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A mindfulness-based intervention to increase resilience to stress in university students (the Mindful Student Study): a pragmatic randomised controlled trial.
Galante, J, Dufour, G, Vainre, M, Wagner, AP, Stochl, J, Benton, A, Lathia, N, Howarth, E, Jones, PB
The Lancet. Public health. 2018;3(2):e72-e81
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There has been a recent increase in students accessing university counselling services, though the reasons for this are currently unclear. Mindfulness-based stress reduction has gained increased attention as evidence has shown mindfulness training can improve anxiety and depression. The aim of this trial was to therefore assess whether a mindfulness course, Mindfulness Skills for Students (MSS), would improve university students’ resilience to stress. Participants were randomly assigned to either enrol in the 8-week MSS course alongside mental health support or receive mental health support alone. A total of 449 participants completed the study and self-reported psychological distress was the primary outcome. Students enrolled in MSS showed reduced distress scores during the examination period compared with those receiving support as usual. Based on these results, the authors conclude that offering mindfulness training could be an effective, feasible component of a wider university mental health strategies. Further controlled studies are required to better understand preventative mental health interventions for students.
Abstract
BACKGROUND The rising number of young people going to university has led to concerns about an increasing demand for student mental health services. We aimed to assess whether provision of mindfulness courses to university students would improve their resilience to stress. METHODS We did this pragmatic randomised controlled trial at the University of Cambridge, UK. Students aged 18 years or older with no severe mental illness or crisis (self-assessed) were randomly assigned (1:1), via remote survey software using computer-generated random numbers, to receive either an 8 week mindfulness course adapted for university students (Mindfulness Skills for Students [MSS]) plus mental health support as usual, or mental health support as usual alone. Participants and the study management team were aware of group allocation, but allocation was concealed from the researchers, outcome assessors, and study statistician. The primary outcome was self-reported psychological distress during the examination period, as measured with the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), with higher scores indicating more distress. The primary analysis was by intention to treat. This trial is registered with the Australia and New Zealand Clinical Trials Registry, number ACTRN12615001160527. FINDINGS Between Sept 28, 2015, and Jan 15, 2016, we randomly assigned 616 students to the MSS group (n=309) or the support as usual group (n=307). 453 (74%) participants completed the CORE-OM during the examination period and 182 (59%) MSS participants completed at least half of the course. MSS reduced distress scores during the examination period compared with support as usual, with mean CORE-OM scores of 0·87 (SD 0·50) in 237 MSS participants versus 1·11 (0·57) in 216 support as usual participants (adjusted mean difference -0·14, 95% CI -0·22 to -0·06; p=0·001), showing a moderate effect size (β -0·44, 95% CI -0·60 to -0·29; p<0·0001). 123 (57%) of 214 participants in the support as usual group had distress scores above an accepted clinical threshold compared with 88 (37%) of 235 participants in the MSS group. On average, six students (95% CI four to ten) needed to be offered the MSS course to prevent one from experiencing clinical levels of distress. No participants had adverse reactions related to self-harm, suicidality, or harm to others. INTERPRETATION Our findings show that provision of mindfulness training could be an effective component of a wider student mental health strategy. Further comparative effectiveness research with inclusion of controls for non-specific effects is needed to define a range of additional, effective interventions to increase resilience to stress in university students. FUNDING University of Cambridge and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England.
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Meditation or exercise for preventing acute respiratory infection (MEPARI-2): A randomized controlled trial.
Barrett, B, Hayney, MS, Muller, D, Rakel, D, Brown, R, Zgierska, AE, Barlow, S, Hayer, S, Barnet, JH, Torres, ER, et al
PloS one. 2018;13(6):e0197778
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Susceptibility to acute respiratory infection (ARI), including the common cold and flu, have been shown to be influenced by psychological, social and behavioural factors. Given these previous associations, the aim of this study was to determine the preventive effects of meditation and exercise on ARI illness. This randomised controlled trial allocated 390 participants to one of three parallel groups either receiving 8-week training in mindfulness-based stress reduction (MBSR), 8-week training in moderate intensity exercise or observational control. ARI symptoms were assessed daily and various psychosocial factors were assessed at baseline and 4 times after the intervention. Blood and nasal wash samples were assessed with each ARI episode as well as at baseline, 1-month and 4-month post-intervention. This study found significant reductions in ARI illness incidence, duration and severity for participants in the MBSR group compared with controls. While this was also true for the exercise group, results were not as significant suggesting a slight advantage of mindfulness over exercise. Based on these results, the authors conclude both mindfulness and exercise should be encouraged and further research be conducted to better understand the benefits of these activities in sick populations.
