Disclosures: Lee and one other study author report grants from the NIH, Brain and Behavior Research Foundation and Stein Institute for Research on Aging during the conduct of the study. The other study authors report no relevant financial disclosures. The editorial authors report no relevant financial disclosures.
May 14, 2020
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Enhancing components of wisdom may improve outcomes among individuals with mental, physical illness

Disclosures: Lee and one other study author report grants from the NIH, Brain and Behavior Research Foundation and Stein Institute for Research on Aging during the conduct of the study. The other study authors report no relevant financial disclosures. The editorial authors report no relevant financial disclosures.
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Ellen E. Lee
 
Dilip V. Jeste

Interventions that enhance prosocial behaviors, emotional regulation and spirituality — all of which researchers consider “components of wisdom” — appeared effective among a proportion of individuals with mental or physical illnesses and from the community, according to results of a systematic review and meta-analysis published in JAMA Psychiatry.

“Our group has been studying wisdom for many years and believe that wisdom is associated with better health and well-being in many different populations,” Ellen E. Lee, MD, and Dilip V. Jeste, MD, both of the department of psychiatry at University of California San Diego, told Healio Psychiatry. “We want to develop an intervention to improve wisdom, but first we needed to know whether the individual components of wisdom could be enhanced and how. We hoped this study would clarify whether wisdom components can be enhanced and allow us to better understand what characteristics of the participants or features of the interventions may contribute to their effectiveness.”

Despite emerging evidence regarding wisdom's relation to health outcomes, the researchers found no published reviews of interventions for increasing wisdom or its components.

Lee and colleagues sought to evaluate the effectiveness of interventions to enhance wisdom’s individual components. They searched PsycINFO and MEDLINE databases for articles published through 2018 and included randomized clinical trials that aimed to enhance a component of wisdom, used published measures to evaluate that component, had a minimum sample size of 40 participants, were published in English and presented data effect size computations. The researchers calculated pooled standardized mean differences (SMDs) for each wisdom component, using random-effect models and assessed heterogeneity through random-effects meta-regression. Improvement in wisdom component using published measures served as the main outcome.

Lee and colleagues analyzed 57 studies that met review criteria, and these included 7,096 participants. Of these studies, 29 evaluated prosocial behaviors, 13 evaluated emotional regulation and 15 evaluated spirituality. Study samples included individuals from the community and those with psychiatric or physical illnesses. A total of 27 studies (47%) showed significant improvement with medium to large effect sizes. According to meta-analytic findings, significant pooled SMDs emerged for prosocial behaviors (23 studies; pooled SMD = 0.43; 95% CI, 0.22-0.63), emotional regulation (12 studies; pooled SMD = 0.67; 95% CI, 0.21-1.12) and spirituality (12 studies; pooled SMD = 1; 95% CI, 0.41-1.6). The researchers reported considerable study heterogeneity for all wisdom components, as well as publication bias for prosocial behavior and emotional regulation studies. After adjustment for this bias, the pooled SMD for prosocial behavior remained significant at 0.4 (95% CI, 0.16-0.78). Meta-regression analysis revealed no effect size variation by wisdom component; however, for trials on prosocial behaviors, the researchers noted an association between large effect sizes and older mean participant age (beta = 0.08) and a reverse association for spirituality trials (beta = 0.13). Higher-quality trials had larger effect sizes for spirituality interventions, although the reverse appeared true for prosocial behavior trials (beta = 0.91).

“We feel encouraged about the potential to enhance wisdom for both the general community and individuals with serious mental illnesses," Lee and Jeste told Healio Psychiatry. "One of our other research findings was that wisdom is strongly and inversely correlated with loneliness. This finding has been replicated among four study populations. This has become especially relevant in the context of the COVID-19 pandemic as social distancing practices have greatly increased risk for social isolation. We believe that wisdom may be an important individual- and societal-level antidote for loneliness."

In a related editorial, Charles F. Reynolds III, MD, of University of Pittsburgh School of Medicine, and Dan G. Blazer, MD, PhD, of Duke University Medical Center, highlighted the importance of a multidimensional intervention approach for enhancing components of wisdom.

“Which specific components should be considered in mechanistic studies to optimize the development of interventions?” they wrote. “Our view is that adopting a multidimensional approach to ascertain associations between wisdom and health or well-being may provide greater, more nuanced information about risk for health than the considerations of individual components alone. We suggest another analogy with depression intervention research, where a combination of interventions is often needed to achieve and sustain optimal outcomes. Again, it may be that, as with depression treatment or prevention, one size does not fit all.” – by Joe Gramigna

Disclosures: Jeste and Lee report grants from the NIH, Brain and Behavior Research Foundation and Stein Institute for Research on Aging during the conduct of the study. The other study authors report no relevant financial disclosures. The editorial authors report no relevant financial disclosures.