An online positive affect skills intervention reduces depression in adults with type 2 diabetes

Abstract

Positive affect predicts improved glycemic control and longevity in adults with type 2 diabetes. We tested DAHLIA, a self-paced online intervention for type 2 diabetes that teaches positive affect skills such as savoring, gratitude, and acts of kindness. Participants (n=49) were randomized to the 5-week DAHLIA course or an emotion-reporting waitlist control. DAHLIA was understood and accepted by participants and showed good retention (78%). At post-intervention, DAHLIA participants showed a significantly greater decrease in depression than controls (−4.3 vs. +0.6 points on the CES-D, p =.05). Secondary analyses found that this effect was considerably stronger in intervention recipients recruited online than those recruited in person. Intervention recipients recruited online also showed significantly increased positive affect, reduced negative affect, and reduced perceived stress. There were no effects on measures of diabetes-specific efficacy or sense of burden, or preliminary measures of health behaviors. This successful feasibility and efficacy trial provides support for a larger trial focusing more specifically on health behavior.

Web-Based Interventions for Depression in Individuals with Diabetes: Review and Discussion (Preprint)

“…According to these criteria, a total of five studies were identified [21,[30][31][32][33]. A summary of the reviewed articles is provided in Table 1.…”

“…Three studies had waitlist as control [21,30,31], one added daily emotion reporting [31]. One study used treatment as usual as control [33].…”

“…Newby and cols [33] excluded participants with a severe profile (PHQ-9 > 23). In Bond and cols [30] and Cohn and cols [31] studies, CES-D was employed but with no established cut-off scores; their treatment groups had a mean baseline CES-D score of 12 (SD=10.4) and 16.9 (SD=11.6), respectively. Khamseh and cols [39] assessed the efficacy and accuracy of the CES-D and the PHQ-9, in comparison with clinical interview in people with type 2 diabetes and found that cut-off scores for CES-D and PHQ-9 of ≥ 23 and ≥ 13 points, respectively, provided an optimal balance between sensitivity and specificity.…”

“…All studies included standardized measures to assess diabetes distress: the Problem Areas in Diabetes Questionnaire (PAID) [21,30,32,33] or the Diabetes Distress Scale (DDS) [31]. Questionnaires were administered online, at baseline, posttreatment and in follow-up (when present).…”

“…All studies included standardized measures to assess symptoms of depression: the Center for Epidemiological Studies-Depression (CES-D) measure [21,[30][31][32] or the Patient Health Questionnaire-9 (PHQ-9) [33]. Questionnaires were administered online, at baseline, posttreatment and at follow-up (when present).…”