Positive Psychology Interventions to Improve Wellbeing and Health Behaviour Adherence in Patients with Type 2 Diabetes Mellitus: A Scoping Review and Meta-analyses
The aim of this review was to evaluate the effectiveness of positive psychological interventions (PPIs) to improve well-being and health behaviour adherence among patients with type 2 diabetes mellitus (T2DM). Medline, PsycINFO, the Cochrane register, EMBASE, and Google Scholar were systematically searched to find relevant studies until January 2020. The primary outcome was reduction in risk factors of cardiovascular disease including HbA1c, systolic blood pressure (SBP), and diastolic blood pressure along with improvement in positive affect, optimism, self-efficacy, and health behaviour adherence such as diet, exercise and medication. The secondary outcomes were reduction in depression, anxiety and stress. A random-effect model was used to compare group effect size at post-test. We identified a total of 11 studies (N=1594 participants) with substantial variability in the interventions. Overall, the results provide evidence that multi-component PPIs have a small but significant effect on positive affect, optimism, health behaviour, self-care and BMI. Further, the review demonstrates that PPIs can be effective in the reduction of anxiety and stress symptoms. However, studies included in this review are heterogenous due to methodological variation, therefore, in future more studies across a wide range of PP interventions needs to be included in order to validate the findings and for conclusive evidence.
Positive Psychology Interventions to Improve Wellbeing and Health Behaviour Adherence in Patients with Type 2 Diabetes Mellitus: A Scoping Review and Meta-analyses, Psychology and Behavioral Sciences.
Vol. 9, No. 5,
2020, pp. 68-86.
Sabatâe E. Adherence to Long Term Therapies: Evidence for Action. Geneva, 2003.
Sirari, T., Patro, B., Datta, P., et al. (2019). Levels of compliance of self-care practices of diabetes mellitus type 2 patients: a study from a tertiary care hospital of North India. International Journal of Diabetes in Developing Countries; 39 (1). p. 193–200.
Baldwin, D. S., Anderson, I. M., Nutt, D. J., et al. (2002). Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. Journal of psychopharmacology (Oxford, England); 19 (6). p. 567–96.
Weaver, L. J., Madhu, S. V. (2015). Type 2 Diabetes and Anxiety Symptoms Among Women in New Delhi, India. American Journal of Public Health; 105 (11). p. 2335–2340.
Joseph, N., Unnikrishnan, B., Raghavendra Babu, Y., et al. (2013). Proportion of depression and its determinants among type 2 diabetes mellitus patients in various tertiary care hospitals in Mangalore city of South India. Indian Journal of Endocrinology and Metabolism; 17 (4). p. 681.
World Health Organization. (2020). World Health Organization, Depression, https://www.who.int/news-room/fact-sheets/detail/depression (accessed 15 August 2020).
Hofmann, M., Köhler, B., Leichsenring, F., et al. (2013). Depression as a risk factor for mortality in individuals with diabetes: A meta-analysis of prospective studies. PLoS ONE; 8 (11). Epub ahead of print November 2013. DOI: 10.1371/journal.pone.0079809.
Davis, W. K., Hess, G. E., Hiss, R. G. (1988). Psychosocial correlates of survival in diabetes. Diabetes care; 11 (7). p. 538–45.
Lloyd, C. E., Hermanns, N., Nouwen, A., et al. (2010). The Epidemiology of Depression and Diabetes. In: Katon W, Maj M, Sartorius N (eds) Depression and Diabetes. Chichester, UK: John Wiley & Sons, Ltd, pp. 1–27.
Lin, E. H. B., Katon, W., Rutter, C., et al. (2006). Effects of enhanced depression treatment on diabetes self-care. Annals of Family Medicine; 4 (1). p. 46–53.
Al-Khawaldeh, O. A., Al-Hassan, M. A., Froelicher, E. S. (2012). Self-efficacy, self-management, and glycemic control in adults with type 2 diabetes mellitus. Journal of Diabetes and its Complications; 26 (1). p. 10–16.
Huffman, J. C., DuBois, C. M., Millstein, R. A., et al. (2015). Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development. Journal of Diabetes Research; 2015 p. 1–18.
Celano, C. M., Freedman, M. E., Beale, E. E., et al. (2018). A Positive Psychology Intervention to Promote Health Behaviors in Heart Failure. The Journal of Nervous and Mental Disease; 206 (10). p. 800–808.
Kubzansky, L. D., Huffman, J. C., Boehm, J. K., et al. (2018). Reprint of: Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series. Journal of the American College of Cardiology; 72 (23). p. 3012–3026.
Moneta, G. B., Vulpe, A., Rogaten, J. (2012). Can positive affect “undo” negative affect? A longitudinal study of affect in studying. Personality and individual differences; 53 (4). p. 448–452.
Celano, C. M., Beale, E. E., Moore, S. V., et al. (2013). Positive psychological characteristics in diabetes: a review. Current diabetes reports; 13 (6). p. 917–929.
