Biopsychosocial Research Articles

Developmental Predictors of Suicidality in Schizophrenia: A Systematic Review.

Background/Objectives: Schizophrenia (SZ) is a severe psychiatric disorder characterized by a complex interplay of genetic, developmental, and environmental factors that significantly increase the risk of suicidal ideation (SI) and suicide attempts (SAs). This systematic review synthesizes current research on the developmental predictors of SI in individuals with SZ, aiming to delineate the multifactorial etiology of suicide within this population. Methods: A comprehensive search across Medline, PsycINFO, and EMBASE databases identified 23 eligible studies, emphasizing the varied methodological approaches and the global distribution of research efforts. Results: These studies demonstrate a robust association between early life adversities, particularly childhood trauma such as physical neglect, emotional abuse, and sexual abuse, and the increased prevalence of SI and SAs in SZ. This review also highlights the significant genetic factors associated with the development of suicidality in SZ, raising the possibility that polymorphisms in inflammation-related genes and neurodevelopmental abnormalities may influence susceptibility to SI. Notably, family history of psychiatric conditions may exacerbate the risk of SI through both hereditary and environmental mechanisms. Environmental factors, including socioeconomic status and social support, are also implicated, underscoring the role of broader socio-environmental conditions influencing outcomes. Conclusions: This review supports the integration of biopsychosocial models in understanding SI in SZ, advocating for interventions addressing the complex interplay of risk factors and the need for longitudinal studies to elucidate the dynamic interactions between risk factors over time. This comprehensive understanding is crucial for developing targeted preventive strategies and enhancing the clinical management of SZ, aiming to reduce suicidality in this vulnerable population.

Psychological problems and their impact on oral mucosal disease patients’ quality of life: A cross-sectional study in the Chinese population

ObjectivesWe aimed to investigate the presence of common psychological factors (i.e., stress, depression, anxiety) and their impact on the Oral health-related quality of life (OHRQoL) in patients diagnosed with four oral mucosal diseases (OMDs): recurrent aphthous ulcers (RAU), oral lichen planus (OLP), oral leukoplakia (OLK), and oral submucous fibrosis (OSF). MethodsA total of 229 patients with clinically diagnosed OMDs were enrolled in this study, consisting of 55 RAU, 68 OLK, 50 OLP, and 56 OSF patients. The patients were statistically analyzed for psychological problems and OHRQoL using the Visual Analog Scale (VAS)､ the 5-item Oral Health Impact Profile (OHIP-5) and the Depression Anxiety Stress Scale-21 (DASS-21) scales. ResultsThere were 229 valid questionnaires collected, consisting of 83 females and 146 males with a mean age of 45.24 (SD = 11.88) years. Multiple regressions between DASS-21 scores and OHIP-5 scores revealed generally negative impacts of psychological problems on OHRQoL, with depression on OLP (β = 0.47), OLK (β = 0.65) and OSF (β = 0.38), stress on RAU (β = 0.29), OLP (β = 0.72), OLK (β = 0.38) and OSF (β = 0.60), and anxiety on OLP (β = 0.33), OLK (β = 0.49) and OSF (β = 0.51). ConclusionsPsychological problems like depression, stress, and anxiety were found to be prevalent in OMDs patients and adversely affected their OHRQoL. The results support the biopsychosocial medical model in the treatment of OMDs patients. Clinical significanceThe present study reinforced the crucial roles of psychological factors in impacting OMDs patients' OHRQoL. Therefore, it is necessary to monitor patients’ psychological status and OHRQoL using questionnaires like DASS-21 and OHIP-5. Followed by psychological interventions, the treatment is expected to be enhanced.

The Big, the Dark, and the Biopsychosocial Shades of Harmony: Personality Traits and Harmony in Life.

