Mindfulness training for stress management: a randomised controlled study of medical and psychology students

Quality of life, anxiety and mindfulness during the prevalence of COVID-19: a comparison between medical and non-medical students

BACKGROUND

The Covid-19 pandemic has affected all areas of society, including students. However, medical students have faced many challenges due to direct contact with patients. The present study was conducted with the aim of investigating and comparing the quality of life (QoL), anxiety and mindfulness between Iranian medical and non-medical students during the COVID-19 pandemic.

METHOD

Five hundred and six students (both medical and non-medical students) participated in the study from August to October 2022 with a convenience sampling method. The data were collected using an online questionnaire including a demographic form, the QoL Questionnaire (WHOQOL- BREF), the Generalized Anxiety Disorder 7-item survey (GAD-7) and the Relaxation/Meditation/Mindfulness Tracker t-Persian version survey (RMMt-P). Pearson correlation and independent t-test and multivariate linear regression were used to determine the relationship between the study variables.

RESULTS

The samples included 272 medical students and 234 non-medical students with a mean age of 21.99 ± 3.46 and 24.17 ± 6.54 years respectively. Most of the medical and non-medical students were female, single and had a bachelor's degree. The mean scores of medical and non-medical students' QoL during the COVID-19 pandemic were 57.86 ± 13.26 and 56.75 ± 14.42, respectively which indicates the higher quality of life of medical students. Anxiety and mindfulness predicted 29% of the variance of the QoL in the medical students, while anxiety and mindfulness and having a chronic disease predicted 30% of the variance of the QoL in the non-medical students. No significant difference existed in the QoL and its subscales during the COVID-19 pandemic between medical and non-medical students (p > 0.05). There was a significant difference in terms of anxiety (p = 0.02) and mindfulness (p = 0.03) between medical and non-medical students during the prevalence of COVID-19.

DISCUSSION AND CONCLUSION

The findings of the present study indicated that medical students exhibited lower levels of anxiety and higher levels of mindfulness. Therefore, interventions aimed at reducing anxiety and increasing mindfulness among non-medical students are necessary. It is recommended that preventive approaches and psychological interventions to improve students' quality of life become an integral part of crisis response during the COVID-19 pandemic. Additionally, reducing anxiety and enhancing mindfulness can improve the quality of education and professional performance of medical students, while also contributing to their mental well-being and effective clinical communication.

A pragmatic randomized trial to examine the effect of combining healthy diet with mindfulness cognitive therapy to reduce depressive symptoms among university students in a low-resource setting: protocol for the NutriMind Project

BACKGROUND

Mental health disorders still rank as leading causes of morbidity worldwide despite increasing awareness and improvements in treatment. Notably, low- and middle-income countries like Uganda, are disproportionately affected by such disorders. The burden of depressive symptoms in these countries is particularly high among students, aggravated by poverty, malnutrition, and inadequate public health governance, yet it is clearly under-researched, making it hard to achieve several of UN Sustainability Development Goals. Current treatment options are insufficient to tackle the increased burden of depressive disease. This is more challenging for low-resource regions especially in Sub-Saharan Africa, suggesting the need for alternative treatments that can swiftly be applied if proven effective. The main aim of this randomized controlled trial (RCT) is therefore to examine if a low-cost healthy diet (based on local Ugandan foods) combined with easy-to access mindfulness cognitive therapy can reduce depressive symptoms among university students in Uganda.

METHODS

We will recruit female and male students at Makerere University, the largest public university in Uganda, to an open, intention-to-treat, two-armed RCT. Those who score above a predefined threshold on a self-reported assessment of depressive symptoms, measured by the Center for Epidemiological Studies - Depression score (CES-D), are eligible for study inclusion and will be randomized to either an intervention (n = 125) or a control (n = 125) group. The intervention group will receive educational group-based sessions on how to prepare a Mediterranean-type of healthy diet and how to adhere to the principles of mindfulness-based cognitive therapy. Outcome measures include self-reported depression symptoms, quality of life, and dietary intakes. In addition we will perform a cost-effectiveness analysis. The RCT intervention will last 9 months, followed by additional 15 months with regular data collections.

DISCUSSION

We here describe a novel approach to treat depressive symptoms among university students living in resource constraint settings, by combining a healthy diet with low threshold psychotherapy. If this intervention succeeds, our project can be viewed as a step towards evidence-based behavior practices for young adults with a common mental disorder (depression) that are beneficial to public mental health initiatives and management.

TRIAL REGISTRATION

The RCT is registered in ClinicalTrials.gov (ID: NCT05848973). The date of registration was August 14, 2023.