Hendriks, T., Schotanus-Dijkstra, M., Hassankhan, A., et al. (2019). The Efficacy of Multi-component Positive Psychology Interventions: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Journal of Happiness Studies. Epub ahead of print February 2019. DOI: 10.1007/s10902-019-00082-1.
Massey, C. N., Feig, E. H., Duque-Serrano, L., et al. (2019). Well-being interventions for individuals with diabetes: A systematic review. Diabetes Research and Clinical Practice; 147 p. 118–133.
Arksey, H., O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology: Theory and Practice; 8 (1). p. 19–32.
Tricco, A. C., Lillie, E., Zarin, W., et al. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine; 169 (7). p. 467–473.
Bolier, L., Haverman, M., Westerhof, G. J., et al. (2013). Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC public health; 13 (1). p. 119.
Chakhssi, F., Kraiss, J. T., Sommers-Spijkerman, M., et al. (2018). The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: a systematic review and meta-analysis. BMC Psychiatry; 18 (1). p. 211.
Dickens, L. R. (2017). Using Gratitude to Promote Positive Change: A Series of Meta-Analyses Investigating the Effectiveness of Gratitude Interventions. Basic and Applied Social Psychology; 39 (4). p. 193–208.
Sin, N. L., Lyubomirsky, S. (2009). Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. Journal of Clinical Psychology; 65 (5). p. 467–487.
Casellas-Grau, A., Font, A., Vives, J. (2014). Positive psychology interventions in breast cancer. A systematic review. Psycho-Oncology; 23 (1). p. 9–19.
Macaskill, A. (2016). Review of Positive Psychology Applications in Clinical Medical Populations. Healthcare; 4 (3). p. 66.
Sutipan, P., Intarakamhang, U., Macaskill, A. (2017). The Impact of Positive Psychological Interventions on Well-Being in Healthy Elderly People. Journal of Happiness Studies; 18 (1). p. 269–291.
Walsh, S., Cassidy, M., Priebe, S. (2017). The Application of Positive Psychotherapy in Mental Health Care: A Systematic Review. Journal of Clinical Psychology; 73 (6). p. 638–651.
Woodworth, R. J., O’Brien-Malone, A., Diamond, M. R., et al. (2016). Happy Days: Positive Psychology interventions effects on affect in an N-of-1 trial. International Journal of Clinical and Health Psychology; 16 (1). p. 21–29.
Rashid, T. (2015). Positive psychotherapy: A strength-based approach. Journal of Positive Psychology; 10 (1). p. 25–40.
Peters, M., Godfrey, C., McInerney, P., et al. (2015). Methodology for jbi scoping reviews. p. 3–24.
Peters, M. D. J., Godfrey, C. M., Khalil, H., et al. (2015). Guidance for conducting systematic scoping reviews. International Journal of Evidence-Based Healthcare; 13 (3). p. 141–146.
Rosenthal, R. Meta-Analytic Procedures for Social Research. SAGE Publications, Inc. Epub ahead of print July 2011. DOI: 10.4135/9781412984997.
Higgins, J. P. T., Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine; 21 (11). p. 1539–1558.
Borenstein, M., Hedges, L. V., Higgins, J. P. T., et al. Publication Bias.
Lipsey, M., & Wilson, D. (2001). Practical meta-analysis - IDoStatistics.
Lipsey, M. W., Wilson, D. B. (1993). The efficacy of psychological, educational, and behavioral treatment: Confirmation from meta-analysis. American Psychologist; 48 (12). p. 1181–1209.
Orwin, R. (1983). A Fail-Safe N for Effect Size in Meta-Analysis. Journal of Educational Statistics; 8 (2). p. 157–159.
Egger, M., Smith, G. D., Schneider, M., et al. (1997). Bias in meta-analysis detected by a simple, graphical test measures of funnel plot asymmetry. Bmj; 315 (7109). p. 629–34.
Duval, S., Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics; 56 (2). p. 455–463.
Bradshaw, B. G., Richardson, G. E., Kumpfer, K., et al. (2007). Determining the efficacy of a resiliency training approach in adults with type 2 diabetes. The Diabetes Educator; 33 (4). p. 650–659.
Celano, C. M., Gianangelo, T. A., Millstein, R. A., et al. (2019). A positive psychology–motivational interviewing intervention for patients with type 2 diabetes: Proof-of-concept trial. International Journal of Psychiatry in Medicine; 54 (2). p. 97–114.
Yalcin, B. M., Karahan, T. F., Ozcelik, M., et al. (2008). The effects of an emotional intelligence program on the quality of life and well-being of patients with type 2 diabetes mellitus. Diabetes Educator; 34 (6). p. 1013–1024.
Cohn, M. A., Pietrucha, M. E., Saslow, L. R., et al. (2014). An online positive affect skills intervention reduces depression in adults with type 2 diabetes. The Journal of Positive Psychology; 9 (6). p. 523–534.
