A Low-Intensity Internet-Based Intervention Focused on the Promotion of Positive Affect for the Treatment of Depression in Spanish Primary Care: Secondary Analysis of a Randomized Controlled Trial
Open accessAbstract
Background: A large number of low-intensity Internet-based interventions (IBIs) for the treatment of depression have emerged in Primary Care; most of them focused on decreasing negative emotions. However, recent studies have highlighted the importance of addressing positive affect (PA) as well. This study is a secondary analysis of a randomized control trial. We examine the role of an IBI focused on promoting PA in patients with depression in Primary Care (PC). The specific objectives were to explore the profile of the patients who benefit the most and to analyze the change mechanisms that predict a significantly greater improvement in positive functioning measures. Methods: 56 patients were included. Measures of depression, affect, well-being, health-related quality of life, and health status were administered. Results: Participants who benefited the most were those who had lower incomes and education levels and worse mental health scores and well-being at baseline (7.9%–39.5% of explained variance). Improvements in depression severity and PA were significant predictors of long-term change in well-being, F (3,55) = 17.78, p < 0.001, R2 = 47.8%. Conclusions: This study highlights the importance of implementing IBIs in PC and the relevance of PA as a key target in Major Depressive Disorder treatment.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Vara et al.'s results supported that promotion of positive affect might have an impact on the decline in clinical symptomatology and improve positive functioning.
“The results of this study supported not only that the promotion of positive affect might have an impact on the decline in clinical symptomatology and improve positive functioning”
From Using Information and Communication Technologies (ICT) for Mental Health Prevention and Treatment (2021) · cites this paper as [6]
Vara et al.'s results supported that both improvements in depression and in positive affect can be responsible for long-term changes in wellbeing.
“but that both the improvements in depression and in positive affect can be responsible for the long-term changes in wellbeing”
From Using Information and Communication Technologies (ICT) for Mental Health Prevention and Treatment (2021) · cites this paper as [6]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Development and validation of brief measures of positive and negative affect: The PANAS scales.
Watson, D., Clark, L. A., & Tellegen, A. (1988) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.54.6.1063 · Cited by 32,433 · see citing works
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
WARE, J. E., KOSINSKI, M., & KELLER, S. D. (1996) · Medical Care · doi:10.1097/00005650-199603000-00003 · Cited by 17,392 · see citing works
Positive psychology: An introduction.
Seligman, M. E. P., & Csikszentmihalyi, M. (2000) · American Psychologist · doi:10.1037/0003-066x.55.1.5 · Cited by 11,351 · see citing works
(1998) · PubMed · Cited by 10,216 · see citing works
Gray, J. A. (1982) · Behavioral and Brain Sciences · doi:10.1017/s0140525x00013066 · Cited by 4,477 · see citing works
Classical and Modern Regression With Applications.
Steinhorst, R. K., & Myers, R. H. (1988) · Journal of the American Statistical Association · doi:10.2307/2288958 · Cited by 3,691 · see citing works
Multiple imputation by chained equations: what is it and how does it work?
Azur, M. J., Stuart, E. A., Frangakis, C., & Leaf, P. J. (2011) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.329 · Cited by 3,542 · see citing works
Fredrickson, B. L. (2001) · American Psychologist · doi:10.1037//0003-066x.56.3.218 · Cited by 3,512 · see citing works
Psychological Well-Being Revisited: Advances in the Science and Practice of Eudaimonia
Ryff, C. D. (2014) · Psychotherapy and Psychosomatics · doi:10.1159/000353263 · Cited by 2,976 · see citing works
Sin, N. L., & Lyubomirsky, S. (2009) · Journal of Clinical Psychology · doi:10.1002/jclp.20593 · Cited by 2,955 · cited 1× · see citing works
“These results emphasize the benefits of including PP exercises and techniques in conventional treatments to promote positive emotions and positive functioning measures [19,20].”
BackgroundCognitive Therapy: Basics and Beyond
Beck, J. S. (1995) · Medical Entomology and Zoology · Cited by 2,208 · see citing works
Watson, D., Wiese, D., Vaidya, J., & Tellegen, A. (1999) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.76.5.820 · Cited by 2,103 · see citing works
Positive psychology interventions: a meta-analysis of randomized controlled studies
Bolier, L., Haverman, M., Westerhof, G. J., Riper, H., Smit, F., & Bohlmeijer, E. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-119 · Cited by 1,996 · cited 1× · see citing works
“These results emphasize the benefits of including PP exercises and techniques in conventional treatments to promote positive emotions and positive functioning measures [19,20].”
