Psychosocial Aspects


Kristel Polhuis, Eline van Bennekom, Mariska Bot, Giesje Nefs, Lenneke Vaandrager, Mirela Habibovic, Johanna Geleijnse, Frans Pouwer, Sabita Soedamah-Muthu

Flourishing mental health and lifestyle behaviours in adults with Type 1 and Type 2 Diabetes Mellitus: results from the Diabetes MILES – The Netherlands Study. Diabetes Care. J Psychosom Res. 2022 Sep;160:110950.

In both T1D and T2D healthy lifestyle behaviours (e.g. balanced diet, physical activity) are important factors in preventing long-term complications. Mental health is, in its turn, an important factor in these behaviours. It is not simply the absence of mental ill-health, but rather ‘a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community’ (WHO definition). Healthy lifestyle behaviours and mental health affect each other in both directions. In both T1D and T2D mental health has been associated with reduced mortality, more self-care activities and more optimal HbA1c. However, these results were based on either hedonic (feeling of happiness) or eudaimonic (individual functioning) aspects of mental health, whereas the WHO definition includes both aspects. This study, co-authored by Diabeter psychologist Giesje Nefs, aimed to assess mental health (ranging from languishing to moderate to flourishing mental health), including both hedonic and eudaimonic aspects, in people with T1D or T2D, and investigate possible associations with lifestyle behaviours (diet, physical activity, alcohol consumption and smoking).


The current study sample comprises n=595 participants of the MILES (Management and Impact for Long-term Empowerment and Success) study, who completed questions on mindfulness and positive mental health (Mental Health Continuum – Short Form [MHC-SF]). Additionally, diet, physical, alcohol consumption and smoking were assessed with a food frequency questionnaire, the International Physical Activity Questionnaire short form (IPAQ) and self-reporting the number of units of alcoholic drinks per week and frequency of smoking, respectively

Key findings:

  • 45% of the participants had T1D and 55% had T2D
  • The number of participants with languishing mental health was too low, so they were excluded from the analysis
  • Participants with T1D or T2D with flourishing mental health had a higher change of having a high quality diet, albeit not significantly so for participants with T1D
  • Flourishing mental health was associated with higher physical activity for participants with T2D but not for participants with T1D
  • No associations were found between flourishing mental health and alcohol consumption and smoking


Concluding, the authors state

"Finally, this study raises the question if positive mental health is more important for specific lifestyle behaviours (i.e. diet and physical activity) compared to others behaviours (i.e. alcohol and smoking), andif the effect of mental health on lifestyle behaviours differs across diabetes types. Although further research is needed, intervention developers may take this in consideration when designing mental health promoting strategies " -

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