DuBois, C. M., Millstein, R. A., Celano, C. M., et al. (2016). Feasibility and Acceptability of a Positive Psychological Intervention for Patients With Type 2 Diabetes. The Primary Care Companion For CNS Disorders. Epub ahead of print 5 May 2016. DOI: 10.4088/PCC.15m01902.
Nishita, C., Cardazone, G., Uehara, D. L., et al. (2013). Empowered Diabetes Management: Life Coaching and Pharmacist Counseling for Employed Adults With Diabetes. Health Education and Behavior; 40 (5). p. 581–591.
Nowlan, J. S., Wuthrich, V. M., Rapee, R. M., et al. (2016). A Comparison of Single-Session Positive Reappraisal, Cognitive Restructuring and Supportive Counselling for Older Adults with Type 2 Diabetes. Cognitive Therapy and Research; 40 (2). p. 216–229.
Peña-Purcell, N. C., Boggess, M. M., Jimenez, N. (2011). An Empowerment-Based Diabetes Self-management Education Program for Hispanic/Latinos: A Quasi-experimental Pilot Study. The Diabetes Educator; 37 (6). p. 770–779.
Steinhardt, M. A., Mamerow, M. M., Brown, S. A., et al. (2009). A resilience intervention in African American adults with type 2 diabetes. The Diabetes Educator; 35 (2). p. 274–284.
Voseckova, A., Truhlarova, Z., Janebová, R., et al. (2017). Activation group program for elderly diabetic patients. Social Work in Health Care; 56 (1). p. 13–27.
Wu, S. F. V., Lee, M. C., Liang, S. Y., et al. (2011). Effectiveness of a self efficacy program for persons with diabetes: A randomized controlled trial. Nursing & health sciences; 13 (3). p. 335–343.
Hendriks, T., Schotanus-Dijkstra, M., Hassankhan, A., et al. (2018). The efficacy of positive psychology interventions from non-Western countries: A systematic review and metaanalysis. International Journal of Wellbeing; 8 (1). p. 71–98.
Moskowitz, J. T., Epel, E. S., Acree, M. (2008). Positive affect uniquely predicts lower risk of mortality in people with diabetes. Health psychology : official journal of the Division of Health Psychology, American Psychological Association; 27 (1S). p. S73-82.
Tsenkova, V. K., Love, G. D., Singer, B. H., et al. (2007). Socioeconomic status and psychological well-being predict cross-time change in glycosylated hemoglobin in older women without diabetes. Psychosomatic medicine; 69 (8). p. 777–84.
Bandura, A. (2004). Health promotion by social cognitive means. Health education & behavior; 31 (2). p. 143–164.
Dlugonski, D., Motl, R. W., Mohr, D. C., et al. (2012). Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: sustainability and secondary outcomes. Psychology, health & medicine; 17 (6). p. 636–51.
Cuijpers, P., Van Straten, A., Bohlmeijer, E., et al. (2010). The effects of psychotherapy for adult depression are overestimated: A meta-analysis of study quality and effect size. Psychological Medicine; 40 (2). p. 211–223.
Christensen, H., Griffiths, K. M., Farrer, L. (2009). Adherence in internet interventions for anxiety and depression. Journal of Medical Internet Research; 11 (2). Epub ahead of print April 2009. DOI: 10.2196/jmir.1194.
Grossman, P., Niemann, L., Schmidt, S., et al. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research; 57 (1). p. 35–43.
Mazzucchelli, T. G., Kane, R. T., Rees, C. S. (2010). Behavioral activation interventions for well-being: A meta-analysis. Journal of Positive Psychology; 5 (2). p. 105–121.
Korte, J., Bohlmeijer, E. T., Cappeliez, P., et al. (2012). Life review therapy for older adults with moderate depressive symptomatology: A pragmatic randomized controlled trial. Psychological Medicine; 42 (6). p. 1163–1173.
Veehof, M. M., Oskam, M. J., Schreurs, K. M. G., et al. (2011). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain; 152 (3). p. 533–542.
Lundahl, B. W., Taylor, M. J., Stevenson, R., et al. (2008). Process-based forgiveness interventions: A meta-analytic review. Research on Social Work Practice; 18 (5). p. 465–478.
van Straten, A., Seekles, W., van’t Veer-Tazelaar, N. J., et al. (2010). Stepped care for depression in primary care: What should be offered and how? Medical Journal of Australia; 192 (SUPPL. 11). Epub ahead of print June 2010. DOI: 10.5694/j.1326-5377.2010.tb03691.x.
Lianov, L. S., Fredrickson, B. L., Barron, C., et al. (2019). Positive Psychology in Lifestyle Medicine and Health Care: Strategies for Implementation. American Journal of Lifestyle Medicine; 13 (5). p. 480–486.
Martínez-Martí, M. L., Avia, M. D., Hernández-Lloreda, M. J. (2010). The Effects of Counting Blessings on Subjective Well-Being: A Gratitude Intervention in a Spanish Sample. The Spanish journal of psychology; 13 (2). p. 886–896.