Review
Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: A meta-analysis

https://doi.org/10.1016/j.ijnurstu.2011.08.014Get rights and content

Abstract

Objectives

Depression, a common mental health problem, is projected to be the second leading cause of disability for adults by year 2020. Mindfulness-based interventions (MFIs) have been integrated into therapeutic work on depression, but limited systematic reviews reported their efficacy on heterogeneous groups of mental disorders. This meta-analysis aimed to examine the efficacy of the MFIs on depressive symptoms in people with various mental disorders.

Design

A meta-analysis of experimental and quasi-experimental studies was undertaken.

Data sources

Multiple search strategies were undertaken to identify published and unpublished studies conducted between 1995 and 2011. Electronic databases used were Scopus, CINAHL, PubMed, ScienceDirect, PsyINFO, Dissertation Abstract International, Web of Science Index, Controlled-trial.com, and clinicaltrails.gov.

Review Methods

Data were extracted and appraised by two reviewers. For each study, the Quality Rating Index (QRI) and Code Sheet for Randomized Controlled Trials (CS-RCT) were used to assess methodological quality and extract relevant data respectively. Data were analysed and synthesized using PASW statistic 17.0 and Comprehensive Meta Analyses Software 2.0.

Results

Thirty-nine studies conducted in ten countries were included and 105 effect sizes were calculated. Most studies utilised single group pretest–posttest quasi-experimental design, convenience sampling, and self-reported questionnaires. Between-group comparisons indicated that MFIs are superior to standard care in reducing depressive symptoms and preventing relapse with effect sizes ranging from 0.11 to 1.65. Exposure-based cognitive therapy (d = 2.09) appeared to be the most efficacious intervention, followed by mindfulness-based stress reduction programme (d = 1.92), acceptance-based behaviour therapy (d = 1.33), and stress less with mindfulness (d = 1.31). Effect sizes were significantly associated with the length of intervention sessions but not related to methodological quality of studies.

Conclusion

The mindfulness-based interventions are efficacious for alleviating depressive symptoms in adults with mental disorders. The interventions could be used in conjunction with other treatments in clinical settings.

Section snippets

What is already known about this topic?

  • Mindfulness-based interventions (MFIs) appear to be effective treatments for people with various medical conditions and psychological problems.

  • Few systematic reviews suggest the potential usefulness of mindfulness-based cognitive therapy (MBCT), one of MFIs, in reducing depressive symptoms in people diagnosed with major depressive disorders.

What this paper adds

  • This meta-analytic study provides evidence to support the efficacy of different types of MFIs on depressive symptoms among people diagnosed with various mental disorders.

  • Exposure-based cognitive therapy (EBCT) is found to be the most effective intervention as evidenced by the strongest effect size, followed by mindfulness-based stress reduction programme (MBSR), acceptance-based behaviour therapy, and stress less with mindfulness.

  • Effect sizes of MFIs are significantly correlated with the length

Search strategies

In order to ensure representativeness of studies, multiple search strategies were performed. Firstly, electronic searches on published studies, unpublished dissertations/theses, unpublished research reports, and conference proceedings were undertaken. The databases used were: Scopus, CINAHL, PubMed, ScienceDirect, PsyINFO, Dissertation Abstract International, Web of Science Index, controlled-trail.com, and clinicaltrials.gov. Secondly, reference lists of original articles and meta-analytic

Results

Following the comprehensive literature search, 788 abstracts were identified and reviewed according to the preset inclusion and exclusion criteria (Fig. 1). After the initial review, 557 abstracts were excluded as they did not fulfill the inclusion criteria and thus 231 potential abstracts were included. Subsequently, corresponding 231 full-text articles were retrieved and thoroughly examined and 192 articles were eventually excluded. Reasons for exclusion are reported in Fig. 1.

Discussion

This meta-analysis examined available evidence concerning the efficacy of mindfulness-based interventions on depressive symptoms and tested the relationships between effect sizes and methodological variables. Thirty-nine studies involving 10 mindfulness-based interventions were included in the review, generating 105 effect sizes. Within-group comparisons yielded all large effect sizes ranging from 0.56 to 2.09 (average d = 0.60, 95% CI = 0.40, 0.80) and between-group analyses produced a range of

Conclusion

This meta-analytic study provides strong evidence to support the efficacy of mindfulness-based interventions in alleviating depressive symptoms in adults with mental disorders. EBCT, MBSR, and ABT displayed the strongest effect sizes, whereas MBCT and modified DBT for ADHD had the weakest. The MFIs could be used in conjunction with other treatments in clinical settings.

Acknowledgement

The authors would like to express sincere gratitude to Professor Beverley Taylor (Visiting Professor, Alice Lee Centre for Nursing Studies, National University of Singapore) for her support and valuable comments/suggestions on this manuscript.

Conflict of interest. There is no conflict of interest in this research.

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