Fundamentals of Mental Health

Fundamentals of Mental Health

Predicting treatment adherence for people with multiple sclerosis through attachment styles mediated by perceived social support and health-related quality of life

Document Type : Research Paper

Authors
Ali Asghar Asgharnejad-Farid 1
Pardis Arji 2
Komeil Zahedi Tajrishi 1
Mohammad Ali Nahayati 3
1 School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.
2 Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.
3 Assistant professor of neurology, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/JFMH.2025.81321.3147
Abstract
Introduction: Multiple Sclerosis (MS) is a chronic neurological disorder that compromises patients’ physical and psychological health. Sustained treatment adherence is essential for effective management, yet often difficult to maintain. This study examines the influence of attachment style, Health-Related Quality of Life (HRQoL) and perceived social support on adherence among individuals with MS.
 
Materials and Methods: This descriptive-correlational study included 239 MS patients from the Comprehensive MS Center in Mashhad-Iran, in 2022. Participants completed validated questionnaires on attachment styles, perceived social support, HRQoL, and treatment adherence. Structural Equation Modeling (SEM) was used to analyze relationships between variables.
 
Results: Bivariate correlations showed avoidant and anxious attachment negatively associated with treatment adherence, while secure attachment was positively associated. However, SEM revealed no significant direct effects of attachment styles on adherence. Perceived social support (β= 0.353, P= 0.001) and HRQoL (β= 0.277, P= 0.003) demonstrated significant positive direct effects on adherence. Indirect effects of attachment styles on adherence via perceived social support and HRQoL were non-significant.
 
Conclusion: Findings emphasize the role of HRQoL and perceived social support in promoting treatment adherence in MS patients. Although attachment styles correlate with adherence, they lack direct predictive power. Interventions targeting HRQoL improvement and social support enhancement could effectively boost adherence in this population.
Keywords
Attachment style
Health-related quality of life
Multiple sclerosis
Perceived social support
Treatment adherence
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Fundamentals of Mental Health
Volume 28, Issue 1
January and February 2026
Pages 45-53