Individual participant data systematic review and meta-analysis of randomised controlled trials assessing adult mindfulness-based programmes for mental health promotion in non-clinical settings

Julieta Galante; Claire Friedrich; Collaboration of Mindfulness Trials (CoMinT) 3; Tim Dalgleish; Peter B Jones; Ian R White; Collaboration of Mindfulness Trials (CoMinT)

doi:10.1038/s44220-023-00081-5

Individual participant data systematic review and meta-analysis of randomised controlled trials assessing adult mindfulness-based programmes for mental health promotion in non-clinical settings

Nat Ment Health. 2023 Jul 10;1(7):462-476. doi: 10.1038/s44220-023-00081-5.

Authors

Julieta Galante¹, Claire Friedrich²; Collaboration of Mindfulness Trials (CoMinT) 3; Tim Dalgleish³, Peter B Jones⁴, Ian R White⁵; Collaboration of Mindfulness Trials (CoMinT)

Collaborators

Napaporn Aeamla-Or⁶, Marieke Arts-de Jong⁷, Bruce Barrett⁸, Susan M Bögels⁹, Jan K Buitelaar¹⁰, Mary M Checovich⁸, Michael S Christopher¹¹, Richard J Davidson¹², Antonia Errazuriz¹³, Simon B Goldberg¹⁴, Corina U Greven¹⁵, Matthew J Hirshberg¹⁶, Shu-Ling Huang¹⁷, Matthew Hunsinger¹¹, Yoon-Suk Hwang¹⁸, Oleg N Medvedev¹⁹, Melissa A Rosenkranz²⁰, Melanie P J Schellekens²¹, Nienke M Siebelink²², Nirbhay N Singh²³, Anne E M Speckens⁷, Feng-Cheng Tang²⁴, Lianne Tomfohr-Madsen²⁵

Affiliations

¹ Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, United Kingdom (second affiliation: Contemplative Studies Centre, Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Australia).
² Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
³ MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom (second affiliation: Cambridgeshire and Peterborough NHS Foundation Trust).
⁴ Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (second affiliation: NIHR Applied Research Collaboration East of England).
⁵ MRC Clinical Trials Unit at UCL, University College London, London, United Kingdom.
⁶ School of Nursing, University of Phayao, Phayao, Thailand.
⁷ Radboudumc Centre for Mindfulness, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.
⁸ Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, USA.
⁹ Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands (second affiliation: Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands).
¹⁰ Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands (second affiliation: Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands).
¹¹ School of Graduate Psychology, Pacific University, Hillsboro, OR, USA.
¹² Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA (second affiliation: Department of Psychology, University of Wisconsin-Madison, WI, USA, third affiliation: Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, WI, USA, fourth affiliation: Department of Psychiatry, University of Wisconsin-Madison, WI, USA).
¹³ Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (second affiliation: Millennium Institute for Research on Depression and Personality-MIDAP, Santiago, Chile).
¹⁴ Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA (second affiliation: Department of Counselling Psychology, University of Wisconsin-Madison, WI, USA).
¹⁵ Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, The Netherlands (second affiliation: Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands).
¹⁶ Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA.
¹⁷ Department of Psychology, Chung Shan Medical University, Taiwan (second affiliation: Room of Clinical Psychology, Chung Shan Medical University Hospital, Taiwan).
¹⁸ Institute for Learning Sciences and Teacher Education, Australian Catholic University, Level 4, 229 Elizabeth Street, Brisbane CBD, QLD 4000, Australia.
¹⁹ School of Psychology, University of Waikato, Hamilton, New Zealand.
²⁰ Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA (second affiliation: Department of Psychiatry, University of Wisconsin- School of Medicine and Public Health Madison, WI, USA).
²¹ Scientific Research Department, Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, the Netherlands (previous affiliation: Radboudumc Centre for Mindfulness, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands).
²² Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands (second affiliation: Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands, third affiliation: Academy Het Dorp, Arnhem, The Netherlands).
²³ Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, USA.
²⁴ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan (second affiliation: Department of Occupational Medicine, Changhua Christian Hospital, Changhua, Taiwan, third affiliation: Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan).
²⁵ Faculty of Education, University of British Columbia, Vancouver, BC, Canada.

Abstract

Introduction: Mindfulness-based programmes (MBPs) are widely used to prevent mental ill-health that is becoming the leading global cause of morbidity. Evidence suggests beneficial average effects but wide variability. We aimed to confirm the effect of MBPs on psychological distress, and to understand whether and how baseline distress, gender, age, education, and dispositional mindfulness modify the effect of MBPs on distress among adults in non-clinical settings.

Methods: We conducted a pre-registered systematic review and individual participant data (IPD) meta-analysis (PROSPERO CRD42020200117). Thirteen databases were searched in December 2020 for randomised controlled trials satisfying a quality threshold and comparing in-person, expert-defined MBPs in non-clinical settings with passive control groups. Two researchers independently selected, extracted, and appraised trials using the revised Cochrane Risk-of-Bias Tool (RoB2). Anonymised IPD of eligible trials were sought from collaborating authors. The primary outcome was psychological distress (unpleasant mental or emotional experiences including anxiety and depression) at 1 to 6 months after programme completion. Data were checked and imputed if missing. Pairwise, random-effects, two-stage IPD meta-analyses were conducted. Effect modification analyses followed a within-studies approach. Public and professional stakeholders were involved in the planning, conduct and dissemination of this study.

Results: Fifteen trials were eligible, 13 trialists shared IPD (2,371 participants representing 8 countries, median age 34 years-old, 71% women, moderately distressed on average, 20% missing outcome data). In comparison with passive control groups, MBPs reduced average distress between one- and six-months post-intervention with a small to moderate effect size (standardised mean difference (SMD) -0.32; 95% confidence interval (CI) -0.41 to -0.24; p-value < 0.001; 95% prediction interval (PI) -0.41 to -0.24 (no heterogeneity)). Results were robust to sensitivity analyses, and similar for the other psychological distress time point ranges. Confidence in the primary outcome result is high. We found no clear indication that this effect is modified by baseline psychological distress, gender, age, education level, or dispositional mindfulness.

Conclusions: Group-based teacher-led MBPs generally reduce psychological distress among community adults who volunteer to receive this type of intervention. More research is needed to identify sources of variability in outcomes at an individual level.

Abstract

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