Promoting the Wellbeing of the Whole Person: A Within-Subjects Mixed-Methods Study Exploring the Effects of the Flourishing Intervention Among Individuals with Depressive Symptoms

Camilla Casaletti Braghetta¹Juliane Piasseschi de Bernardin Gonçalves¹Willyane de Andrade Alvarenga²Richard Gregory Cowden³Clarice Gorenstein^1,4Giancarlo Lucchetti⁵Homero Vallada^1,6*

• ¹Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
• ²Centro Universitario Santo Agostinho, Teresina, Brazil
• ³Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Boston, United States
• ⁴Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, São Paulo, Brazil
• ⁵Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
• ⁶University of São Paulo, São Paulo, Brazil

Objective: This study examines the effect of the Flourishing Intervention on depressive symptoms and well-being among individuals with moderate to moderately severe depressive symptoms. The study also seeks to understand participants' experiences, acceptability, and satisfaction with the intervention.: A quasi-experimental pre-post mixed-methods design was used, incorporating an embedded approach in which descriptive qualitative data complemented quantitative data. The Flourishing Intervention consisted of a 12week online group-based program, with each session lasting approximately 90 minutes. The study included 98 participants (18-59 years) with moderate to moderately severe depressive symptoms on the Patient Health Questionnaire-9(PHQ-9), who had completed elementary school or better, resided in São Paulo, and had internet access. All participants were assessed immediately before and after the intervention using the PHQ-9, the Beck Depression Inventory-II (BDI-II), and a range of secondary outcome measures.Evidence supported improvements in depressive symptoms postintervention (d=-1.14 for PHQ-9 and d=-1.24 for the BDI-II). Positive postintervention changes were also observed for anxiety symptoms, personal flourishing, spirituality, quality of life, religious/spiritual coping, social support, happiness, gratitude, forgiveness, and life satisfaction.The Flourishing Intervention has the potential to be an effective approach for adults with depressive symptoms. It provides support for the idea that a multidimensional intervention focused on promoting whole-person functioning can alleviate these symptoms. Lessons learned from this study can be used to guide evaluation strategies for a controlled trial, which is an important next step in research on this intervention.