Mindfulness-based programmes for mental health promotion in adults in nonclinical settings: A systematic review and meta-analysis of randomised controlled trials
Galante, J. ; Friedrich, C. ; Dawson, A.F. ; Modrego-Alarcón, M. (Universidad de Zaragoza) ; Gebbing, P. ; Delgado-Suárez, I. ; Gupta, R. ; Dean, L. ; Dalgleish, T. ; White, I.R. ; Jones, P.B.
Resumen: Background
There is an urgent need for mental health promotion in nonclinical settings. Mindfulness–based programmes (MBPs) are being widely implemented to reduce stress, but a comprehensive evidence synthesis is lacking. We reviewed trials to assess whether MBPs promote mental health relative to no intervention or comparator interventions.
Methods and findings
Following a detailed preregistered protocol (PROSPERO CRD42018105213) developed with public and professional stakeholders, 13 databases were searched to August 2020 for randomised controlled trials (RCTs) examining in–person, expert–defined MBPs in nonclinical settings. Two researchers independently selected, extracted, and appraised trials using the Cochrane Risk–of–Bias Tool 2.0. Primary outcomes were psychometrically validated anxiety, depression, psychological distress, and mental well–being questionnaires at 1 to 6 months after programme completion. Multiple testing was performed using p < 0.0125 (Bonferroni) for statistical significance. Secondary outcomes, meta–regression and sensitivity analyses were prespecified. Pairwise random–effects multivariate meta–analyses and prediction intervals (PIs) were calculated. A total of 11, 605 participants in 136 trials were included (29 countries, 77% women, age range 18 to 73 years). Compared with no intervention, in most but not all scenarios MBPs improved average anxiety (8 trials; standardised mean difference (SMD) = -0.56; 95% confidence interval (CI) -0.80 to -0.33; p–value < 0.001; 95% PI -1.19 to 0.06), depression (14 trials; SMD = -0.53; 95% CI -0.72 to -0.34; p–value < 0.001; 95% PI -1.14 to 0.07), distress (27 trials; SMD = -0.45; 95% CI -0.58 to -0.31; p–value < 0.001; 95% PI -1.04 to 0.14), and well–being (9 trials; SMD = 0.33; 95% CI 0.11 to 0.54; p–value = 0.003; 95% PI -0.29 to 0.94). Compared with nonspecific active control conditions, in most but not all scenarios MBPs improved average depression (6 trials; SMD = -0.46; 95% CI -0.81 to -0.10; p–value = 0.012, 95% PI -1.57 to 0.66), with no statistically significant evidence for improving anxiety or distress and no reliable data on well–being. Compared with specific active control conditions, there is no statistically significant evidence of MBPs’ superiority. Only effects on distress remained when higher–risk trials were excluded. USA–based trials reported smaller effects. MBPs targeted at higher–risk populations had larger effects than universal MBPs. The main limitation of this review is that confidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is moderate to very low, mainly due to inconsistency and high risk of bias in many trials.
Conclusions
Compared with taking no action, MBPs of the included studies promote mental health in nonclinical settings, but given the heterogeneity between studies, the findings do not support generalisation of MBP effects across every setting. MBPs may have specific effects on some common mental health symptoms. Other preventative interventions may be equally effective. Implementation of MBPs in nonclinical settings should be partnered with thorough research to confirm findings and learn which settings are most likely to benefit.
Idioma: Inglés
DOI: 10.1371/journal.pmed.1003481
Año: 2021
Publicado en: PLOS MEDICINE 18, 1 (2021), e1003481[40 pp]
ISSN: 1549-1277
Factor impacto JCR: 11.613 (2021)
Categ. JCR: MEDICINE, GENERAL & INTERNAL rank: 22 / 172 = 0.128 (2021) - Q1 - T1
Factor impacto CITESCORE: 15.0 - Medicine (Q1)
Factor impacto SCIMAGO: 4.18 - Biochemistry (Q1) - Molecular Biology (Q1) - Medicine (miscellaneous) (Q1) - Biotechnology (Q1)
Financiación: info:eu-repo/grantAgreement/ES/MECD/FPU15-00598
Financiación: info:eu-repo/grantAgreement/ES/MECD/FPU16-03565
Tipo y forma: Article (Published version)
Área (Departamento): Área Psicolog.Evolut.Educac (Dpto. Psicología y Sociología)
You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
Exportado de SIDERAL (2023-05-18-15:20:07)
Visitas y descargas
There is an urgent need for mental health promotion in nonclinical settings. Mindfulness–based programmes (MBPs) are being widely implemented to reduce stress, but a comprehensive evidence synthesis is lacking. We reviewed trials to assess whether MBPs promote mental health relative to no intervention or comparator interventions.