BackgroundSeligman, M. E. P., Rashid, T., & Parks, A. C. (2006) · American Psychologist · doi:10.1037/0003-066x.61.8.774 · Cited by 1,560 · see citing works
Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies.
Cuijpers, P., van Straten, A., Andersson, G., & van Oppen, P. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0013075 · Cited by 1,050 · cited 1× · see citing works
“Even though there are effective treatments for this disorder (pharmacotherapy, psychotherapy, or both) [4,5], only half the people with depression receive adequate care [6], only two-thirds of patients respond to treatment, and only about one-third experience remission of their depressive symptoms [7,8].”
BackgroundTransdiagnostic approaches to mental health problems: Current status and future directions.
Dalgleish, T., Black, M., Johnston, D., & Bevan, A. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000482 · Cited by 883 · see citing works
Kessler, R. C. (2012) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2011.11.005 · Cited by 871 · see citing works
Treatment-resistant depression: therapeutic trends, challenges, and future directions
Al-harbi (2012) · Patient Preference and Adherence · doi:10.2147/ppa.s29716 · Cited by 796 · see citing works
Karyotaki, E., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., Mackinnon, A., Meyer, B., Botella, C., Littlewood, E., et al. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.0044 · Cited by 691 · see citing works
Self-citationDiez-Quevedo, C., Rangil, T., Sanchez-Planell, L., Kroenke, K., & Spitzer, R. L. (2001) · Psychosomatic Medicine · doi:10.1097/00006842-200107000-00021 · Cited by 649 · see citing works
Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.02.026 · Cited by 586 · see citing works
A Review of the Clinical, Economic, and Societal Burden of Treatment-Resistant Depression: 1996–2013
Mrazek, D. A., Hornberger, J. C., Altar, C. A., & Degtiar, I. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300059 · Cited by 580 · cited 1× · see citing works
“Major depressive disorder (MDD) is one of the most prevalent mental disorders worldwide, and it is associated with significant personal and social costs [1,2].”
BackgroundInterpretación de los cuestionarios de salud SF-36 y SF-12 en España: componentes físico y mental
Vilagut, G., Valderas, J. M., Ferrer, M., Garín, O., López‐García, E., & Alonso, J. (2008) · Medicina Clínica · doi:10.1157/13121076 · Cited by 574 · see citing works
(1999) · PubMed · Cited by 548 · see citing works
(1999) · Psicothema · Cited by 507 · see citing works
Positive Clinical Psychology: A new vision and strategy for integrated research and practice
Wood, A. M., & Tarrier, N. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.06.003 · Cited by 488 · see citing works
Positive Affect and Health: What Do We Know and Where Next Should We Go?