Implementation and Evaluation of a National Well-Being Curriculum for KL2 Scholars

Introduction: The study aimed to pilot test a well-being curriculum for KL2 scholars to be used across the Clinical and Translational Science Award consortium. Methods: Between November 2022, and May 2023, 36 KL2 scholars from 25 hubs participated in the program. The General Well-Being Index for U.S. Workers and the Patient Reported Outcomes Measurement Information System (PROMIS-29) were completed by scholars before and after the program. Results: Postparticipation, there was a trend of improvement in the domains of well-being, sleep, anxiety, and fatigue. Conclusion: Implementing a virtual synchronous well-being curriculum allowed the scholars to connect across the consortium and improve their well-being.

Emotional intelligence, spiritual intelligence, depression and anxiety, and satisfaction with life among emerging adults in Israel and India: the impact of gender and individualism/collectivism

Much research has focused on how emotional and spiritual intelligences promote well-being and help combat mental health issues. This comparative study, which was conducted in Israel and India with emerging adults enrolled in higher education, explored the relationship of emotional intelligence, spiritual intelligence, anxiety and depression, and satisfaction with life. The results in Israel showed a positive correlation of emotional intelligence with satisfaction with life, but in India, only spiritual intelligence correlated positively with satisfaction with life. In both groups, female participants scored higher on all variables than male participants. We offer initial explanations for these results.

The effects of mindfulness-based interventions on alleviating academic burnout in medical students: a systematic review and meta-analysis

BACKGROUND

Mindfulness-based interventions have been tested to be the effective approach for preventing/reducing burnout in medical students. Therefore, this systematic review and meta-analysis aimed to synthesize the scientific evidence and quantify the pooled effect of MBIs on the burnout syndrome in medical students.

METHODS

A comprehensive literature search was conducted in the databases, including PubMed, Embase, ERIC, PsycINFO, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), China National knowledge Information Database (CNKI) and WanFang Database from database inception to February 2023 using the terms of "mindfulness", "burnout" and "medical students". Two reviewers independently reviewed the studies, and extracted the data of the eligible studies, as well as assessed the risk of bias. A random-effects model was employed to calculate the standardized mean differences (SMD) with 95% confidence intervals (CI) of overall burnout and its sub-domains of burnout (i.e., emotional exhaustion, cynicism, and academic efficacy).

RESULTS

Of 316 records in total, nine studies (with 810 medical students) were ultimately included. The four RCT studies demonstrated an overall judgment of some concerns risk of bias, and the overall risk of biases of the five qRCT studies were judged as serious. In term of the SORT, the RCT and qRCT studies were evaluated as level 2 evidence, and the overall strength of recommendation was classified as B (limited-quality patient-oriented evidence). The pooled analysis showed that MBIs were associated with significant small to moderate improvements for medical students' overall burnout (SMD=-0.64; 95% CI [-1.12, -0.16]; P = 0.009) in the included four RCTs, emotional exhaustion (SMD=-0.27; 95% CI [-0.50, -0.03]; P = 0.03) and academic efficacy (SMD = 0.43; 95% CI [0.20, 0.66]; P<0.001) in the four qRCTs.

CONCLUSIONS

MBIs can serve as an effective approach for reducing burnout symptoms in medical students. Future high-quality studies with a larger sample size and robust randomized controlled trial methodologies should be obtained to reinforce the effectiveness of MBIs for reducing academic burnout in medical students.

Developing a typology of interventions to support doctors' mental health and wellbeing

BACKGROUND

The problem of mental ill-health in doctors is complex, accentuated by the COVID-19 pandemic, and impacts on healthcare provision and broader organisational performance. There are many interventions to address the problem but currently no systematic way to categorise them, which makes it hard to describe and compare interventions. As a result, implementation tends to be unfocussed and fall short of the standards developed for implementing complex healthcare interventions. This study aims to develop: 1) a conceptual typology of workplace mental health and wellbeing interventions and 2) a mapping tool to apply the typology within research and practice.

METHODS

Typology development was based on iterative cycles of analysis of published and in-practice interventions, incorporation of relevant theories and frameworks, and team and stakeholder group discussions.

RESULTS

The newly developed typology and mapping tool enable interventions to be conceptualised and/or mapped into different categories, for example whether they are designed to be largely preventative (by either improving the workplace or increasing personal resources) or to resolve problems after they have arisen. Interventions may be mapped across more than one category to reflect the nuance and complexity in many mental health and wellbeing interventions. Mapping of interventions indicated that most publications have not clarified their underlying assumptions about what causes outcomes or the theoretical basis for the intervention.

