Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.
Cochrane Database Syst Rev. 2021 Dec 10;12(12):CD013740. doi: 10.1002/14651858.CD013740.pub2.
Mindfulness interventions are increasingly popular as an approach to improve mental well-being. To date, no Cochrane Review examines the effectiveness of mindfulness in medical students and junior doctors. Thus, questions remain regarding the efficacy of mindfulness interventions as a preventative mechanism in this population, which is at high risk for poor mental health. OBJECTIVES: To assess the effects of psychological interventions with a primary focus on mindfulness on the mental well-being and academic performance of medical students and junior doctors.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and five other databases (to October 2021) and conducted grey literature searches. SELECTION CRITERIA: We included randomised controlled trials of mindfulness that involved medical students of any year level and junior doctors in postgraduate years one, two or three. We included any psychological intervention with a primary focus on teaching the fundamentals of mindfulness as a preventative intervention. Our primary outcomes were anxiety and depression, and our secondary outcomes included stress, burnout, academic performance, suicidal ideation and quality of life. DATA COLLECTION AND ANALYSIS: We used standard methods as recommended by Cochrane, including Cochrane's risk of bias 2 tool (RoB2). MAIN RESULTS: We included 10 studies involving 731 participants in quantitative analysis. Compared with waiting-list control or no intervention, mindfulness interventions did not result in a substantial difference immediately post-intervention for anxiety (standardised mean difference (SMD) 0.09, 95% CI -0.33 to 0.52; P = 0.67, I= 57%; 4 studies, 255 participants; very low-certainty evidence). Converting the SMD back to the Depression, Anxiety and Stress Scale 21-item self-report questionnaire (DASS-21) showed an estimated effect size which is unlikely to be clinically important. Similarly, there was no substantial difference immediately post-intervention for depression (SMD 0.06, 95% CI -0.19 to 0.31; P = 0.62, I = 0%; 4 studies, 250 participants; low-certainty evidence). Converting the SMD back to DASS-21 showed an estimated effect size which is unlikely to be clinically important. No studies reported longer-term assessment of the impact of mindfulness interventions on these outcomes. For the secondary outcomes, the meta-analysis showed a small, substantial difference immediately post-intervention for stress, favouring the mindfulness intervention (SMD -0.36, 95% CI -0.60 to -0.13; P < 0.05, I= 33%; 8 studies, 474 participants; low-certainty evidence); however, this difference is unlikely to be clinically important. The meta-analysis found no substantial difference immediately post-intervention for burnout (SMD -0.42, 95% CI -0.84 to 0.00; P = 0.05, I² = 0%; 3 studies, 91 participants; very low-certainty evidence). The meta-analysis found a small, substantial difference immediately post-intervention for academic performance (SMD -0.60, 95% CI -1.05 to -0.14; P < 0.05, I² = 0%; 2 studies, 79 participants; very low-certainty evidence); however, this difference is unlikely to be clinically important. Lastly, there was no substantial difference immediately post-intervention for quality of life (mean difference (MD) 0.02, 95% CI -0.28 to 0.32; 1 study, 167 participants; low-certainty evidence). There were no data available for three pre-specified outcomes of this review: deliberate self-harm, suicidal ideation and suicidal behaviour. We assessed the certainty of evidence to range from low to very low across all outcomes. Across most outcomes, we most frequently judged the risk of bias as having 'some concerns'. There were no studies with a low risk of bias across all domains. AUTHORS' CONCLUSIONS: The effectiveness of mindfulness in our target population remains unconfirmed. There have been relatively few studies of mindfulness interventions for junior doctors and medical students. The available studies are small, and we have some concerns about their risk of bias. Thus, there is not much evidence on which to draw conclusions on effects of mindfulness interventions in this population. There was no evidence to determine the effects of mindfulness in the long term.
正念干预作为一种改善心理健康的方法，越来越受到关注。迄今为止，尚无 Cochrane 综述评估正念对医学生和初级医生的有效性。因此，对于正念干预作为这一高心理健康风险人群的预防机制的疗效，仍存在疑问。
评估以正念为主要焦点的心理干预对医学生和初级医生的心理健康和学业成绩的影响。
我们检索了 Cochrane 中央对照试验注册库（CENTRAL）、MEDLINE、Embase 和其他五个数据库（截至 2021 年 10 月），并进行了灰色文献检索。
我们纳入了涉及任何年级医学生和研究生一、二或三年级初级医生的正念随机对照试验。我们纳入了任何以教授正念基本原理为主要焦点的心理干预，作为预防干预措施。我们的主要结局指标是焦虑和抑郁，次要结局指标包括压力、倦怠、学业成绩、自杀意念和生活质量。
我们使用了 Cochrane 推荐的标准方法，包括 Cochrane 偏倚风险 2 工具（RoB2）。
我们纳入了 10 项研究，涉及 731 名参与者进行定量分析。与等待名单对照或无干预相比，正念干预在干预后即刻并未导致焦虑有显著差异（标准化均数差（SMD）0.09，95%置信区间（CI）-0.33 至 0.52；P = 0.67，I = 57%；4 项研究，255 名参与者；极低确定性证据）。将 SMD 转换回抑郁、焦虑和压力量表 21 项自评问卷（DASS-21）显示，估计的效应大小不太可能具有临床意义。同样，干预后即刻抑郁也没有显著差异（SMD 0.06，95%CI -0.19 至 0.31；P = 0.62，I = 0%；4 项研究，250 名参与者；低确定性证据）。将 SMD 转换回 DASS-21 显示，估计的效应大小不太可能具有临床意义。没有研究报告正念干预对这些结局的长期影响。对于次要结局，meta 分析显示，干预后即刻压力有较小但具有统计学意义的差异，正念干预更有利（SMD -0.36，95%CI -0.60 至 -0.13；P < 0.05，I² = 33%；8 项研究，474 名参与者；低确定性证据）；然而，这种差异不太可能具有临床意义。meta 分析发现，干预后即刻倦怠没有显著差异（SMD -0.42，95%CI -0.84 至 0.00；P = 0.05，I² = 0%；3 项研究，91 名参与者；极低确定性证据）。meta 分析发现，干预后即刻学业成绩有较小但具有统计学意义的差异（SMD -0.60，95%CI -1.05 至 -0.14；P < 0.05，I² = 0%；2 项研究，79 名参与者；极低确定性证据）；然而，这种差异不太可能具有临床意义。最后，干预后即刻生活质量没有显著差异（均数差（MD）0.02，95%CI -0.28 至 0.32；1 项研究，167 名参与者；低确定性证据）。本综述的三个预定结局指标（蓄意自伤、自杀意念和自杀行为）没有数据。我们评估证据的确定性范围从低到极低，所有结局均如此。在大多数结局中，我们最常判断偏倚风险为“存在一些关注”。没有研究在所有领域都具有低偏倚风险。
正念在我们的目标人群中的有效性仍未得到证实。针对初级医生和医学生的正念干预研究相对较少。现有研究规模较小，我们对其偏倚风险存在一些担忧。因此，对于正念干预在这一人群中的疗效，我们没有太多的证据可以得出结论。没有证据表明正念的长期效果。
