Galante Julieta, Friedrich Claire, Dalgleish Tim, Jones Peter B, White Ian R
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).
Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
Nat Ment Health. 2023 Jul 10;1(7):462-476. doi: 10.1038/s44220-023-00081-5.
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.
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.
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.
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.
基于正念的项目（MBPs）被广泛用于预防心理健康问题，而心理健康问题正成为全球发病的主要原因。有证据表明其具有有益的平均效果，但存在很大差异。我们旨在确认MBPs对心理困扰的影响，并了解基线困扰、性别、年龄、教育程度和特质正念是否以及如何改变MBPs对非临床环境中成年人困扰的影响。
我们进行了一项预先注册的系统评价和个体参与者数据（IPD）荟萃分析（PROSPERO CRD42020200117）。2020年12月，我们检索了13个数据库，以寻找符合质量阈值并将非临床环境中由专家定义的面对面MBPs与被动对照组进行比较的随机对照试验。两名研究人员使用修订后的Cochrane偏倚风险工具（RoB2）独立选择、提取和评估试验。我们向合作作者索取符合条件试验的匿名IPD。主要结局是项目完成后1至6个月的心理困扰（包括焦虑和抑郁在内的不愉快的心理或情绪体验）。对数据进行检查，如有缺失则进行插补。进行了成对、随机效应、两阶段IPD荟萃分析。效应修饰分析采用研究内方法。公众和专业利益相关者参与了本研究的规划、实施和传播。
15项试验符合条件，13位试验者共享了IPD（2371名参与者，代表8个国家，中位年龄34岁，71%为女性，平均困扰程度为中度，20%的结局数据缺失）。与被动对照组相比，MBPs在干预后1至6个月降低了平均困扰程度，效应大小为小到中度（标准化平均差（SMD）-0.32；95%置信区间（CI）-0.41至-0.24；p值<0.001；95%预测区间（PI）-0.41至-0.24（无异质性））。结果对敏感性分析具有稳健性，在其他心理困扰时间点范围内也相似。对主要结局结果的信心很高。我们没有发现明确迹象表明这种效应会因基线心理困扰、性别、年龄、教育水平或特质正念而改变。
基于小组、由教师主导的MBPs通常会降低自愿接受此类干预的社区成年人的心理困扰。需要更多研究来确定个体层面结局变异性的来源。
