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Mindfulness-based programmes for mental health promotion in adults in nonclinical settings: A systematic review and meta-analysis of randomised controlled trials.

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Friedrich, Claire 
Dawson, Anna F 
Modrego-Alarcón, Marta  ORCID logo


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.



Adult, Health Promotion, Humans, Mental Disorders, Mindfulness, Randomized Controlled Trials as Topic

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PLoS Med

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Public Library of Science (PLoS)


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Department of Health (via National Institute for Health Research (NIHR)) (PDF-2017-10-018)
Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) (Unknown)
MRC (unknown)
Wellcome Trust (via University of Oxford) (107496/Z/15/Z?)
Medical Research Council (MR/N019067/1)
Wellcome Trust (095844/Z/11/Z)
Medical Research Council (MC_UU_00005/4)
Wellcome Trust (104908/Z/14/Z)
This publication presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. JG is funded by a NIHR Post-doctoral Fellowship for this research project (salary and all project costs, PDF-2017-10-018,, she is also supported by the NIHR Applied Research Collaboration (ARC) East of England (grant awarded to PBJ, RNAG/564, CF's salary for this research project was funded by a Cambridgeshire & Peterborough NHS Foundation Trust grant awarded to JG (RNAG/552, IW was supported by the UK Medical Research Council (MC_UU_12023/21, TD was supported by the UK Medical Research Council (SUAG/043 G101400,, the Wellcome Trust (104908/Z/14/Z, 107496/Z/15/Z,, and the NIHR Cambridge Biomedical Research Centre (RG85446, 247730, PBJ is supported by the Wellcome Trust (095844/Z/11/Z,, the UK Medical Research Council (MR/N019067/1,, and the NIHR ARC East of England (RNAG/564, MMA and IDS were supported by the Spanish Ministry of Education, Culture and Sport (FPU15/00598 and FPU16/03565 respectively, The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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