychological distress (M= 15.43± 10.81), mindfulness (M= 132.93± 36.30), resilience (M= 78.76± 15.95), and cognitive flexibility (M= 56.81± 20.91).The analyses confirmed significant relationships: resilience and mindfulness directly affect psychological distress and indirectly influence it through cognitive flexibility, with all effects being statistically significant (P< 0.05).
Conclusion: In conclusion, fostering mindfulness and resilience, alongside enhancing cognitive flexibility, offers a promising approach for alleviating psychological distress in patients with diabetes. Future studies should explore targeted intervention strategies to effectively strengthen these psychological resources, ultimately contributing to better disease management and quality of life.
 
Full-Text [PDF 760 kb]   (7 Downloads)    
Type of Study: Research | Subject: Special
Received: 2025/09/15 | Accepted: 2025/12/20 | Published: 2026/02/21

References
1. Chen X, Wang Y, Wang JN, Zhang YC, Zhang YR, Sun RX, et al. Lactylation-driven FTO targets CDK2 to aggravate microvascular anomalies in diabetic retinopathy. EMBO Molecular Medicine. 2024;16(2):294-318. [DOI:10.1038/s44321-024-00025-1]
2. Najafipour H, Farjami M, Sanjari M, Amirzadeh R, Shadkam Farokhi M, Mirzazadeh A. Prevalence and incidence rate of diabetes, pre-diabetes, uncontrolled diabetes, and their predictors in the adult population in southeastern Iran: findings from KERCADR study. Frontiers in public health. 2021;9:611652. [DOI:10.3389/fpubh.2021.611652]
3. Zawudie AB, Daka DW, Teshome D, Ergiba MS. Economic burden of diabetic mellitus among patients on follow-up care in hospitals of Southwest Shewa Zone, Central Ethiopia. BMC health services research. 2022;22(1):1398. [DOI:10.1186/s12913-022-08819-0]
4. Harding JL, Weber MB, Shaw JE. The global burden of diabetes. Textbook of diabetes. 2024:28-40. [DOI:10.1002/9781119697473.ch3]
5. American Diabetes Association Professional Practice Committee. "2. Diagnosis and classification of diabetes: standards of care in diabetes-2025." Diabetes Care 48, no. Supplement_1 (2025): S27-S49. doi: 10.2337/dc25-S002. PMID: 39651986; PMCID: PMC11635041. [DOI:10.2337/dc25-S002]
6. Antar SA, Ashour NA, Sharaky M, Khattab M, Ashour NA, Zaid RT, et al. Diabetes mellitus: Classification, mediators, and complications; A gate to identify potential targets for the development of new effective treatments. Biomedicine & Pharmacotherapy. 2023;168:115734. [DOI:10.1016/j.biopha.2023.115734]
7. Kulkarni A, Thool AR, Daigavane S. Understanding the clinical relationship between diabetic retinopathy, nephropathy, and neuropathy: a comprehensive review. Cureus. 2024;16(3):e56674. [DOI:10.7759/cureus.56674]
8. Li Y, Liu Y, Liu S, Gao M, Wang W, Chen K, et al. Diabetic vascular diseases: molecular mechanisms and therapeutic strategies. Signal transduction and targeted therapy. 2023;8(1):152. [DOI:10.1038/s41392-023-01400-z]
9. Bassi G, Gabrielli S, Donisi V, Carbone S, Forti S, Salcuni S. Assessment of psychological distress in adults with type 2 diabetes mellitus through technologies: literature review. Journal of medical Internet research. 2021;23(1):e17740. [DOI:10.2196/17740]
10. Ahmed MM, Ibrahim RM, Younis NM. Diabetic Distress among Patients with Type II: A Descriptive Study. Advanced Biomedical Research. 2025;14(1):23. [DOI:10.4103/abr.abr_328_24]
11. Zu W, Zhang S, Du L, Huang X, Nie W, Wang L. The effectiveness of psychological interventions on diabetes distress and glycemic level in adults with type 2 diabetes: a systematic review and meta-analysis. BMC psychiatry. 2024;24(1):660. [DOI:10.1186/s12888-024-06125-z]
12. Sendekie AK, Limenh LW, Bizuneh GK, Kasahun AE, Wondm SA, Tamene FB, et al. Psychological distress and its impact on glycemic control in patients with diabetes, Northwest Ethiopia. Frontiers in Medicine. 2025;12:1488023. [DOI:10.3389/fmed.2025.1488023]
13. Patra S, Patro BK, Padhy SK, Mantri J. Relationship of mindfulness with depression, self-management, and quality of life in type 2 diabetes mellitus: Mindfulness is a predictor of quality of life. Indian journal of social psychiatry. 2023;39(1):70-6. [DOI:10.4103/ijsp.ijsp_436_20]
14. Chems-Maarif R, Cavanagh K, Baer R, Gu J, Strauss C. Defining mindfulness: A review of existing definitions and suggested refinements. Mindfulness. 2025;16(1):1-20. [DOI:10.1007/s12671-024-02507-2]