CONCLUSION

The conceptual typology and mapping tool aims to raise the quality of future research and promote clear thinking about the nature and purpose of interventions, In doing so it aims to support future research and practice in planning interventions to improve the mental health and wellbeing of doctors.

Effects of a mindfulness course on vital signs and five facet mindfulness questionnaire scores of college students

Objective: This study examined the effects of a college mindfulness course on vital-signs and Five Facet Mindfulness Questionnaire (FFMQ) scores. Participants: Two independent groups of 20 students were enrolled in the mindfulness course during the Fall 2018 (Trial 1) and Spring 2019 (Trial 2) semesters. Methods: Blood pressure, heart rate, and respiration rate were recorded before and after in-class mindfulness meditations several times throughout each semester. FFMQ scores were recorded at the beginning and conclusion of each semester. Results: Statistical analyses indicated that 20 minutes of mindfulness meditation significantly decreased respiration rate (both trials) and heart rate (Trial 2) for female students. There were significant changes in the FFMQ mean scores for "non-react," "observe," "act aware," and "non-judge." Conclusions: These results suggest that mindfulness meditation may be beneficial for students to enhance their well-being. Recommendations are provided to further examine the implications of consistent mindfulness practices for college students.

Understanding and mitigating negative affect in preventive health behaviors: Evidence from the COVID-19 vaccination process

The study investigated the willingness for vaccine uptake during the COVID-19 pandemic (April-June 2021), and explored the effect of both mindfulness and health education in managing negative affect post-vaccination. In study 1, a sample of 468 Chinese college students completed a one-time survey, assessing loneliness, stress, medical fear, and vaccination likelihood. Results showed that medical fear mediated the relationship between loneliness, stress and vaccination likelihood. In study 2, 70 college students were randomly assigned to one of three intervention conditions (mindfulness, health education, and control) during vaccination. Participants in mindfulness group showed lower negative affect scores than the control group post-intervention (p = 0.019). However, no significant difference was reported between health education with the other two conditions. As such, medical fear would be an important factor to target for improving the likelihood of vaccine uptake. Furthermore, a short mindfulness intervention was effective to improve experience of vaccination through mitigating negative affect.

The impact of mindfulness apps on psychological processes of change: a systematic review

Mindfulness-based interventions (MBIs) have demonstrated therapeutic efficacy for various psychological conditions, and smartphone apps that facilitate mindfulness practice can enhance the reach and impact of MBIs. The goal of this review was to summarize the published evidence on the impact of mindfulness apps on the psychological processes known to mediate transdiagnostic symptom reduction after mindfulness practice. A literature search from January 1, 1993, to August 7, 2023 was conducted on three databases, and 28 randomized controlled trials involving 5963 adults were included. Across these 28 studies, 67 outcome comparisons were made between a mindfulness app group and a control group. Between-group effects tended to favor the mindfulness app group over the control group in three psychological process domains: repetitive negative thinking, attention regulation, and decentering/defusion. Findings were mixed in other domains (i.e., awareness, nonreactivity, non-judgment, positive affect, and acceptance). The range of populations examined, methodological concerns across studies, and problems with sustained app engagement likely contributed to mixed findings. However, effect sizes tended to be moderate to large when effects were found, and gains tended to persist at follow-up assessments two to six months later. More research is needed to better understand the impact of these apps on psychological processes of change. Clinicians interested in integrating apps into care should consider app-related factors beyond evidence of a clinical foundation and use app databases to identify suitable apps for their patients, as highlighted at the end of this review.

The effects of mindfulness-based interventions in medical students: a systematic review

The number of studies on the effects of mindfulness on healthcare professionals is increasing. The main aim of this study was to collate the quantitative results of original studies analyzing the effects of mindfulness-based interventions on a variety of outcomes in medical students. We also analyzed how the study design and characteristics of the intervention affect the results, and identified qualitative effects of mindfulness interventions. A literature search was performed in different databases in June 2020. Original articles meeting the following criteria were included: (1) at least 50% of the participants were medical students, (2) included a mindfulness intervention, (3) analyzed any outcome relating to mindfulness intervention, (4) peer-reviewed (5) written in English. Eventually, 31 articles including 24 different samples were included. Over half of the studies were RCTs. In over half of the studies, the intervention was 4- to 10-week original Mindfulness-Based Stress Reduction or Mindfulness-Based Cognitive Therapy or a modification of these. In general, satisfaction with the interventions was good. Based on a meta-analysis, after the intervention, the intervention group had statistically significantly fewer symptoms of stress and distress and had higher mindfulness than the controls. The beneficial effects persisted in follow-ups over months or years. Both long and shorter courses and courses with and without face-to-face sessions were effective. Both controlled and uncontrolled studies had statistically significant results. Qualitative results revealed potential factors behind the quantitative effects. The number of studies on mindfulness interventions in medical students has increased drastically. Mindfulness-based interventions seem to offer a good possibility to enhance medical students' well-being.

