{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T13:34:18Z","timestamp":1777901658642,"version":"3.51.4"},"reference-count":64,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study examines the effect of the Flourishing Intervention on depressive symptoms and wellbeing among individuals with moderate to moderately severe depressive symptoms. The study also seeks to understand participants\u2019 experiences, acceptability, and satisfaction with the intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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 12-week online group-based program, with each session lasting approximately 90 minutes. The study included 98 participants (18\u201359 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 S\u00e3o 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Evidence supported improvements in depressive symptoms postintervention (d=-1.14 for PHQ-9 and d=-1.24 for 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:uri>https:\/\/ensaiosclinicos.gov.br\/rg\/RBR-776skr9<\/jats:uri>, identifier RBR-776skr9.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1532843","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T09:02:48Z","timestamp":1750323768000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["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"],"prefix":"10.3389","volume":"16","author":[{"given":"Camilla Casaletti","family":"Braghetta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliane Piasseschi de Bernardin","family":"Gon\u00e7alves","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willyane de Andrade","family":"Alvarenga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard G.","family":"Cowden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clarice","family":"Gorenstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giancarlo","family":"Lucchetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Homero","family":"Vallada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s12963-020-00204-5","article-title":"Depressive disorders in Brazil: results from the Global Burden of Disease Study 2017","volume":"18","author":"Bonadiman","year":"2020","journal-title":"Popul Health Metr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2529","DOI":"10.1001\/jama.2018.17824","article-title":"The challenges of improving treatments for depression","volume":"320","author":"Cuijpers","year":"2018","journal-title":"JAMA"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-023-01426-8","article-title":"Global mental health: where we are and where we are going","volume":"25","author":"Moitra","year":"2023","journal-title":"Curr Psychiatry Rep"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1590\/1413-81232020255.33972019","article-title":"Pobreza e desigualdades sociais: tens\u00f5es entre direitos, austeridade e suas implica\u00e7\u00f5es na aten\u00e7\u00e3o prim\u00e1ria","volume":"25","author":"Pitombeira","year":"2020","journal-title":"Cien Saude Colet"},{"key":"B6","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/978-3-031-18329-4_2","article-title":"Shifting the paradigm of positive psychology: toward an existential positive psychology of wellbeing","volume-title":"Broadening the Scope of Wellbeing Science","author":"Wong","year":"2022"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.60.5.410","article-title":"Positive psychology progress: empirical validation of interventions","volume":"60","author":"Seligman","year":"2005","journal-title":"Am Psychol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.21933","article-title":"Meta-analysis of positive psychology interventions on the treatment of depression","volume":"14","author":"Pan","year":"2022","journal-title":"Cureus"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1080\/17439760.2020.1818807","article-title":"Effectiveness of positive psychology interventions: a systematic review and metaanalysis","volume":"16","author":"Carr","year":"2021","journal-title":"J Posit Psychol"},{"key":"B10","doi-asserted-by":"crossref","DOI":"10.4324\/9781315659794-12","article-title":"Critique of positive psychology and positive interventions 1","volume-title":"The Routledge International Handbook of Critical Positive Psychology","author":"Wong","year":"2017"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s10608-016-9778-9","article-title":"A comparative study on the efficacy of a positive psychology intervention and a cognitive behavioral therapy for clinical depression","volume":"41","author":"Chaves","year":"2017","journal-title":"Cognit Ther Res"},{"key":"B12","doi-asserted-by":"publisher","first-page":"392","DOI":"10.4236\/psych.2021.123025","article-title":"The effectiveness of an online positive psychology intervention among healthcare professionals with depression, anxiety