Our current understanding of the relationship between personality traits and subjective well-being, or happiness, is limited to the conceptualization of subjective well-being as being life satisfaction and a positive affective experience (i.e., the presence of positive emotions and the absence of negative ones), thus lacking the sense of acceptance, balance, adaptation, and self-transcendent unity (i.e., harmony in life) that is appreciated as part of the good life in many ancient and modern cultures. Moreover, most studies use the Big Five Model to understand which personality traits predict subjective well-being. Here, I examine the predictive power of personality on harmony in life using the Big Five Model, the Dark Triad, and Cloninger's Biopsychosocial Model. The present study utilized past published data from three cross-sectional studies. In each separate sample, participants self-reported personality by answering the Big Five Inventory (N1 = 297), the Short Dark Triad (N2 = 1876), or the Temperament and Character Inventory (N3 = 436). All participants (NTotal = 3698) answered to the Harmony in Life Scale. The traits in the Biopsychosocial Model explained the highest variance in harmony in life (R2 = 0.435, F(7, 428) = 47.136, p < 0.001), followed by the Big Five (R2 = 0.341, F(5, 291) = 30.110, p < 0.001) and the Dark Triad (R2 = 0.096, F(3, 1872) = 66.055, p < 0.001). The key significant predictors were Self-Directedness, Self-Transcendence, and Harm Avoidance from the Biopsychosocial Model and Agreeableness, Conscientiousness, and Neuroticism from the Big Five. Narcissism was the only predictor from the Dark Triad, although this relationship was very small. The findings underscore the importance of a multidimensional approach for understanding subjective well-being and the inclusion of harmony in life as its third component. The Biopsychosocial Model's inclusion of both temperament and character dimensions provided the most comprehensive understanding of harmony in life. While positive traits like Agreeableness, Self-Directedness, and Self-Transcendence enhance harmony, negative traits like Neuroticism and Harm Avoidance diminish it. Moreover, research only including "dark traits" might give the impression that an inflated sense of self-importance, a deep need for admiration, and a lack of empathy for others (i.e., Narcissism) is predictive of balance in life. However, this association was not only extremely low but can be interpreted as misguided since the results using the other models showed that helpful, empathetic, kind, and self-transcendent behavior predicted harmony. These results suggest that interventions aimed at enhancing well-being should consider a broad range of personality traits, especially those that are not present in the Big Five Model, thus advocating for a biopsychosocial approach to well-being interventions.

Narrative Review of the Theoretical-Methodological Foundations of the TREINI Program.

Scientific knowledge has advanced in the implementation of safe and beneficial interventions for children and adolescents with cerebral palsy (CP). Although the importance of interdisciplinary interventions that integrate all components of the International Classification of Functioning, Disability and Health (ICF) into family-centered practices is widely recognized, this approach is not yet widely adopted. Instead, many programs remain focused on isolated domains. This study presents the theoretical and methodological foundation of TREINI, an interdisciplinary and family-centered program developed for children and youth with CP and other neurodevelopmental disorders. TREINI incorporates intervention strategies that address all ICF domains. It is grounded in the biopsychosocial model of health and utilizes principles based on the best evidence in pediatric rehabilitation, including intensive training, task-oriented training, and a naturalistic learning environment. Unlike traditional rehabilitation approaches, the care provided by the TREINI program is delivered through an intensive and interdisciplinary approach, by a team working collaboratively in a single location. In addition to including evidence-based interventions, the TREINI program features two innovative components: the "City of Tomorrow", a naturalistic learning environment, and the "TREINI Exoflex" therapeutic suit, specifically designed to address deficiencies in the body functions and structures of children with CP and other neurodevelopmental disorders. This program has been carefully designed to support the process of neurological re-education and rehabilitation for children and adolescents with neuropsychomotor developmental delays.

Geographical disparities in fibromyalgia severity: An Italian study.

Geographic origin may represent a variable capable of influencing health status. This study aims to investigate the presence of differences of disease severity in Italian patients with fibromyalgia from different macro-regions. This retrospective, cross-sectional study involved patients included in the Italian Fibromyalgia Registry. Three geographical macro-regions were identified, comprising patients from Northern Italy, Central Italy and Southern Italy. Clinical differences (evaluated through PolySymptomatic Distress Scale [PSD], revised Fibromyalgia Impact Questionnaire [FIQR] and modified Fibromyalgia Assessment Status [FASmod]) among the geographical macro-regions were studied using one-way analysis of variance (ANOVA) and the Scheffé's test. A total of 6095 patients (5719 females and 376 males) were included, with 1957 from Northern Italy, 2979 from Central Italy and 1159 from Southern Italy. All studied clinical indices showed a trend indicative of greater disease severity in Southern Italy, followed by Northern Italy and then Central Italy (mean values for PSD: 19.97 ± 6.20 in Northern Italy, 18.61 ± 7.12 in Central Italy, 23.01 ± 5.66 in Souther Italy). These differences were statistically significant for the overall scores of all studied indices, evaluated with ANOVA (all p < 0.001) and in the head to head comparisons, evaluted with Scheffé's test. Geographic background is significantly associated with variations in the severity of fibromyalgia in Italian patients. This is the first study to demonstrate geographical origin-dependent intra-national differences in the severity of fibromyalgia. The results confirm the necessity of considering fibromyalgia within the context of the biopsychosocial model and of implementing healthcare policies targeted towards the most underserved regions.