Methods and findings
Following a detailed preregistered protocol (PROSPERO CRD42018105213) developed with public and professional stakeholders, 13 databases were searched to August 2020 for randomised controlled trials (RCTs) examining in–person, expert–defined MBPs in nonclinical settings. Two researchers independently selected, extracted, and appraised trials using the Cochrane Risk–of–Bias Tool 2.0. Primary outcomes were psychometrically validated anxiety, depression, psychological distress, and mental well–being questionnaires at 1 to 6 months after programme completion. Multiple testing was performed using p < 0.0125 (Bonferroni) for statistical significance. Secondary outcomes, meta–regression and sensitivity analyses were prespecified. Pairwise random–effects multivariate meta–analyses and prediction intervals (PIs) were calculated. A total of 11, 605 participants in 136 trials were included (29 countries, 77% women, age range 18 to 73 years). Compared with no intervention, in most but not all scenarios MBPs improved average anxiety (8 trials; standardised mean difference (SMD) = -0.56; 95% confidence interval (CI) -0.80 to -0.33; p–value < 0.001; 95% PI -1.19 to 0.06), depression (14 trials; SMD = -0.53; 95% CI -0.72 to -0.34; p–value < 0.001; 95% PI -1.14 to 0.07), distress (27 trials; SMD = -0.45; 95% CI -0.58 to -0.31; p–value < 0.001; 95% PI -1.04 to 0.14), and well–being (9 trials; SMD = 0.33; 95% CI 0.11 to 0.54; p–value = 0.003; 95% PI -0.29 to 0.94). Compared with nonspecific active control conditions, in most but not all scenarios MBPs improved average depression (6 trials; SMD = -0.46; 95% CI -0.81 to -0.10; p–value = 0.012, 95% PI -1.57 to 0.66), with no statistically significant evidence for improving anxiety or distress and no reliable data on well–being. Compared with specific active control conditions, there is no statistically significant evidence of MBPs’ superiority. Only effects on distress remained when higher–risk trials were excluded. USA–based trials reported smaller effects. MBPs targeted at higher–risk populations had larger effects than universal MBPs. The main limitation of this review is that confidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is moderate to very low, mainly due to inconsistency and high risk of bias in many trials.
Conclusions
Compared with taking no action, MBPs of the included studies promote mental health in nonclinical settings, but given the heterogeneity between studies, the findings do not support generalisation of MBP effects across every setting. MBPs may have specific effects on some common mental health symptoms. Other preventative interventions may be equally effective. Implementation of MBPs in nonclinical settings should be partnered with thorough research to confirm findings and learn which settings are most likely to benefit.
Idioma: Inglés
DOI: 10.1371/journal.pmed.1003481
Año: 2021
Publicado en: PLOS MEDICINE 18, 1 (2021), e1003481[40 pp]
ISSN: 1549-1277
Factor impacto JCR: 11.613 (2021)
Categ. JCR: MEDICINE, GENERAL & INTERNAL rank: 22 / 172 = 0.128 (2021) - Q1 - T1
Factor impacto CITESCORE: 15.0 - Medicine (Q1)
Factor impacto SCIMAGO: 4.18 - Biochemistry (Q1) - Molecular Biology (Q1) - Medicine (miscellaneous) (Q1) - Biotechnology (Q1)
Financiación: info:eu-repo/grantAgreement/ES/MECD/FPU15-00598
Financiación: info:eu-repo/grantAgreement/ES/MECD/FPU16-03565
Tipo y forma: Article (Published version)
Área (Departamento): Área Psicolog.Evolut.Educac (Dpto. Psicología y Sociología)
You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. Exportado de SIDERAL (2023-05-18-15:20:07)
Permalink:
Visitas y descargas
Este artículo se encuentra en las siguientes colecciones:
Articles > Artículos por área > Psicología Evolutiva y de la Educación
Record created 2021-02-12, last modified 2023-05-19