or stress symptoms and burnout","volume":"12","author":"Alexiou","year":"2021","journal-title":"Psychology"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e63","DOI":"10.2196\/jmir.1850","article-title":"Disseminating self-help: positive psychology exercises in an online trial","volume":"14","author":"Schueller","year":"2012","journal-title":"J Med Internet Res"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s42761-022-00153-2.","article-title":"Terminology and the well-being literature","volume":"4","author":"VanderWeele","year":"2023","journal-title":"Affect Sci"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1038\/s44220-025-00423-5","article-title":"The global flourishing study: study profile and initial results on flourishing","author":"VanderWeele","year":"2025","journal-title":"Nat Ment Health"},{"key":"B16","doi-asserted-by":"crossref","DOI":"10.1590\/S0102-311X2013001200006","article-title":"Sensibilidade e especificidade do Patient Health Questionnaire-9 (PHQ-9) entre adultos da popula\u00e7\u00e3o geral","volume":"29","author":"Santos","year":"2013","journal-title":"Cad Saude Publica"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291722003385","article-title":"The associations between depressive symptoms, functional impairment, and quality of life, in patients with major depression: undirected and Bayesian network analyses","volume":"53","author":"Zhou","year":"2023","journal-title":"Psychol Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1702996114","article-title":"On the promotion of human flourishing","volume":"114","author":"VanderWeele","year":"2017","journal-title":"Proc Natl Acad Sci"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.3035","article-title":"Reimagining health\u2014Flourishing","volume":"321","author":"VanderWeele","year":"2019","journal-title":"JAMA"},{"key":"B20","doi-asserted-by":"publisher","first-page":"100172","DOI":"10.1016\/j.ssmmh.2022.100172","article-title":"Flourishing in critical dialogue","volume":"3","author":"VanderWeele","year":"2023","journal-title":"SSM - Ment Health"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1064137","article-title":"Development of a comprehensive flourishing intervention to promote mental health using an e-Delphi technique","volume":"14","author":"Gon\u00e7alves JP de","year":"2023","journal-title":"Front Psych"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.47626\/1516-4446-2022-2945.","article-title":"Translating measurement into practice: Brazilian norms for the Patient Health Questionnaire (PHQ-9) for assessing depressive symptoms","volume":"45","author":"Damiano","year":"2023","journal-title":"Braz J Psych"},{"key":"B23","article-title":"Validation of a Portuguese version of the Beck Depression Inventory and the State-Trait Anxiety Inventory in Brazilian subjects","volume":"29","author":"Gorenstein","year":"1996","journal-title":"Rev Bras Pesqui Med Biol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.9788\/TP2016.1-25","article-title":"Factor structure, reliability, and item parameters of the Brazilian-portuguese version of the GAD-7 questionnaire","volume":"24","author":"Moreno","year":"2016","journal-title":"Temas em Psicologia"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1590\/S0102-311X2009000100023","article-title":"Estrutura fatorial e consist\u00eancia interna do Self-Reporting Questionnaire (SRQ-20) em popula\u00e7\u00e3o urbana","volume":"25","author":"Santos","year":"2009","journal-title":"Cad Saude Publica"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1590\/S0034-89102000000200012","article-title":"Aplica\u00e7\u00e3o da vers\u00e3o em portugu\u00eas do instrumento abreviado de avalia\u00e7\u00e3o da qualidade de vida \u201cWHOQOL-bref","volume":"34","author":"Fleck","year":"2000","journal-title":"Rev Sa\u00fade P\u00fablica"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1080\/23311908.2019.1598926","article-title":"Flourish Index and Secure Flourish Index\u2013Validation in workplace settings","volume":"6","author":"Weziak-Bialowolska","year":"2019","journal-title":"Cogent Psychol"},{"key":"B28","article-title":"Translation and cross-cultural validation of the flourishing and secure flourishing indexes in the Brazilian portuguese language","author":"Gon\u00e7alves JP de","year":"","journal-title":"Braz J Psych"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1590\/S0101-60832012000400003","article-title":"Valida\u00e7\u00e3o da vers\u00e3o brasileira da escala de religiosidade de Duke (DUREL)","volume":"39","author":"Taunay","year":"2012","journal-title":"Arch Clin Psychiatry (S\u00e3o Paulo)"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1007\/s10943-010-9429-5","article-title":"Validation of the duke religion index: DUREL (Portuguese