Pressman, S. D., Jenkins, B. N., & Moskowitz, J. T. (2019) · Annual Review of Psychology · doi:10.1146/annurev-psych-010418-102955 · Cited by 452 · see citing works
Craske, M. G., Meuret, A. E., Ritz, T., Treanor, M., Dour, H., & Rosenfield, D. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000396 · Cited by 451 · see citing works
Weiss, L. A., Westerhof, G. J., & Bohlmeijer, E. T. (2016) · PLOS ONE · doi:10.1371/journal.pone.0158092 · Cited by 405 · see citing works
Positive emotion regulation in emotional disorders: A theoretical review
Carl, J. R., Soskin, D. P., Kerns, C., & Barlow, D. H. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.01.003 · Cited by 391 · see citing works
Craske, M. G., Meuret, A. E., Ritz, T., Treanor, M., & Dour, H. J. (2016) · Depression and Anxiety · doi:10.1002/da.22490 · Cited by 387 · see citing works
Fava, G. A., & Ruini, C. (2003) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/s0005-7916(03)00019-3 · Cited by 386 · see citing works
Chakhssi, F., Kraiss, J. T., Sommers‐Spijkerman, M., & Bohlmeijer, E. T. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1739-2 · Cited by 372 · see citing works
Preventing Depression: A Global Priority
Cuijpers, P., Beekman, A. T. F., & Reynolds, C. F. (2012) · JAMA · doi:10.1001/jama.2012.271 · Cited by 368 · see citing works
Watson, D., & Naragon-Gainey, K. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.11.002 · Cited by 349 · see citing works
Bower, P., Kontopantelis, E., Sutton, A., Kendrick, T., Richards, D. A., Gilbody, S., Knowles, S., Cuijpers, P., Andersson, G., Christensen, H., et al. (2013) · BMJ · doi:10.1136/bmj.f540 · Cited by 341 · see citing works
Prevalence and comorbidity of common mental disorders in primary care
Roca, M., Gili, M., Garcia-Garcia, M., Salva, J., Vives, M., Garcia Campayo, J., & Comas, A. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.03.014 · Cited by 311 · see citing works
Self-citationHervás, G., & Vázquez, C. (2013) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-11-66 · Cited by 274 · cited 2× · see citing works
“Well-being: The Pemberton Happiness Index (PHI; [39]) consists of 11 items related to different domains of remembered well-being (general, hedonic, eudaimonic, and social well-being), each with an 11-point Likert-type scale (0 = strongly disagree, 10 = strongly agree), and 10 items related to experienced well-being (p…”
BackgroundMethodAn investigation of the relationship between positive affect regulation and depression
Werner-Seidler, A., Banks, R., Dunn, B. D., & Moulds, M. L. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.11.001 · Cited by 241 · cited 1× · see citing works
“Several studies point out the importance of promoting PA—as well as gratitude, resilience, and positive functioning—as core elements of interventions to facilitate recovery from depression [13,14].”
BackgroundTaylor, C. T., Lyubomirsky, S., & Stein, M. B. (2017) · Depression and Anxiety · doi:10.1002/da.22593 · Cited by 233 · see citing works
Wakida, E. K., Talib, Z. M., Akena, D., Okello, E. S., Kinengyere, A., Mindra, A., & Obua, C. (2018) · Systematic Reviews · doi:10.1186/s13643-018-0882-7 · Cited by 219 · see citing works
White, C. A., Uttl, B., & Holder, M. D. (2019) · PLoS ONE · doi:10.1371/journal.pone.0216588 · Cited by 203 · see citing works
Linde, K., Sigterman, K., Kriston, L., Rucker, G., Jamil, S., Meissner, K., & Schneider, A. (2015) · The Annals of Family Medicine · doi:10.1370/afm.1719 · Cited by 196 · see citing works
Chaves, C., Lopez-Gomez, I., Hervas, G., & Vazquez, C. (2017) · Cognitive Therapy and Research · doi:10.1007/s10608-016-9778-9 · Cited by 196 · see citing works
Depression in Primary Care: Current and Future Challenges
Craven, M. A., & Bland, R. C. (2013) · The Canadian Journal of Psychiatry · doi:10.1177/070674371305800802 · Cited by 168 · see citing works
Johnson, J., & Wood, A. M. (2015) · Cognitive Therapy and Research · doi:10.1007/s10608-015-9728-y · Cited by 130 · see citing works
Positive interventions in clinical practice
Rashid, T. (2009) · Journal of Clinical Psychology · doi:10.1002/jclp.20588 · Cited by 122 · see citing works
Gilbert, K. E., Nolen-Hoeksema, S., & Gruber, J. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.08.004 · Cited by 112 · see citing works
Santos, V., Paes, F., Pereira, V., Arias-Carrión, O., Silva, A. C., Carta, M. G., Nardi, A. E., & Machado, S. (2013) · Clinical Practice & Epidemiology in Mental Health · doi:10.2174/1745017901309010221 · Cited by 112 · see citing works
Wakida, E. K., Akena, D. H., Okello, E. S., Kinengyere, A. A., Kamoga, R., Mindra, A., Obua, C., & Talib, Z. M. (2017) · Systematic Reviews · doi:10.1186/s13643-017-0561-0 · Cited by 105 · see citing works
Proyer, R. T., Wellenzohn, S., Gander, F., & Ruch, W. (2015) · Applied Psychology: Health and Well-Being · doi:10.1111/aphw.12039 · Cited by 101 · see citing works
Treatment adequacy of anxiety and depressive disorders: Primary versus specialised care in Spain
Fernández, A., Haro, J. M., Codony, M., Vilagut, G., Martínez‐Alonso, M., Autonell, J., Salvador‐Carulla, L., Ayuso‐Mateos, J. L., Fullana, M. A., & Alonso, J. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.05.005 · Cited by 93 · see citing works
A spanish validation study of the mini international neuropsychiatric interview
Bobes, J. (1998) · European Psychiatry · doi:10.1016/s0924-9338(99)80240-5 · Cited by 79 · cited 2× · see citing works
“0 [31,32] was used to assess different mental disorders and establish the diagnosis.”
