The predictive role of psychological flexibility and cognitive emotion regulation strategies on depression, anxiety and stress in type 2 diabetic patients

Diabetes mellitus is one of the most common chronic diseases in the world, the disease is a metabolic one characterized by deficiencies in insulin secretion, which is classified to two different diabetes type. Considering the high prevalence of psychiatric disorders in type 2 diabetic patients and role of psychological flexibility and cognitive emotion regulation strategies on psychological problems, the aim of this study was to investigate the predicting role of psychological flexibility and cognitive emotion regulation strategies on depression, anxiety and stress in type 2 diabetic patients. 

The study was a cross–sectional and correlation one. Participants consisted of 102 men and women with type 2 diabetes that they referred to treatment centers in Khorramabad city (Lorestan province, West of Iran) including public and private hospitals, clinics and health centers who were selected by convenient sampling. Using cognitive emotion regulation questionnaire (CERQ), acceptance and action questionnaire (acceptance and action questionnaire–II) and anxiety, stress and depression questionnaire (24–DASS) to collect data. To analyze the data at the level of descriptive statistics, mean and standard deviation were used and at the level of inferential statistics Pearson correlation coefficient and regression were used and to analyze data SPSS software (SPSS version 24 IBM crop., Armonk. NY) were used. 

There is a significant negative correlation between psychological flexibility with depression in patients (p<0.001). There was a significant negative correlation between mental flexibility and anxiety variable in patients (p=0.028). On the other hand, a significant negative relationship between psychological flexibility and stress in patients (p<0.001) observed. There was a significant negative correlation between the depression variable and the adaptive cognitive emotion regulation strategies (p=0.015). There was a significant negative correlation between the stress variable and the adaptive cognitive emotion regulation strategies (p=0.017). However, there was not a significant relationship between adaptive cognitive emotion regulation strategies and anxiety. There was a significant adaptive correlation between the depression variable and the inadaptive cognitive emotion regulation strategies (p=0.05). However, there was not a significant relationship between adaptive cognitive emotion regulation strategies with stress, and there was not a significant relationship between adaptive cognitive emotion regulation strategies with anxiety. Also, psychological flexibility was an acceptable tool to determined depression, anxiety; also, it was the most important factor in predicting stress (p<0.001). Adaptive and inadaptive variables of cognitive emotion regulation strategies were not able to predict components of depression and anxiety significantly. However, the cognitive emotion regulation adaptive strategy could predict the stress component (p<0.01) significantly, and psychological flexibility and adaptive cognitive strategies were predictors of stress (p<0.001).

In general, individuals with high adaptive cognitive emotion regulation strategies and psychological flexibility accept their defects and problems, judge themselves less, and they are aware of their problems. This condition has led to less stress, anxiety, and depression. Therefore, it is recommended to exercise suitable practices to increase positive cognitive emotion regulation strategies and psychological flexibility in type 2 diabetic patients.