version)","volume":"51","author":"Lucchetti","year":"2012","journal-title":"J Relig Health"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1590\/S1413-73722005000300019","article-title":"Escala de coping religioso-espiritual (Escala CRE): elabora\u00e7\u00e3o e valida\u00e7\u00e3o de construto","volume":"10","author":"Panzini","year":"2005","journal-title":"Psicologia em Estudo"},{"key":"B32","doi-asserted-by":"crossref","first-page":"764132","DOI":"10.3389\/fpsyg.2021.764132","article-title":"Development of an instrument to assess spirituality: reliability and validation of the attitudes related to spirituality scale (ARES)","author":"Braghetta","year":"2021","journal-title":"Front Psychol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.15689\/ap.2019.1804.18595.07","article-title":"Evid\u00eancia de Validade da Escala Brasileira de Gratid\u00e3o (B-GRAT) na Psicologia Positiva","volume":"18","author":"Vazquez","year":"2019","journal-title":"Rev Avalia\u00e7\u00e3o Psicol\u00f3g"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.15689\/ap.2018.1703.15208.10","article-title":"Escala breve de compaix\u00e3o Santa Clara: propriedades psicom\u00e9tricas para o contexto brasileiro","volume":"17","author":"Marchetti","year":"2018","journal-title":"Rev Avalia\u00e7\u00e3o Psicol\u00f3g"},{"key":"B35","first-page":"30","article-title":"Selfreport Altruism Scale: evidences of construct validity","volume":"33","author":"Gouveia","year":"2010","journal-title":"Aletheia"},{"key":"B36","doi-asserted-by":"publisher","first-page":"17","DOI":"10.11144\/Javeriana.UPSY13-1.vppb","article-title":"Validation and psychometric properties of the Brazilian version of the subjective happiness scale","volume":"13","author":"Dam\u00e1sio","year":"2014","journal-title":"Universitas Psycholo"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.9788\/TP2017.4-18En","article-title":"Psychometric properties of the multidimensional scale of perceived social support","volume":"25","author":"Gabardo-Martins","year":"2017","journal-title":"Trends Psychol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1590\/0103-166X2015000200001","article-title":"Escala de Disposi\u00e7\u00e3o para Perdoar: estrutura, consist\u00eancia interna e invari\u00e2ncia fatorial","volume":"32","author":"Gouveia","year":"2015","journal-title":"Estudos Psicologia (Campinas)"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1590\/S0102-311X2005000200010","article-title":"Adapta\u00e7\u00e3o transcultural, confiabilidade e validade da escala de resili\u00eancia","volume":"21","author":"Pesce","year":"2005","journal-title":"Cadernos Sa\u00fade P\u00fablica"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.15689\/ap.2019.1802.15459.08","article-title":"Teste prop\u00f3sito de vida: propriedades psicom\u00e9tricas e evid\u00eancias de validade","volume":"18","author":"Nascimento","year":"2019","journal-title":"Avalia\u00e7ao Psicol: Interamerican J psychol Assess"},{"key":"B41","volume-title":"Satisfa\u00e7\u00e3o com a vida, afetos positivos e negativos: Evid\u00eancias de validade e precis\u00e3o de escalas propostas por Diener","author":"de Sousa","year":"2013"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200412000-00006","article-title":"Monitoring depression treatment outcomes with the patient health questionnaire-9","volume":"42","author":"L\u00f6we","year":"2004","journal-title":"Med Care"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1097\/01.pra.0000348364.88676.83","article-title":"Predictors of attrition during one year of depression treatment: A roadmap to personalized intervention","volume":"15","author":"Warden","year":"2009","journal-title":"J Psychiatr Pract"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"Elo","year":"2008","journal-title":"J Adv Nurs"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for reporting qualitative research","volume":"89","author":"O\u2019Brien","year":"2014","journal-title":"Acad Med"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.5502\/ijw.v13i4.3665","article-title":"A flexible map of flourishing: The dynamics and drivers of flourishing, well-being, health, and happiness","volume":"13","author":"Lomas","year":"2023","journal-title":"Int J Wellbeing"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1080\/17439760.2019.1590624","article-title":"Resilience and well-being in the Caribbean: Findings from a randomized controlled trial of a culturally adapted multi-component positive psychology intervention","volume":"15","author":"Hendriks","year":"2020","journal-title":"J Posit Psychol"},{"key":"B48","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1186\/s12888-018-1739-2","article-title":"The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: a systematic review and meta-analysis","volume":"18","author":"Chakhssi","year":"2018","journal-title":"BMC