Evolutionary theory can advance and revitalise the biopsychosocial model

The biopsychosocial model remains a key paradigm for healthcare, despite widely recognised scientific and philosophical shortcomings. Here we report on recent updates integrating evolutionary theory with the biopsychosocial model to provide a more comprehensive and scientifically complete approach to understanding the multiple relevant levels of causation of medical and psychiatric problems.

"What Is Normal?": A Qualitative Exploration of Health Practitioners' Reports of Treating Patients Presenting with Unpleasant Sexual Experiences.

Sexual health, including sexual pleasure, is fundamental to holistic health and well-being, and is considered an area of priority health in Australia. Despite the importance of sexual functioning, women experience significant gaps in sexual well-being compared to men and often do not seek medical care or treatment. Health practitioners are central to the identification and treatment of sexual dysfunction, including fostering sexual well-being for patients. Despite this, minimal research has explored health practitioners' experiences in treating reports of unpleasant sex. This study aimed to explore health practitioners' experiences, responses, and confidence in treating patients presenting for unpleasant sexual experiences. An online, mixed-methods survey was completed by 96 participants. Thematic analysis identified 11 core themes. These themes included five patient centred themes (health risks, diverse sex acts, painful vaginal intercourse, relationship breakdown and violence, unwanted sex) and six health practitioner centred themes (communication and counselling, what is normal, ongoing care and follow up, emotional response, limited practical training, and highly prevalent). Participants described a complex sexual health landscape, with social contexts impacting women's sexual experiences and engagement in treatment. Additionally, health practitioners reported the need for a biopsychosocial approach to understanding and responding to unpleasant sexual experiences for patients, while simultaneously reporting limited education in this area. Findings reflect the need for health practitioners to be cognisant of matters related to sexual function, consent, coercion, client engagement, and treatment pathways, identifying a need for greater education and holistic approaches to sexual healthcare across medical settings.

Biopsychosocial Model Analysis of a Recurrent Guillain–Barré Syndrome Patient’s Recovery

Abstract Guillain–Barré syndrome (GBS) is an autoimmune disease that generally follows a monophasic course and typically does not recur. This case report explores the application of the biopsychosocial model in the context of a 46-year-old patient who experienced GBS for the second time in 2 years. It highlights the predisposing, precipitating, perpetuating, and protective factors affecting the patient’s biological, psychological, and social aspects during their recovery journey. The patient’s excellent socioeconomic status, social activity, and strong family support along with vigorous physical therapy played a crucial role in their remarkable recovery.

Older Métis Adults’ Experiences of Physical Activity and Implications to Health Providers

Physical activity supports health and wellness, and specifically supports healthy aging. Little is known about the experiences of older Métis adults with physical activity through their lifespan and how this has impacted wellness. This study was co-constructed with 12 older Métis adults in Sakitawak (Île-à-la-Crosse) Saskatchewan using a participatory action approach, two-eyed seeing and the ontology of Breath of Life Theory, as described by Cindy Blackstock. Older Métis adults described physical activity within three themes, Wahkotowin (Related to Everything), Ahkameyimowin (Never Give up), and E ti Meyo Matshohot (Becoming/Living a Better Life). The results of this study have implications for health care professions which are founded within biomedical and biopsychosocial models. We consider the context and experiences of physical activity among Indigenous populations in Canada to better address the gaps and identify practices that aim to support population health.

The octagon of opportunities in obesity.

The Ominous Octet is a popular construct, which has been used to describe the aetiopathology of diabetes, as well as the endocrine causation of obesity. We utilize this model to create a smart and salutogenic rubric of obesity pathogenesis. Our optimistic Octagon of Opportunities lists eight causative or contributory factors, all of which are associated with the development of obesity. The model gives equal weightage to the biomedical and psychosocial arms of the biopsychosocial model of health. The framework encourages a proactive and comprehensive approach to the prevention and management of obesity.

What should we be studying? Research priorities according to women and gender-diverse individuals with sexual interest/arousal disorder and their partners.