15. Ee CC, Al-Kanini I, Armour M, Piya MK, McMorrow R, Rao VS, et al. Mindfulness-based interventions for adults with type 2 diabetes mellitus: A systematic review and meta-analysis. Integrative Medicine Research. 2025:101138. [DOI:10.1016/j.imr.2025.101138]
16. Yılmazer E, Altinok A. Innovating Mindfulness-Based Stress Reduction (MBSR) delivery in cancer care: Enhancing accessibility and engagement. Clinical Cancer Investigation Journal. 2024;13(2-2024):6-15. [DOI:10.51847/lrPe9pz2wg]
17. Färber F, Rosendahl J. The association between resilience and mental health in the somatically ill: a systematic review and meta-analysis. Deutsches Ärzteblatt International. 2018;115(38):621. [DOI:10.3238/arztebl.2018.0621]
18. Shahwan S, Tay EH, Shafie S, Tan YB, Gunasekaran S, Tan RH, et al. The protective role of resilience and social support against burnout during the COVID-19 pandemic. Frontiers in Public Health. 2024;12:1374484. [DOI:10.3389/fpubh.2024.1374484]
19. Riepenhausen A, Wackerhagen C, Reppmann ZC, Deter HC, Kalisch R, Veer IM, et al. Positive cognitive reappraisal in stress resilience, mental health, and well-being: A comprehensive systematic review. Emotion Review. 2022;14(4):310-31. [DOI:10.1177/17540739221114642]
20. Xu J, Yang X. The influence of resilience on stress reaction of college students during COVID-19: the mediating role of coping style and positive adaptive response. Current Psychology. 2024;43(13):12120-31. [DOI:10.1007/s12144-022-04214-4]
21. Amin SN, El-Akabawy G, Abuqasem MA, Al-Rawashdeh AA, Ayyad MM, Ibrahim AK, et al. Assessment of cognitive flexibility in jordanian diabetic patients by wisconsin card sorting and trail making tests: implications with demographic, anthropometric and therapeutic variables. Diabetes, Metabolic Syndrome and Obesity. 2024:2655-70. [DOI:10.2147/DMSO.S457799]
22. Uddin LQ. Cognitive and behavioural flexibility: neural mechanisms and clinical considerations. Nature reviews neuroscience. 2021;22(3):167-79. [DOI:10.1038/s41583-021-00428-w]
23. Roberts MZ, Scheiber FA, Moskovich AA, Merwin RM. A Scoping Review of the Relationship Between Psychological (In) flexibility and Living with and Managing Type 1 and Type 2 Diabetes. Behavioral Sciences. 2025; 15(6):792. [DOI:10.3390/bs15060792]
24. Mangoulia P, Milionis C, Vlachou E, Ilias I. The interrelationship between diabetes mellitus and emotional well-being: Current concepts and future prospects. InHealthcare 2024;12(14):1457. [DOI:10.3390/healthcare12141457]
25. Kline RB. Principles and practice of structural equation modeling. Guilford publications; 2023.https://www.guilford.com/books/Principles-and-Practice-of-Structural-Equation-Modeling/Rex-Kline/9781462551910
26. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological medicine. 2002;32(6):959-76. [DOI:10.1017/S0033291702006074]
27. Ataei J, Morteza-Shamshirgaran S, Iranparvar M, Safaeian A, Malek A. Reliability and validity of the Persian version of the Kessler psychological distress scale among patients with type 2 diabetes. Journal of Research in Clinical Medicine. 2015;3(2):99-106. [DOI:10.15171/jarcm.2015.015]
28. Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, et al. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008;15(3):329-42. [DOI:10.1177/1073191107313003]
29. Ahmadvand Z, Heydarinasab L, Shairi MR. An investigation of the validity and reliability of psychometric characteristics of five facet mindfulness questionnaire in Iranian non-clinical samples. International Journal of Behavioral Sciences. 2013;7(3):229-37.(in Persian)
30. Connor KM, Davidson JR. Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depression and anxiety. 2003;18(2):76-82. [DOI:10.1002/da.10113]
31. Samani S, Joukar B, Sahragard N. Effects of resilience on mental health and life satisfaction. Iranian Journal of Psychiatry and Clinical Psychology. 2007;13(3):290-95. (in Persian)
32. Dennis JP, Vander Wal JS. The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research. 2010;34(3):241-53. [DOI:10.1007/s10608-009-9276-4]
33. Heidari S, Maktabi G, SHEHNI YM, Behroozi N. The effect of mindfulness training on cognitive flexibility in sixth-grade female students. Iranian Evolutionary Educational Psychology Journal. 2020;2(2):131-40 [DOI:10.29252/ieepj.2.2.131]

Add your comments about this article : Your username or Email:
CAPTCHA

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2026 CC BY 4.0 | Iranian Journal of Diabetes and Obesity

Designed & Developed by : Yektaweb