4 - (SYM 149) Mediators of a Self-guided Positive Psychological Intervention for People with Elevated Depressive Symptoms

Background: Building on revised Stress and Coping Theory and Broaden and Build Theory, the Positive Pathways to Health Model suggests that positive psychological interventions (PPIs) improve mental health outcomes such as depression by increasing positive affect and psychosocial resources. In a randomized controlled trial of a web-based PPI called MARIGOLD (Mobile Affect Regulation Intervention with the Goal of Lowering Depression, NCT02861755), prior analyses showed main effects of the intervention on depression but did not support mediation by positive affect. Secondary analyses therefore examined resilience and coping resources as potential mediators.

Methods: Adults with elevated depressive symptoms (PHQ-8 > 5; N = 602) were recruited online, stratified by symptom severity, and randomized to receive MARIGOLD, a 5-week positive emotion skills regulation program delivered in an web-based, self-guided format, or an emotion reporting only control condition. MARIGOLD included 8 cognitive and behavioral skills shown in prior research to increase positive affect: noticing positive events, savoring, mindfulness, personal strengths, behavioral activation, positive reappraisal, acts of kindness, and gratitude. Self-reported measures of well-being and potential mediators were assessed at baseline, post-intervention, and 3- and 6-month follow-up. Data were analyzed in SPSS using the Process Macro to evaluate whether intervention effects on depression (CES-D) were mediated by self-compassion (Self-Compassion Scale - Short Form), prioritizing positivity (Prioritizing Positivity Scale), and resilience (Brief Resilience Scale).

Results: Mean age of participants was 38 (range 18-80). The sample was primarily White (74%) and female (74%), with variability in socioeconomic status (e.g., 38% without a college degree; 36% < $30,000 annual income). Baseline depressive symptoms (PHQ-8) were 23% mild, 32% moderate, 29% moderately severe, and 16% severe. Self-compassion (β = -.15, SE = .01, 95% CI [-.171, -.124]), prioritizing positivity (β = -.06, SE =.01, 95% CI [-.076, -.043]), and resilience (β =  -.08, SE = .01, 95% CI [ -.100, -.064]) partially mediated effects of the intervention on depression over time.

Conclusions: Results suggest that a self-guided PPI can improve adults’ depressive symptoms by increasing their positive psychological cognitive-behavioral skills and resources, including resilience, self-compassion, and organizing day-to-day activities to include more positive experiences.