Sexual interest/arousal disorder (SIAD) is one of the most common sexual problems for women. In clinical research, there are often misalignments between the research priorities of patients and researchers, which can negatively impact care, and gender-diverse individuals are often excluded from research. Inclusion of patient perspectives when establishing research priorities may help to reduce these gaps; however, the research priorities of couples coping with SIAD remain unclear. Identify the research priorities of women and gender-diverse individuals with SIAD and their partners. In an online survey, couples coping with SIAD provided consent and responded to an open-ended question asking them to list the top 3 things they think are important for researchers to focus on related to couples coping with low sexual desire. A team-based content analysis was conducted to identify themes and their frequency of endorsement. An author-developed open-ended question. Analysis of 1279 responses (n = 667 from women and gender-diverse individuals with SIAD, n =612 from partners) resulted in our identification of 6 main themes: general causes, general treatment and coping, biophysiological, relationship, psychological, and environmental/contextual. Additionally, we identified 4 sub-themes within each of the latter 4 main themes: general, cause, treatment, and impact. For women and gender-diverse individuals with SIAD, their partners, and specifically gender-diverse participants, the 3 most endorsed themes were psychological general factors (24.3%, 21.2%, 24.3%; eg, stress and the link between SIAD and anxiety), relationship general factors (15.7%, 13.2%, 18.6%; eg, relationship length and communication on sexual desire), and biophysiological general factors (12.3%, 12.4%, 14.3%; eg, research on medications and hormones). Clinical researchers should consider the research priorities of couples coping with SIAD to ensure their work aligns with the needs of the affected population. This study is the first to identify the research priorities of both women and gender-diverse individuals with SIAD and their partners. Most participants identified as heterosexual, North American, and of middle to high socioeconomic status; results may not generalize. Responses were sometimes brief and/or vague; interpretation of these responses was therefore limited and may have required more contextual information. Findings suggest that women and gender-diverse individuals with SIAD, their partners, and gender-diverse participants have similar research priorities that are consistent with a biopsychosocial approach to research. Heterogeneity of responses across themes supports a multidisciplinary, patient-oriented approach to SIAD research.

Examining the Impact of the Design-Thinking Intergenerational Service-Learning Model on Older Adults’ Self-Care Behaviors and Well-Being

The Design-Thinking Intergenerational Service-Learning Model (DTISLM), rooted in the biopsychosocial model, aims to empower older adults to improve their chronic-disease management behavior through tailored programs addressing their specific healthcare needs. This study, conducted in Taiwan, used a convenience sampling method ( n = 172) to evaluate the impact of DTISLM on Taiwan’s adult day center participants’ perception of self-care behaviors, feelings of happiness, depression, and perceived social support using pretest–posttest surveys. The results indicated a significant enhancement in participants’ perception of self-care behaviors, reduction in depression score, and improvements in perceived social support following the completion of the program. The findings underscore the efficacy of applying a design-thinking framework in an intergenerational context. Future studies should investigate how the DTISLM can be scaled to various demographics and healthcare settings to enhance its applicability and understand its long-term effects.

An in-Depth Exploration of Consumer and Consumer Representative Views on Chronic Pain Management in Australia: A Key Informant Interview Study

Chronic pain affects millions of Australians. Despite guidelines recommending non-pharmacological approaches as the first line treatment, opioid medications remain among the most common treatments. This study interviewed consumers and consumer representatives (i.e., representatives of peak pain advocacy organizations in Australia) to gain first-hand perspectives on chronic pain treatment in Australia. Individual semi-structured Key Informant Interviews (KIIs) with three consumers and three representatives were undertaken. Interviews were transcribed, and thematic analysis applied. Results showed that consumers and consumer representatives identified critical treatment access barriers. Another shared theme related to overarching principles of care, with sub-themes pertaining to the need for an interdisciplinary approach and pain education. A further shared theme focused on typical medical interventions, with one shared subtheme regarding the benefits and drawbacks of pain medications. Both groups highlighted the importance of a biopsychosocial approach with consideration of mental health, particularly related to perceived stigma and comorbidities. These findings highlight that chronic pain remains both undertreated and inadequately treated in Australia. There is a critical need to use novel approaches to overcome access barriers and stigma, and to advance precision medicine to match patients to the treatment most likely to be of benefit as early as possible in their journey.

