Positive Psychology Interventions in Medical Populations: Critical Issues in Intervention Development, Testing, and Implementation

The heart's silver lining: Positive psychological well-being and health related quality of life in patients with heart failure

OBJECTIVE

Psychological distress, including depression, is linked to poor health outcomes in cardiovascular disease. Emerging evidence suggests that positive psychological well-being (PPWB), including optimism and purpose, may also impact health outcomes. However, the role of PPWB in heart failure (HF), a highly prevalent and progressive condition that severely affects health-related quality of life (HRQoL), remains unclear. This study explored the association between PPWB and HRQoL in patients with HF.

METHODS

In this cross-sectional study, 101 patients with HF from a cardiac hospital completed validated measures of PPWB (BIT), depression (PHQ-9), disease-specific HRQoL (KCCQ-12), and generic HRQoL (SF-36). Spearman correlations and hierarchical multiple linear regression analyses were conducted, adjusting for sex, age, depression, and comorbidities (Charlson Comorbidity Index).

RESULTS

Participants (mean age = 68.2 ± 9.9; 36 % female; 76 % NYHA class II) reported moderate PPWB (BIT = 3.7 ± 0.7), "fair" disease-specific HRQoL (KCCQ-12 Total score = 61.3 ± 23), and below-average generic HRQoL (SF-36 General Health = 36.2 ± 19.4). PPWB was significantly positively correlated with all KCCQ-12 and SF-36 subscales, with the strongest correlation for SF-36 General Health (r = 0.58, p < .001). In multivariable models, higher BIT scores were associated with better HRQoL across domains, including KCCQ-12-QoL (β = 0.26, p = .012), KCCQ-12 Social Limitations (β = 0.26, p = .017), KCCQ-12 Total score (β = 0.21, p = .042), SF-36 Energy (β = 0.38, p < .001), and SF-36 General Health (β = 0.48, p < .001).

CONCLUSION

PPWB is significantly associated with both disease-specific and generic HRQoL in patients with HF, even after adjusting for comorbidities and depression. These findings highlight the importance of focusing on well-being, not just distress, in future HF research.

Effectiveness of Nurse-Led Psychological Interventions on Diabetes Distress, Depression, and Glycemic Control in Individuals With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

PURPOSE

To explore the effect of nurse-led psychological interventions on diabetes distress, depression, and glycemic control in individuals with type 2 diabetes mellitus (T2DM).

METHOD

Seven databases were systematically searched. Outcome measures were diabetes distress, depression, and hemoglobin A1c (HbA1c) level. RoB 2.0 was used for risk of bias assessment. Data were synthesized using Review Manager 5.4 software.

RESULTS

Fourteen studies were included from 2,837 articles. Five studies pooled in the meta-analysis demonstrated reduction in diabetes distress (standard mean difference = -0.36, 95% confidence interval [-0.49, -0.24], p < 0.001), favoring nurse-led psychological interventions over controls. Effects of the interventions on depression and HbA1c level were inconsistent across studies.

CONCLUSION

Nurse-led psychological interventions demonstrated the effect of reducing diabetes distress and some promising benefits for depression and glycemic control. Integrating nurse-led psychological interventions into usual care will be beneficial for individuals with T2DM in the future. [Journal of Psychosocial Nursing and Mental Health Services, 63(3), 11-18.].

Positive Psychological Well-Being in Early Palliative Care: A Narrative Review of the Roles of Hope, Gratitude, and Death Acceptance

In the advanced cancer setting, low psychological functioning is a common symptom and its deleterious impact on health outcomes is well established. Yet, the beneficial role of positive psychological well-being (PPWB) on several clinical conditions has been demonstrated. Early palliative care (EPC) is a recent value-based model consisting of the early integration of palliative care into standard care for solid tumors and hematologic malignancies. While the late palliative care primary offers short-term interventions, predominantly pharmacological in nature and limited to physical symptom reduction, EPC has the potential to act over a longer term, enabling specific interventions aimed at promoting PPWB. This narrative review examines nine English studies retrieved from MEDLINE/PubMed, published up to October 2023, focusing on EPC and three dimensions of PPWB: hope, gratitude, and death acceptance. These dimensions consistently emerge in our clinical experience within the EPC setting for advanced cancer patients and appear to contribute to its clinical efficacy. The choice of a narrative review reflects the novelty of the topic, the limited existing research, and the need to incorporate a variety of methodological approaches for a comprehensive exploration.

A Conceptual Protocol for a Single-Session Solution-Focused Brief Therapy for Medication Adherence Intervention Delivered by General Providers

New approaches to medication adherence interventions are needed. This manuscript presents a highly structured protocol of a single-session solution-focused brief therapy (SFBT) for medication adherence intervention (SFBT-MAI) delivered by general providers. It conceptually integrates the procedure of tailored interventions, techniques of SFBT, and the four steps of Qitang Lin' conceptualization of single-session SFBT. With specific techniques and examples to reduce operational difficulties, the SFBT-MAI includes two parts. The first part focuses on selecting non-adherent patients and clarifying their barriers to medication adherence. The second part focuses on individualized interventions with four steps: closing, hoping, empowering, and changing and acting. It is hoped that this work will improve the effectiveness of medication adherence interventions for patients with coronary heart disease and to promote the use of brief psychological interventions in clinical practice.

Introduction to Special Issue: Interventions to Modify Psychological Well-Being and Population Health

Psychological ill-being is on the rise, with 1 in 5 Americans suffering from a mental disorder in any given year. Additional evidence demonstrates that psychological well-being has also decreased over time. These trends are particularly worrisome given the substantial and growing body of evidence demonstrating that psychological ill-being (e.g., depression, anxiety, anger) is associated with an elevated risk of developing chronic diseases and premature mortality, while aspects of psychological well-being (e.g., positive affect, sense of purpose and meaning, life satisfaction) are independently associated with improved physical health outcomes. An underexplored but promising approach to enhancing both psychological and physical health is through developing a set of tools that specifically target psychological well-being (often referred to as positive psychological interventions (PPIs) although many interventions developed outside the field of positive psychology also achieve these goals). Such interventions hold promise as a strategy for improving population health. However, critical knowledge gaps hold us back, and we have not yet developed a robust set of intervention strategies that can improve psychological well-being in meaningful, durable, and scalable ways that would also have downstream effects on physical health. The goal of this special issue is to help address these knowledge gaps by bringing together current conceptual frameworks, critical examination of key constructs, and novel empirical evidence needed to identify and examine interventions that can modify psychological well-being, particularly those that have the potential to be scaled at the population level and with durable effects.