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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

PainSci » bibliography » Kuyken et al 2022

PainSci notes on Kuyken 2022:

This study showed that mindfulness exercises actually made teens’ mental health … worse?! 😬 Jules Evans:

Anyone hoping to ‘solve’ the mental health crisis should think very carefully: am I going to make it worse? Unfortunately, every decade a new intervention becomes the hot new thing, the magic bullet that is going to save the world, and the people promoting it become wide-eyed evangelists. ‘We are saving the world! We are doing such important work!’ Such is their enthusiasm, they never stop to ask, ‘is it possible this intervention will harm some people?’

When you look at the history of mental health, it is littered with failed interventions that turned out to do more harm than good.

Much like the history of all kind of health. Most treatment ideas don’t pan out. They never have, and they never will, because it’s much easier to find treatment ideas that are more popular and profitable than actually helpful. And quite a few of those are even worse than ineffective.

Jules Evans’ full analysis is excellent.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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).

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