Predictive utility of self-efficacy in early stroke rehabilitation

ABSTRACT Introduction A biopsychosocial approach entailing person-centered factors provides valuable insight to post-stroke rehabilitation potential. The consideration of an individual’s belief in their capabilities, known as self-efficacy, may prove especially informative in the inpatient rehabilitation setting where motor learning often occurs. Objective To assess the predictive utility of self-efficacy in functional independence status change during inpatient rehabilitation. Methods Individuals with stroke admitted to an inpatient rehabilitation facility (IRF) completed an assessment battery near IRF admission and discharge involving motor assessments, participant-reported self-efficacy (Stroke Self-Efficacy Questionnaire), and functional independence status evaluation (sum of self-care and mobility Quality Indicators (QI) from the IRF-Patient Assessment Instrument). Linear regression was performed to determine the predictive performance of self-efficacy on QI change during IRF stay while accounting for age, time post-stroke, and IRF length of stay. Regression procedures were repeated for separate subgroups based on initial motor impairment level. Results Thirty individuals with stroke (14 females, age = 67.0 ± 9.80 years, 10.4 ± 3.46 days post-stroke) were enrolled. Self-efficacy at IRF admission explained a significant percentage of variance in QI Change for the cohort (R2 = 30.7%, p = .001) and for the moderate to severe motor impairment subgroup (n = 12; R2 = 49.9%, p = .010). After accounting for confounders, self-efficacy remained a significant predictor for the cohort (n = 30) model. Discussion Findings generated from this work support the predictive utility of self-efficacy in early post-stroke motor recovery. The inclusion of self-efficacy in a multi-faceted evaluation framework may therefore optimize rehabilitation outcomes by providing therapists with additional knowledge to better tailor an individual’s care.

Fatigue in chronic physical diseases

The term fatigue is used to describe states of unusual tiredness and exhaustion that can occur in connection with various chronic diseases, particularly cancer, multiple sclerosis, Parkinson's disease and rheumatoid arthritis. In contrast to states of exhaustion in healthy people, fatigue is characterized by the fact that it can last for long periods, is disproportionate to previous activities and does not subside after recovery phases. Fatigue is described as amultidimensional problem that encompasses physical, emotional and cognitive aspects and is associated with ahigh level of subjective suffering. Depending on the severity and course of the symptoms, fatigue is associated with aseverely reduced quality of life and it impairs participation and coping with everyday life. It also makes professional reintegration and reemployment more difficult. Although we cannot yet fully explain the aetiology and pathogenesis, fatigue in physical illnesses must be understood based on amultifactorial biopsychosocial model. The possibilities of diagnostics and an overview of various measures for clarifying fatigue are presented. The challenges for medical care are also outlined and advice is given on how to deal with them in everyday clinical practice.

Moving beyond biology: the critical role of social and structural determinants in atopic dermatitis.

Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disease with a substantial global burden and negative impact on quality of life. While genetics and pathophysiology are key to understanding AD, emerging evidence indicates that social and structural determinants of health (SDOH and StDOH) strongly influence the condition's onset, severity, and outcomes. SDOH, such as economic stability, education quality and access, healthcare quality and access, neighborhood environment, and social/community context, shape individual risk and disease experience. StDOH, including government processes, economic policies, social/public policies, and cultural/societal values, further act as upstream forces that directly and indirectly influence AD outcomes. In this review, we synthesize current knowledge on the impacts of SDOH and StDOH on AD incidence, severity, and disparities. Embracing a biopsychosocial model is crucial to elucidate the etiology, epidemiology, and optimal management of AD. Future research should adopt a holistic approach, moving beyond a purely biological perspective to consider the intricate interplay of social and structural determinants in understanding and managing AD.

Biopsychosocial pathways model of early childhood appetite self-regulation: Temperament as a key to modulation of interactions among systems

The widespread discrimination against individuals with obesity often stems from a simplistic perception of obesity as a mere consequence of personal choices of overeating and insufficient physical activity. This reductionist perception fails to acknowledge the complexity of the epidemic of obesity, which extends beyond diet and exercise decisions. The concept of appetite self-regulation (ASR) has been explored as a crucial element in identifying obesogenic behavioral approaches to food. Although an extensive understanding of ASR in children is essential as an early precursor and modifiable factor influencing obesity, the prevailing view of self-regulation of eating solely as a matter of cognitive and behavioral processing tends to overlook interacting systems of influences. This narrow approach attributes obesity to the lack of voluntary self-control in food consumption while neglecting to account for the biological, psychological, and social influences implicated in the developmental processes of ASR, which may further contribute to the stigmatization of obesity. The current critical analysis provides a comprehensive developmental framework that could guide future studies with testable hypotheses, outlining pathways of interactions among biopsychosocial systems, all of which contribute to the development of ASR in early childhood. Adopting developmental perspectives allows a holistic approach to investigating ASR, which accounts for intricate interactions between biological (B), psychological (P), and social (S) factors influential in the early manifestation of ASR.

