与常规学校教育相比，基于学校的普遍正念训练在降低青少年心理健康问题风险和促进幸福感方面的有效性和成本效益：MYRIAD 整群随机对照试验
Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial.
作者信息
Kuyken Willem, Ball Susan, Crane Catherine, Ganguli Poushali, Jones Benjamin, Montero-Marin Jesus, Nuthall Elizabeth, Raja Anam, Taylor Laura, Tudor Kate, Viner Russell M, Allwood Matthew, Aukland Louise, Dunning Darren, Casey Tríona, Dalrymple Nicola, De Wilde Katherine, Farley Eleanor-Rose, Harper Jennifer, Kappelmann Nils, Kempnich Maria, Lord Liz, Medlicott Emma, Palmer Lucy, Petit Ariane, Philips Alice, Pryor-Nitsch Isobel, Radley Lucy, Sonley Anna, Shackleford Jem, Tickell Alice, Blakemore Sarah-Jayne, Team The Myriad, Ukoumunne Obioha C, Greenberg Mark T, Ford Tamsin, Dalgleish Tim, Byford Sarah, Williams J Mark G
机构信息
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, Devon, UK.
出版信息
Evid Based Ment Health. 2022 Jul 12;25(3):99-109. doi: 10.1136/ebmental-2021-300396.
BACKGROUND
Systematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health.
OBJECTIVE
The My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU).
METHODS
MYRIAD was a parallel group, cluster-randomised controlled trial. Eighty-five eligible schools consented and were randomised 1:1 to TAU (43 schools, 4232 students) or SBMT (42 schools, 4144 students), stratified by school size, quality, type, deprivation and region. Schools and students (mean (SD); age range=12.2 (0.6); 11-14 years) were broadly UK population-representative. Forty-three schools (n=3678 pupils; 86.9%) delivering SBMT, and 41 schools (n=3572; 86.2%) delivering TAU, provided primary end-point data. SBMT comprised 10 lessons of psychoeducation and mindfulness practices. TAU comprised standard social-emotional teaching. Participant-level risk for depression, social-emotional-behavioural functioning and well-being at 1 year follow-up were the co-primary outcomes. Secondary and economic outcomes were included.
FINDINGS
Analysis of 84 schools (n=8376 participants) found no evidence that SBMT was superior to TAU at 1 year. Standardised mean differences (intervention minus control) were: 0.005 (95% CI -0.05 to 0.06) for risk for depression; 0.02 (-0.02 to 0.07) for social-emotional-behavioural functioning; and 0.02 (-0.03 to 0.07) for well-being. SBMT had a high probability of cost-effectiveness (83%) at a willingness-to-pay threshold of £20 000 per quality-adjusted life year. No intervention-related adverse events were observed.
CONCLUSIONS
Findings do not support the superiority of SBMT over TAU in promoting mental health in adolescence.
CLINICAL IMPLICATIONS
There is need to ask what works, for whom and how, as well as considering key contextual and implementation factors.
TRIAL REGISTRATION
Current controlled trials ISRCTN86619085. This research was funded by the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z).
背景
系统评价表明，基于学校的正念训练（SBMT）在促进学生心理健康方面显示出前景。
目的
“青少年我的复原力（MYRIAD）试验”评估了SBMT与常规教学（TAU）相比的有效性和成本效益。
方法
MYRIAD是一项平行组、整群随机对照试验。85所符合条件的学校同意参与并按1:1随机分为TAU组（43所学校，4232名学生）或SBMT组（42所学校，4144名学生），按学校规模、质量、类型、贫困程度和地区分层。学校和学生（均值（标准差）；年龄范围 = 12.2（0.6）；11 - 14岁）大致代表英国人口。提供主要终点数据的43所实施SBMT的学校（n = 3678名学生；86.9%）和41所实施TAU的学校（n = 3572名学生；86.2%）。SBMT包括10节心理教育和正念练习课程。TAU包括标准的社会情感教学。1年随访时抑郁的参与者水平风险、社会情感行为功能和幸福感是共同主要结局。纳入了次要结局和经济结局。
结果
对84所学校（n = 8376名参与者）的分析发现，没有证据表明1年时SBMT优于TAU。标准化均值差异（干预减去对照）为：抑郁风险0.005（95%置信区间 -0.05至0.06）；社会情感行为功能0.02（-0.02至0.07）；幸福感0.02（-0.03至0.07）。在每质量调整生命年20000英镑的支付意愿阈值下，SBMT具有较高的成本效益概率（83%）。未观察到与干预相关的不良事件。
结论
研究结果不支持SBMT在促进青少年心理健康方面优于TAU。
临床意义
需要探讨什么有效、对谁有效以及如何有效，同时考虑关键的背景和实施因素。
试验注册
当前受控试验ISRCTN86619085。本研究由惠康信托基金资助（WT104908/Z/14/Z和WT107496/Z/15/Z）。
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