Comparing the Effects of Hope Therapy and Spiritual Therapy on Self-Care, Depression, and HbA1c in Middle-Aged Women with Type 2 Diabetes

A highly prevalent problem in patients with type 2 diabetes is depression; it can directly affect patients’ biologically derived substances, e.g., fasting blood glucose and HbA1c. Depressive symptoms significantly impact self–care and wellbeing. Multiple demographic, socioeconomic, and social support factors can facilitate self–care activities in diabetic patients; however, a health psychologist’s role in promoting self–care is vital. Psychological interventions, such as Hope Therapy (HT) and Spiritual Therapy (ST) might be effective in managing biological variables, depression, and quality of life in patients with diabetes. Thus, this study aimed to compare the effects of HT and ST on depression, self–care, and HbA1c in patients with type 2 diabetes.

This was a quasi–experimental study with pretest–posttest–follow–up and a control group design. The statistical population included all middle–aged women with type 2 diabetes referring to Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute in Tehran City, Iran, in 2020. In total, 45 eligible volunteers were selected by the convenience sampling method. They completed Beck Depression Inventory (BDI; Beck et al., 1961) before and after the interventions. Individuals with a depression score of >11 were randomly assigned into 3 research groups (n=15/group). The inclusion criteria of the study included having a minimum literacy to complete the questionnaires, providing an informed consent form, willingness to participate in the study, obtaining a minimum depression score of 11, and being in the 45–60 years age range. The exclusion criteria of the study included receiving psychological therapies during the study, severe physical illnesses due to diabetes, such as kidney failure, vision, etc., consuming psychiatric drugs during the study, increasing the dose of related drugs due to diabetes, and the patient's unwillingness to continue treatment. The experimental groups received HT according to Snyder’s treatment protocol (2002) in 8 weekly sessions and ST according to Richards et al.’s treatment protocol (2007) in 8 weekly sessions; however, the controls received no intervention. The necessary data were collected using the BDI, the Self–Care Questionnaire ‎(Tobert et al., 2000), ‎and the HbA1c blood test. Pretest and posttest steps were performed in all research groups. A month after the posttest, all measures were repeated (follow–up). Descriptive statistics, such as mean and SD were used to describe the obtained data. The collected data were analyzed using repeated–measures Analysis of Variance (ANOVA) and Bonferroni posthoc test in SPSS at the significance level of 0.05.

The present study data indicated that HT and ST reduced depression (p<0.001) and HbA1c (p=0.024), and enhanced self–care (p<0.001). The mean score of depression (p<0.001), HbA1c (p<0.001), and self–care (p<0.001) significantly reduced over time. The significant time*groups interaction effect was observed for depression (p<0.001), HbA1c (p<0.001), and self–care (p<0.001) in the experimental groups, compared to the controls. Bonferroni posthoc test data revealed a significant difference between the intervention groups and the controls concerning depression (p<0.001 & p<0.001, respectively), HbA1c (p=0.046 & p=0.034, respectively), and self–care (p<0.001 & p<0.001, respectively); however, there was a significant difference between HT and ST in depression (p=0.038). There was a significant difference between pretest and posttest phases and the follow–up phase respecting depression (p<0.001), HbA1c (p<0.001), and self–care (p<0.001); however, there was no significant difference between posttest and follow–up phases for depression (p=1.000), HbA1c (p=0.974), and self–care (p=0.143), highlighting the positive and persisting (until follow–up) effects of HT and ST.

Based on the current research findings, HT and ST reduced depression and HbA1c, and increased self–care among the explored middle–aged women with type 2 diabetes; however, there was a significant difference between the effects of HT and ST concerning depression where ST was more effective than HT.