PERMA-based psychological intervention in glioma rehabilitation: An RCT examining affective distress,treatment adherence,and neuro-oncological outcomes

Abstract

Objective

Postoperative glioma patients often experience negative emotions, which affect their treatment adherence and prognosis. The PERMA intervention (focusing on Positive emotions, Engagement, Relationship, Meaning, and Accomplishment) seeks to enhance psychological well-being and quality of life (QoL). This study examines the effects of the PERMA intervention on negative emotions, treatment adherence, and prognosis in postoperative glioma patients.

Methods

A total of 124 postoperative glioma patients recruited from January 2022 to February 2024 were randomly assigned to an intervention group (n = 62) or a control group (n = 62). The control group received routine postoperative care, while the intervention group received an additional PERMA psychological intervention for 1 month. Outcome assessments included anxiety symptoms (SAS), depressive symptoms (SDS), treatment adherence, complications, and QoL. Outcomes were analyzed using Kaplan-Meier (KM) survival curves.

Results

Baseline characteristics were comparable between groups (P > 0.05). After the intervention, both groups showed significant improvements in SAS and SDS scores (P < 0.05); furthermore, post-intervention SAS and SDS scores in the intervention group were significantly lower than those in the control group (P < 0.0001). Treatment adherence was significantly higher and complication rates significantly lower in the intervention group compared to control group (P < 0.05). QoL was improved in both groups (P < 0.05); however, the intervention group scored significantly higher than the control group across all QoL domains (P < 0.0001). KM analysis revealed a significant association between the PERMA-based intervention and better outcomes overall (P < 0.05).

Conclusion

A PERMA-based psychological intervention effectively reduced anxiety and depression, enhanced treatment adherence, lowered complication risks, and improved QoL compared to routine post-operative care in postoperative glioma patients.

Keywords

PERMA integrated psychological intervention glioma SAS SDS complication

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References

Young

Al-Adli

Sibih

, et al. Recognizing the psychological impact of a glioma diagnosis on mental and behavioral health: a systematic review of what neurosurgeons need to know. J Neurosurg. 2023;139:11-19.

Otto-Meyer

Lumibao

Kim

, et al. The interplay among psychological distress, the immune system, and brain tumor patient outcomes. Curr Opin Behav Sci. 2019;28:44-50.

Heshmati

Kibrislioglu

Kim

Oravecz

Donaldson

. Momentary PERMA: an adapted measurement tool for studying well-being in daily life. J Happiness Stud. 2023;24:2441-2472.

McCormick

Cushman

. Happiness when the body hurts: achieving well-being in chronic health conditions. Child Adolesc Psychiatr Clin N Am. 2019;28:147-156.

Lou

Zhang

Slesinger

, et al. Positive psychology themes in interviews of children with atopic dermatitis: qualitative study. JMIR Pediatr Parent. 2022;5:e38725.

Luo

Zhou

, et al. Study on the effect of positive psychological intervention based on PERMA model on perioperative patients with AIDS complicated with breast cancer. Comput Math Methods Med. 2022;2022:9788122.

Fang

Zeng

Liu

Zhu

. The effect of the PERMA model-based positive psychological intervention on the quality of life of patients with breast cancer. Heliyon. 2023;9:e17251.

Wang

Shen

Wang

Feng

. Influences of psychological intervention on negative emotion, cancer-related fatigue and level of hope in lung cancer chemotherapy patients based on the PERMA framework. Iran J Public Health. 2021;50:728-736.

Zeilinger

Oppenauer

Knefel

, et al. Prevalence of anxiety and depression in people with different types of cancer or haematologic malignancies: a cross-sectional study. Epidemiol Psychiatr Sci. 2022;31:e74.

10.

Gibson

Graber

. Distinguishing and treating depression, anxiety, adjustment, and post-traumatic stress disorders in brain tumor patients. Ann Palliat Med. 2021;10:875-892.

