Mentalizing in chronic conditions: A cross-sectional study of reflective functioning and adherence in transplant recipients

Background: Solid organ transplantation presents significant psychological challenges for recipients. While research has established relationships between psychological distress and medication non-adherence, the potential protective role of mentalization remains unexplored in transplant populations. This pilot study investigated whether reflective functioning moderates the relationship between psychopathological symptoms and medication adherence in transplant recipients. Methods: This cross-sectional study examined 117 adult solid organ transplant recipients (kidney 57.3 %, liver 25.6 %, heart 11.1 %, lung 3.4 %, multiple organs 2.6 %). Participants completed validated measures assessing reflective functioning, medical adherence, psychopathological symptoms, perceived social support, and health-related quality of life. Hierarchical multiple regression analyses tested the proposed moderation model, controlling relevant demographic and clinical variables. Results: Psychopathology negatively predicted medication adherence, while reflective functioning demonstrated a significant positive association with adherence behaviors. The interaction between psychopathology and reflective functioning was significant, indicating that the deleterious relationship between psychopathological symptoms and adherence was significantly stronger when reflective functioning was impaired but non-significant at high levels of reflective functioning. Conclusions: These findings demonstrate that mentalization functions as a psychological buffer against non-adherence during periods of psychological distress in transplant recipients. Impaired reflective functioning represents a specific risk factor for medication non-adherence, particularly when recipients experience elevated psychopathological symptoms. Results support the development of mentalization-based interventions to enhance transplant recipients' psychological integration of the transplant experience and promote sustained adherence to immunosuppressive therapy.