MethodGeschwind, N., Arntz, A., Bannink, F., & Peeters, F. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.03.005 · Cited by 79 · see citing works
Andrews, G., & Williams, A. D. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.05.006 · Cited by 72 · see citing works
Is Benefit Finding Good for Your Health?
Bower, J. E., Moskowitz, J. T., & Epel, E. S. (2009) · Current Directions in Psychological Science · doi:10.1111/j.1467-8721.2009.01663.x · Cited by 70 · see citing works
Positive Psychology in the Clinical Domains
Ruini, C. (2017) · doi:10.1007/978-3-319-52112-1 · Cited by 40 · see citing works
Gili, M., Castro, A., García‐Palacios, A., García‐Campayo, J., Mayoral, F., Botella, C., Roca, M., Barceló‐Soler, A., Hurtado, M. M., Navarro, M., et al. (2020) · Journal of Medical Internet Research · doi:10.2196/15845 · Cited by 36 · see citing works
Self-citationMira, A., Bretón-López, J., Enrique, Á., Castilla, D., García-Palacios, A., Baños, R., & Botella, C. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.02360 · Cited by 21 · see citing works
Self-citationCastro, A., García‐Palacios, A., García‐Campayo, J., Mayoral, F., Botella, C., García‐Herrera, J. M., Pérez‐Yus, M., Vives, M., Baños, R., Roca, M., et al. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0475-0 · Cited by 17 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- [36]American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) Masson Barcelona, Spain 1995
Cited by
Sorted by citations
Using Information and Communication Technologies (ICT) for Mental Health Prevention and Treatment
Fonseca, A., & Osma, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18020461 · Cited by 30 · see citing works
- Authors
- Vara, M. D., Mira, A., Miragall, M., García-Palacios, A., Botella, C., Gili, M., Riera-Serra, P., García-Campayo, J., Mayoral-Cleries, F., & Baños, R. M.
- Affiliations
- Polibienestar Research Institute, University of Valencia, 46022 Valencia, Spain
- Universitat de València (ES)
- CIBERObn Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Universitat Jaume I (ES)
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (ES)
- Institut Universitari d’Investigació en Ciències de la Salut, University of Balearic Islands, E-07122 Palma de Mallorca, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
- Mental Health Unit, Hospital Regional of Malaga, Biomedicine Research Institute (IBIMA), 29010 Málaga, Spain
- ORCID
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2020-11-03
- Volume
- 17
- Issue
- 21
- Pages
- 8094
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC7662551
- OpenAlex
- W3096962330
- Cited by
- 7
- References
- 62
- Citations by year
- 2026: 1 · 2024: 2 · 2022: 1 · 2021: 3
- FWCI
- 0.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Repositori UJI (Universitat Jaume I) (acceptedVersion, cc-by-sa)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, cc-by)
- Zaguan (Universidad de Zaragoza) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Docusalut (Conselleria de Salut i Consum del Govern de les Illes Balears) (submittedVersion, cc-by)
- Hispana (submittedVersion, cc-by)
- Funders
- Ministerio de Economía y Competitividad (PI13/01171)
- Conselleria d'Educació, Investigació, Cultura i Esport (PROMETEO/2018/110)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- online intervention, positive affect, depression, major depressive disorder, primary care, well-being, health-related quality of life, predictors of treatment response, socioeconomic factors
- MeSH terms
- Internet-Based Intervention, Adult, Affect, Depression, Major Depressive Disorder, Facial Expression, Female, Humans, Male, Middle Aged, Primary Health Care, Quality of Life, Treatment Outcome, Internet
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