Manual therapy plus sexual advice compared with manual therapy or exercise therapy alone for lumbar radiculopathy: a randomized controlled trial.

The biopsychosocial approach to managing low back pain (LBP) has the potential to improve the quality of care for patients. However, LBP trials that have utilized the biopsychosocial approach to treatment have largely neglected sexual activity, which is an important social component of individuals with LBP. The objectives of the study are to determine the effects of manual therapy plus sexual advice (MT+SA) compared with manual therapy (MT) or exercise therapy (ET) alone in the management of individuals with lumbar disc herniation with radiculopathy (DHR) and to determine the best sexual positions for these individuals. This was a single-blind randomized controlled trial. Fifty-four participants diagnosed as having chronic DHR (>3 months) were randomly allocated into three groups with 18 participants each in the MT+SA, MT and ET groups. The participants in the MT+SA group received manual therapy (including Dowling's progressive inhibition of neuromuscular structures and Mulligan's spinal mobilization with leg movement) plus sexual advice, those in the MT group received manual therapy only and those in the ET group received exercise therapy only. Each group received treatment for 12 weeks and then followed up for additional 40 weeks. The primary outcomes were pain, activity limitation, sexual disability and kinesiophobia at 12 weeks post-randomization. The MT+SA group improved significantly better than the MT or ET group in all outcomes (except for nerve function), and at all timelines (6, 12, 26, and 52 weeks post-randomization). These improvements were also clinically meaningful for back pain, leg pain, medication intake, and functional mobility at 6 and 12 weeks post-randomization and for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at 6, 12, 26, and 52 weeks post-randomization (p<0.05). On the other hand, many preferred sexual positions for individuals with DHR emerged, with "side-lying" being the most practiced sexual position and "standing" being the least practiced sexual position by females. While "lying supine" was the most practiced sexual position and "sitting on a chair" was the least practiced sexual position by males. This study found that individuals with DHR demonstrated better improvements in all outcomes when treated with MT+SA than when treated with MT or ET alone. These improvements were also clinically meaningful for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at long-term follow-up. There is also no one-size-fits-all to sexual positioning for individuals with DHR.

Risk factors for persistent postoperative opioid use: an entity distinct from chronic postsurgical pain

Despite a decline in opioid prescriptions over the past decade, patients commonly receive opioid analgesics as a treatment for postoperative pain in the USA. One complication that patients may experience...

Pengaruh Emosi Positif Terhadap Hasil Pengobatan Penyakit Rheumatoid Arthritis

This study evaluates the impact of positive emotions on rheumatoid arthritis (RA) treatment outcomes through a meta-analysis of 47 studies (2015-2024) involving 12,384 patients. The primary findings reveal a significant positive correlation between positive emotions and improved RA treatment outcomes (r = 0.42, p &lt; 0.001), with the strongest effects observed in enhanced quality of life (r = 0.51) and physical function (r = 0.45). Patients exhibiting high positive emotions demonstrated greater reductions in pain (d = 0.38), decreased inflammation (d = 0.29), and improved physical function (d = 0.45) compared to control groups. Moreover, moderator analyses uncovered stronger effects among elderly patients (? = 0.012, p = 0.025) and those with longer RA duration (? = 0.018, p = 0.009). Finally, mediational analyses indicated that positive emotions contributed to improved treatment adherence (indirect effect = 0.09, 95% CI [0.05, 0.13]) and increased physical activity (indirect effect = 0.07, 95% CI [0.03, 0.11]) in RA patients. These findings extend Fredrickson's (2001) Broaden-and-Build theory and support Keefe et al.'s (2002) biopsychosocial model. Compared to meta-analyses by Brosseau et al. (2018) and Zhou et al. (2020), this study provides more comprehensive evidence on the role of positive emotions in various RA treatment outcomes. The novelty of this research lies in the analysis of previously unexplored mediating and moderating mechanisms, as well as a comparison of effectiveness with pharmacological interventions (SMD = 0.18, 95% CI [-0.05, 0.41], p = 0.124). These results support the integration of positive emotion-based interventions in RA management and expand upon Strand et al.'s (2019) findings on patient expectations in RA treatment.