2019年冠状病毒病大流行期间针对一线医护人员心理健康结果的正念干预：一项随机对照试验

Mindfulness-Based Interventions for Mental Health Outcomes in Frontline Healthcare Workers During the COVID-19 Pandemic: A Randomized Controlled Trial.

作者信息

Arts-de Jong Marieke, Geurts Dirk E M, Spinhoven Philip, Ruhé Henricus G, Speckens Anne E M

机构信息

Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.

Donders Centre for Medical Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.

出版信息

J Gen Intern Med. 2025 May 19. doi: 10.1007/s11606-025-09529-z.

DOI:10.1007/s11606-025-09529-z

PMID:40388083

Abstract

BACKGROUND

The COVID-19 pandemic significantly impacted the mental health of frontline healthcare workers (HCWs), but solid evidence on psychological interventions for HCWs remains limited.

OBJECTIVE

Whether an adjusted therapist-assisted Mindfulness-based Stress Reduction group intervention (adjusted MBSR) is superior to a minimal self-guided mindfulness-based intervention (self-guided MBI) in improving mental health of HCWs during the COVID-19 pandemic.

DESIGN

Randomized controlled trial.

PARTICIPANTS

201 frontline HCWs (47 physicians, 120 nurses, 34 supporting staff); enrollment between June 2020 and September 2021.

INTERVENTIONS

A 4-week adjusted MBSR with eight biweekly 1.5-h sessions; or a 4-week self-guided MBI with 24 mindfulness/compassion exercises.

MEASURES

Primary outcome was the Patient Health Questionnaire - Somatic, Anxiety and Depressive Symptom Scales (PHQ-SADS) at 6-month follow-up. Secondary outcomes included posttraumatic symptoms, insomnia, alcohol use, repetitive negative thinking, mental well-being, posttraumatic growth, mindfulness, and self-compassion at post-intervention and 3- and 6-month follow-up.

KEY RESULTS

At 6-month follow-up, the adjusted MBSR was not superior to the self-guided MBI (mean difference (SE) PHQ-SADS, 0.23 (1.03), P=0.82). Both interventions showed similar within-group improvement in PHQ-SADS (Cohen's d between baseline and 6-month follow-up: adjusted MBSR -0.78 (95% CI -1.07; -0.48), self-guided MBI -0.72 (95% CI -1.01; -0.43)). Secondary outcomes showed that symptom trajectories differed between groups for PHQ-SADS (interventiontime F(3, 420)=3.99, P=0.008), with greater reduction at post-intervention for adjusted MBSR, and posttraumatic growth (interventiontime F(3, 350)=5.32, P=0.001), with exclusive increase post-intervention in adjusted MBSR. Both interventions showed comparable significant within-group improvements on posttraumatic symptoms, insomnia, repetitive negative thinking, mental well-being, mindfulness, and self-compassion.

CONCLUSIONS

The adjusted MSBR was not superior to the self-guided MBI; both were accompanied by significant reductions of depressive, anxiety, and somatic symptoms after 4 weeks of treatment which was sustained at 6-month follow-up. Further research is needed to investigate the possible role of MBIs to support HCWs involved in future healthcare crises.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04720404; onderzoekmetmensen.nl/en NL73793.091.20.

摘要

背景

2019冠状病毒病疫情对一线医护人员的心理健康产生了重大影响，但关于医护人员心理干预的可靠证据仍然有限。

目的

在2019冠状病毒病疫情期间，调整后的治疗师辅助正念减压小组干预（调整后的MBSR）在改善医护人员心理健康方面是否优于最低限度的自我引导正念干预（自我引导的MBI）。

设计

随机对照试验。

参与者

201名一线医护人员（47名医生、120名护士、34名辅助人员）；2020年6月至2021年9月期间入组。

干预措施

为期4周的调整后的MBSR，每两周进行8次1.5小时的课程；或为期4周的自我引导的MBI，包含24项正念/慈悲练习。

测量指标

主要结局是6个月随访时的患者健康问卷-躯体、焦虑和抑郁症状量表（PHQ-SADS）。次要结局包括干预后、3个月和6个月随访时的创伤后症状、失眠、饮酒、反复消极思维、心理健康、创伤后成长、正念和自我慈悲。

关键结果

在6个月随访时，调整后的MBSR并不优于自我引导的MBI（平均差（SE）PHQ-SADS，0.23（1.03），P = 0.82）。两种干预措施在PHQ-SADS方面均显示出相似的组内改善（基线与6个月随访之间的Cohen's d：调整后的MBSR为-0.78（95%CI -1.07；-0.48），自我引导的MBI为-0.72（95%CI -1.01；-0.43））。次要结局显示，PHQ-SADS的症状轨迹在两组之间存在差异（干预时间F(3, 420)=3.99，P = 0.008），调整后的MBSR在干预后下降幅度更大，创伤后成长也存在差异（干预时间F(3, 350)=5.32，P = 0.001），调整后的MBSR仅在干预后有所增加。两种干预措施在创伤后症状、失眠、反复消极思维、心理健康、正念和自我慈悲方面均显示出相当的显著组内改善。