Abstract
BACKGROUND Practice of meditation or exercise may enhance health to protect against acute infectious illness. OBJECTIVE To assess preventive effects of meditation and exercise on acute respiratory infection (ARI) illness. DESIGN Randomized controlled prevention trial with three parallel groups. SETTING Madison, Wisconsin, USA. PARTICIPANTS Community-recruited adults who did not regularly exercise or meditate. METHODS 1) 8-week behavioral training in mindfulness-based stress reduction (MBSR); 2) matched 8-week training in moderate intensity sustained exercise (EX); or 3) observational waitlist control. Training classes occurred in September and October, with weekly ARI surveillance through May. Incidence, duration, and area-under-curve ARI global severity were measured using daily reports on the WURSS-24 during ARI illness. Viruses were identified multiplex PCR. Absenteeism, health care utilization, and psychosocial health self-report assessments were also employed. RESULTS Of 413 participants randomized, 390 completed the trial. In the MBSR group, 74 experienced 112 ARI episodes with 1045 days of ARI illness. Among exercisers, 84 had 120 episodes totaling 1010 illness days. Eighty-two of the controls had 134 episodes with 1210 days of ARI illness. Mean global severity was 315 for MBSR (95% confidence interval 244, 386), 256 (193, 318) for EX, and 336 (268, 403) for controls. A prespecified multivariate zero-inflated regression model suggested reduced incidence for MBSR (p = 0.036) and lower global severity for EX (p = 0.042), compared to control, not quite attaining the p<0.025 prespecified cut-off for null hypothesis rejection. There were 73 ARI-related missed-work days and 22 ARI-related health care visits in the MBSR group, 82 days and 21 visits for exercisers, and 105 days and 24 visits among controls. Viruses were identified in 63 ARI episodes in the MBSR group, compared to 64 for EX and 72 for control. Statistically significant (p<0.05) improvements in general mental health, self-efficacy, mindful attention, sleep quality, perceived stress, and depressive symptoms were observed in the MBSR and/or EX groups, compared to control. CONCLUSIONS Training in mindfulness meditation or exercise may help protect against ARI illness. LIMITATIONS This trial was likely underpowered. TRIAL REGISTRATION Clinicaltrials.gov NCT01654289.
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Effect of Mindfulness-Based Stress Reduction Therapy on Work Stress and Mental Health of Psychiatric Nurses.
Yang, J, Tang, S, Zhou, W
Psychiatria Danubina. 2018;30(2):189-196
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Many studies have found mindfulness-based stress reduction (MBSR) therapy to significantly reduce stress levels and enhance wellbeing. Among healthcare practitioners, psychiatric nurses experience higher stress and poorer mental health. Therefore the aim of this study was to examine the effects of MBSR on the mental health of 100 psychiatric nurses in China. Nurses were randomised to either receive psychological support including MBSR or to receive psychological support without MBSR weekly. Mental health assessments were taken at baseline and completion of the intervention. This study found that while all participants showed improvements in mental health, those receiving MBSR experienced significant improvement compared with the control group. Based on these results the authors conclude that MBSR therapy is conducive to reducing work-related stress of psychiatric nurses.
Abstract
BACKGROUND Psychiatric nurses are a special group of nursing staff, they experience greater work stress and lower mental health levels than regular nurses. In order to address this problem, the effect of mindfulness-based stress reduction (MBSR) therapy on work stress and mental health of psychiatric nurses is investigated in this study. SUBJECTS AND METHODS From August 2017 to November 2017, 100 psychiatric nurses, including 68 females and 32 males, were selected as participants from three hospitals in Hunan Province of China. They were randomly divided into the intervention and control groups, with 50 respondents in each group. MBSR therapy was used as psychological intervention in the intervention group. Before and after the intervention, the two groups were assessed with the Symptom Checklist-90 (SCL-90) scale, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Nursing Stress Scale. RESULTS (1) After the intervention, the SCL-90 score of the intervention group decrease significantly, and a statistically significant difference is observed with the figure before the intervention (P<0.001). No statistically significant difference is found in the control group (P>0.05). (2) After the intervention, the SDS and SAS scores of the intervention group decrease significantly, and a statistically significant difference is observed with the figures before the intervention (P<0.001). No statistically significant difference is found in the control group (P>0.05). (3) After the intervention, the Nursing Stress Scale score of the intervention group Nursing Stress Scale decrease significantly, and a statistically significant difference is observed with the figure before the intervention (P<0.001). No statistically significant difference is found in the control group (P>0.05). CONCLUSIONS MBSR therapy can reduce work stress, anxiety, depression, and other negative emotions among psychiatric nurses and improve their mental health.
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Multiple risk-behavior profiles of smokers with serious mental illness and motivation for change.
Prochaska, JJ, Fromont, SC, Delucchi, K, Young-Wolff, KC, Benowitz, NL, Hall, S, Bonas, T, Hall, SM
Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2014;33(12):1518-29
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Individuals with serious mental illness (SMI) are at greater risk for chronic disease, which are largely preventable through health behaviour change. Within this population tobacco use is a major health concern and recent trials have demonstrated treating tobacco dependence supports mental health recovery. As risk behaviours tend to co-occur, the aim of this study was to examine the behavioural risk profiles of adult smokers with SMI to further understand frequencies and patterns of risks in order to best inform interventional programmes. In the context of a tobacco-treatment trial, 693 adult smokers from inpatient psychiatry wards were recruited. The Staging Health Risk Assessment was used which screens for risk status and readiness to change 11 health behaviours. The findings of this study showed that most smokers with SMI engage in multiple risks including poor diet, inadequate sleep, physical inactivity and marijuana use. This study can help prioritise health intervention programme targets and provide further benefit for this population.
Abstract
OBJECTIVE Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs. METHOD Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization. RESULTS Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence. CONCLUSION Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health.