11.

van der Meer

Dirven

Hertler

, et al. Depression and anxiety in glioma patients. Neuro-Oncol Pract. 2023;10:335-343.

12.

Louis

Perry

Wesseling

, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro Oncol. 2021;23:1231-1251.

13.

Zung

. A rating instrument for anxiety disorders. Psychosomatics. 1971;12:371-379.

14.

Zung

. A self-rating depression scale. Arch Gen Psychiatry. 1965;12:63-70.

15.

Development of the World Health Organization . WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998;28:551-558.

16.

Weller

Wen

Chang

, et al. Glioma. Nat Rev Dis Primers. 2024;10:33.

17.

Hao

Huang

. Anxiety and depression in glioma patients: prevalence, risk factors, and their correlation with survival. Ir J Med Sci. 2021;190:1155-1164.

18.

Wang

. Risk factors, prognostic potency, and longitudinal variation of anxiety and depression in postoperative glioma patients. Front Surg. 2022;9:1069709.

19.

Dong

Chen

Weng

, et al. The effect of depression and anxiety on survival in patients with glioma: a systematic review and meta-analysis. J Neuro Oncol. 2024;170(2):265-275.

20.

Levine

Cohen

Commodore-Mensah

, et al. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American heart association. Circulation. 2021;143:e763-e783.

21.

Daida

Boscarino

Moorman

, et al. Mental and physical health status among chronic hepatitis B patients. Qual Life Res. 2020;29:1567-1577.

22.

Tsay

Chang

Chen

Liu

. Daily activity, mood, and quality of life in colorectal cancer patients with chemotherapy-induced peripheral neuropathy: a mediation effect analysis. Cancer Med. 2019;8:963-971.

23.

Lee

Kim

Jung

. Association between depression and disease-specific treatment. J Affect Disord. 2020;260:124-130.

24.

Lorenz

Beyer

Hagitte

. Measuring PERMA+4: validation of the German version of the positive functioning at work scale. Front Psychol. 2023;14:1231299.

25.

Kovich

Simpson

Foli

Hass

Phillips

. Application of the PERMA model of well-being in undergraduate students. Int J Community Wellbeing. 2023;6:1-20.

26.

Magare

Graham

Eloff

. An assessment of the reliability and validity of the PERMA well-being scale for adult undergraduate students in an open and distance learning context. Int J Environ Res Publ Health. 2022;19:16886.

27.

Ibrahim

Mohamad Sharif

Saleh

Mat Hasan

Jayiddin

. PERMA well-being and innovative work behaviour : a systematic literature review. F1000Research. 2023;12:1338.

28.

Grosvenor

Errichetti

Holingue

Beasley

Kalb

. Self-report measurement of well-being in autistic adults: psychometric properties of the PERMA profiler. Autism Adulthood. 2023;5:401-410.

29.

Cheiloudaki

Alexopoulos

. Adherence to treatment in stroke patients. Int J Environ Res Publ Health. 2019;16:196.

30.

Loots

Goossens

Vanwesemael

Morrens

Van Rompaey

Dilles

. Interventions to improve medication adherence in patients with schizophrenia or bipolar disorders: a systematic review and meta-analysis. Int J Environ Res Publ Health. 2021;18:10213.

31.

Carreno

Eisenbeck

Ucles-Juarez

Garcia-Montes

. Reappraising personal values in cancer: meaning-in-life adaptation, meaningfulness, and quality of life. Psychooncology. 2023;32:1905-1917.

32.

Garcimartin

Astals-Vizcaino

Badosa

, et al. The impact of motivational interviewing on self-care and health-related quality of life in patients with chronic heart failure. J Cardiovasc Nurs. 2022;37:456-464.

33.

Gao

Guo

Liu

, et al. The effects of message framing on self-management behavior among people with type 2 diabetes: a randomized controlled trial. Int J Nurs Stud. 2023;142:104491.