Predicting psychological well-being based on resilience and life expectancy in diabetic patients with retinal damage

Dissertation for Master Degree (M.A)

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Introduction

Diabetes is not only a common disease but also a major health problem that has become widespread in the contemporary world. Diabetes or sugar disease is a metabolic (fuel) disorder in the body. In this disease, the ability to produce insulin in the body is lost, or the body becomes resistant to insulin, and therefore the produced insulin cannot perform its normal function. The main role of insulin is to lower blood sugar by different mechanisms. There are two main types of diabetes. In type 1 diabetes, the destruction of beta cells in the pancreas leads to the failure of insulin production, and in type 2 diabetes, there is a progressive resistance of the body to insulin, which may eventually lead to the destruction of pancreatic beta cells and the complete failure of insulin production. In type 2 diabetes, it is known that genetic factors, obesity and inactivity play an important role in a person's disease (Maraskin[1], 2012).

In diabetes, the speed and ability of the body to use and completely metabolize glucose decreases, hence the blood sugar level is increased, which is called hyperglycemia. When this increase in sugar is present in the body for a long time, microvascular complications of diabetes or the destruction of very small vessels in the body occur, which can involve different organs of the body such as kidneys, eyes, and nerves (Schiffer, Andrew, Lee, and Fleischer [2], 2011).

Diabetic retinopathy is one of the complications of diabetes that affects the eyes. Diabetic retinopathy is seen in three forms of macular edema (diffuse or localized vascular leakage in the macula), progressive vascular accumulation (microaneurysm, intraretinal hemorrhages, vascular curvature) and retinal arterial occlusion (Boyd [3] et al., 2013). 

Since not controlling diabetes can be associated with serious damage, including damage to the retina, it is very important to examine the psychological well-being and the factors affecting it in diabetic patients with retinal damage.

Psychological well-being has been studied abundantly in the research literature in the last two decades, and the scope of its studies has been extended from the field of individual life to social interactions (Cole, 2009). Psychological well-being, as one of the important aspects of well-being, means striving for transcendence and promotion, which is manifested in the realization of individual talents and abilities, or in other words, striving for perfection in order to realize the real potential abilities of the individual (Raif [4], 1995). Various models and opinions regarding psychological well-being have been proposed by psychologists and experts in the field of mental health. One of the most important models for explaining psychological well-being is the model of Rife and Keys (1995). In this model, psychological well-being is considered as an effort to reach perfection in order to realize the real potential abilities of a person, which includes six components of self-following [5], environmental mastery [6], personal growth [7], positive relationship with others [8], purpose and direction in life [9] and self-acceptance [10]. Even if it contradicts the customs and traditions accepted in the society; Environmental mastery means being under control of the surrounding world so that a person can control his life and environment to a large extent; Personal development includes the ability to flourish all forces and talents and cultivate new abilities in a person; A positive relationship with others refers to establishing intimate and close relationships with others, while having a desire to establish such relationships, as well as the ability to love those around you; Purpose and orientation in life means the ability to find meaning in life and to be purposeful and pursue goals; Self-acceptance also includes a person's positive attitude towards himself, which does not mean narcissism or high self-esteem, but rather self-respect that takes place by knowing one's own strengths and weaknesses (Reif and Keyes, 1995).

The role of support factors in helping people to actively adapt to stressful events has always been of interest to researchers in the field of psychology. So that they believe that in dealing with problems, people can develop more strength and endurance capacity in themselves while fighting stubbornly, so that they can overcome problems in this way. In the last two decades, researchers have found that people who are successful in dealing with stressful issues and pressures have different characteristics and characteristics, in comparison to people who are fragile in the face of problems, and in this way, they can handle less pressure.In the last two decades, researchers have found that people who are successful in dealing with stressful issues and pressures have different characteristics and characteristics compared to people who are fragile in the face of problems, and in this way, they can withstand less pressure and reach the point of mental balance as quickly as possible. One of these features has been proposed in the form of a concept called resilience [11]. Resilience is one of the main constructs of the positive psychology approach [12]. In recent years, this approach with the slogan of paying attention to human talents and capabilities (instead of addressing disorders and anomalies) has been the focus of researchers. Resilience includes different concepts. The term resilience has been defined in various ways: such as the ability to successfully adapt[13] to a changing environment (Darwin[14], 1989; Cicchitti and Cohen[15], 1995); Toughness[16] and invulnerability[17] (Anthony[18], 1974; Kobasa[19], 1979; Maddy and Khoshaba[20], 1994); and successful adaptation despite high stress and adverse circumstances (Stewart, Reid, & Mangham, 1997). But all definitions have a common description, and that is "the ability to return to the original state[22]" (quoted from Sahragard, 2016).

Garmazi and Masten (1991) consider resilience as a process, ability or result of successful adaptation despite challenging and threatening conditions. In another definition, resilience means revealing competence in people despite being under pressure and high stress (Garmzi, Masten and Telgen [23], 1984). Rutter [24] (2001) believes that resilience is a positive adaptation in response to adverse conditions.

Life expectancy as one of the precursors of psychological well-being has various definitions. Jenanche Frankel (1984) believes that when a person does his favorite activities, meets others, watches works of art and literature, or takes refuge in the lap of nature, he feels hope in himself. Also, when he feels that his existence is linked to a single source, and he considers himself dependent on broad and reliable frameworks and supports such as religion, and he has chosen a philosophy to live, he sees life, understands it, and feels it.   

Regarding the importance of examining the antecedents of psychological well-being in diabetic patients with retinal damage, the present study aims to investigate the predictive effect of resilience and life expectancy on the psychological well-being of diabetic patients with retinal damage.

2-1- Statement of the problem

World Health Organization (2001), health as a state of It defines complete physical, mental and social well-being and not merely the absence of disease. In other words, according to this organization, mental health is a state of well-being in which a person is aware of his abilities, adapts to psychological pressures, and is productive in his useful work (World Health Organization, 2004). Despite the above emphasis on positive issues, health professionals are often so focused on the problems of sick people that they forget the needs of healthy people. In other words, instead of paying attention to the positive aspects of health, mental health centers are more involved in the treatment of mental illnesses (Pilgrim[25], 1997).

Diabetes or diabetes is a metabolic disorder (fuel production) in the body. In this disease, the ability to produce insulin in the body is lost, or the body becomes resistant to insulin, and therefore the produced insulin cannot perform its normal function (Maraskin, 2012). Therefore, diabetes is one of the diseases that threaten a person's health and has a destructive effect on other body parts, including the eye (Boyd et al., 2013).

One of the eye injuries caused by diabetes is known as diabetic retinopathy. This disease directly targets the retina and causes the growth of abnormal blood vessels in that part. Therefore, it causes serious vision problems (Boyd et al., 2013).     

According to what was mentioned, the need to pay attention to the physical and mental health of these patients becomes more obvious. Therefore, knowing the factors that determine people's mental health is one of the most important issues of humanities in contemporary years. Theories such as Maslow's theories of self-actualization [26], full functioning [27] Rogers [28] and mature man or growth [29] Allport [30] have accepted and benefited from this basic hypothesis in forming the concept of psychological health (Ryan and Desi [31], 2001). Following the emergence of these theories and the positive psychology movement [32], which emphasized the existence of positive characteristics and the development of individual abilities in mental health, a group of psychologists have used the term psychological well-being [34] instead of the term mental health [33].