Psych"},{"key":"B49","first-page":"33","article-title":"A comparative study on the effectiveness of positive psychotherapy and group cognitive-behavioral therapy for the patients suffering from major depressive disorder","volume":"6","author":"Asgharipoor","year":"2012","journal-title":"Iran J Psychiatry Behav Sci"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1080\/17439760.2019.1663250","article-title":"A comparative study of the efficacy of group positive psychotherapy and group cognitive behavioral therapy in the treatment of depressive disorders: A randomized controlled trial","volume":"15","author":"Furchtlehner","year":"2020","journal-title":"J Posit Psychol"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1007\/s10879-016-9343-6","article-title":"A randomized controlled trial of the say yes to life (SYTL) positive psychology group psychotherapy program for depression: an interim report","volume":"47","author":"Carr","year":"2017","journal-title":"J Contemp Psychother"},{"key":"B52","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780190088859.001.0001","volume-title":"Handbook of Religion and Health","author":"Koenig","year":"2024"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.23232","article-title":"Religious\/spiritual struggles and psychological distress: A test of three models in a longitudinal study of adults with chronic health conditions","volume":"78","author":"Cowden","year":"2022","journal-title":"J Clin Psychol"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1080\/13674676.2021.2003312","article-title":"The pain and gain of religious\/spiritual struggles: a longitudinal study of South African adults","volume":"25","author":"Jung","year":"2022","journal-title":"Ment Health Relig Cult"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1002\/ijop.13135","article-title":"Religious\/spiritual struggles and whole person functioning among Colombian university students: Longitudinal evidence of mutual influence","volume":"59","author":"Cowden","year":"2024","journal-title":"Int J Psychol"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1080\/10508619.2013.795815","article-title":"Spirituality as an irreducible human motivation and process","volume":"23","author":"Pargament","year":"2013","journal-title":"Int J Psychol Religion"},{"key":"B57","first-page":"3","article-title":"Envisioning an integrative paradigm for the psychology of religion and spirituality","volume-title":"APA handbook of psychology, religion, and spirituality (Vol 1): Context, theory, and research","author":"Mahoney","year":"2013"},{"key":"B58","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1177\/0963721412469809","article-title":"How do simple positive activities increase well-being","volume":"22","author":"Lyubomirsky","year":"2013","journal-title":"Curr Dir Psychol Sci"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1037\/a0024889","article-title":"A Tuesday in the life of a flourisher: The role of positive emotional reactivity in optimal mental health","volume":"11","author":"Catalino","year":"2011","journal-title":"Emotion"},{"key":"B60","first-page":"1","article-title":"Positive emotions broaden and build","volume-title":"Advances in Experimental Social Psychology","author":"Fredrickson","year":"2013"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2013.0178","article-title":"Consulting psychiatry within an integrated primary care model","volume":"24","author":"Zeidler Schreiter","year":"2013","journal-title":"J Health Care Poor Underserved"},{"key":"B62","doi-asserted-by":"publisher","first-page":"l4516","DOI":"10.1136\/bmj.l4516","article-title":"Achieving universal health coverage for mental disorders","volume":"366","author":"Patel","year":"2019","journal-title":"BMJ"},{"key":"B63","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1177\/1529100614531398","article-title":"The impact of mental illness stigma on seeking and participating in mental health care","volume":"15","author":"Corrigan","year":"2014","journal-title":"psychol Sci Public Interest"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2017.0044","article-title":"Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms: A meta-analysis of individual participant data","volume":"74","author":"Karyotaki","year":"2017","journal-title":"JAMA Psych"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1532843\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T09:02:51Z","timestamp":1750323771000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1532843\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":64,"alternative-id":["10.3389\/fpsyt.2025.1532843"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1532843","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,19]]},"article-number":"1532843"}}