Effectiveness of Mindfulness-Based Stress Reduction on Mental Health and Psychological Quality of Life among University Students: A GRADE-Assessed Systematic Review

Background

Psychological distress is a progressive health problem that has been linked to decreased quality of life among university students. This meta-analysis reviews existing randomized controlled trials (RCTs) that have examined the effects of mindfulness-based stress reduction (MBSR) on the relief of psychosomatic stress-related outcomes and quality of life among university students.

Methods

The PubMed, EMBASE, Web of Science, PsycINFO (formerly PsychLit), Ovid MEDLINE, ERIC, Scopus, Google Scholar, ProQuest, and Cochrane Library databases were searched in November 2023 to identify the RCTs for analysis. Data on pathology (anxiety, depression, and perceived stress), physical capacity (sleep quality and physical health), and well-being (mindfulness, self-kindness, social function, and subjective well-being) were analyzed.

Results

Of the 276 articles retrieved, 29 met the inclusion criteria. Compared with control therapies, the pooled results suggested that MBSR had significant effects, reducing anxiety (SMD = -0.29; 95% CI: -0.49 to -0.09), depression (SMD = -0.32; 95% CI: -0.62 to -0.02), and perceived stress (SMD = -0.41; 95% CI: -0.60 to -0.29) and improving mindfulness (SMD = 0.34; 95% CI: 0.08 to 0.59), self-kindness (SMD = 0.57; 95% CI: 0.30 to 1.12), and physical health (SMD = -0.59; 95% CI: -1.14 to -0.04). No significant differences were observed in sleep quality (SMD = -0.20; 95% CI: -0.06 to 0.20), social function (SMD = -0.71; 95% CI: -2.40 to 0.97), or subjective well-being (SMD = 0.07; 95% CI: -0.18 to 0.32). The quality of the evidence regarding sleep quality and physical health outcomes was low.

Conclusions

MBSR therapy appears to be potentially useful in relieving functional emotional disorders. However, additional evidence-based large-sample trials are required to definitively determine the forms of mindfulness-based therapy that may be effective in this context and ensure that the benefits obtained are ongoing. Future studies should investigate more personalized approaches involving interventions that are tailored to various barriers and students' clinical characteristics. To optimize the effects of such interventions, they should be developed and evaluated using various designs such as the multiphase optimization strategy, which allows for the identification and tailoring of the most valuable intervention components.

Mental Health in Swiss Veterinary Medicine Students: Variables Associated with epression Scores

Mental health and wellbeing in veterinary students have become an important area of study, given the high levels of mental distress compared to other professions. Although research has identified poor mental health of veterinary students, few studies have examined positive factors such as self-compassion, which can have a favorable effect on mental health. The aim of this study was to examine self-reported symptoms of depression and factors influencing this construct, such as loneliness, self-compassion, and various demographic aspects in Swiss veterinary students. A sample of 374 Swiss veterinary students completed online measures including a demographic questionnaire, the Center for Epidemiological Studies Depression Scale-Revised (CESD-R), a short form of the University of California Loneliness Scale (UCLA-9), and the short form of the Self-Compassion Scale (SCS-SF). Results showed that 54.3% of the students were above the CESD-R cut-off score for depression, indicating a higher likelihood to suffer from depression. Results from the backward selection linear regression showed loneliness to be a risk factor, while self-compassion and rural upbringing were protective of depression. Findings suggest that Swiss veterinary students are highly burdened and may benefit from interventions aimed at reducing loneliness and improving self-compassion.

Effects of the mental health promotion seminar 'Coping with stress' in the undergraduate medical curriculum of the Medical University of Vienna

BACKGROUND

High prevalence rates of distress and burnout in medical students are well-documented in mental health literature. Different types of interventions have been developed in the past in order to reduce stress in medical undergraduate students and promote better coping skills. There is, however, a paucity of studies that have tested the effectiveness of these interventions. This study aimed to examine the effect of different versions of the seminar 'Coping with stress', which was implemented in the first year of the undergraduate curriculum of the Medical University of Vienna in the summer semester of 2018, on students' mental health.

METHODS

Invitations to participate in the study were sent via email to six cohorts of students from the Medical University of Vienna. Two cohorts participated in the onsite version of the seminar 'Coping with stress', whereas two cohorts participated in the online version of the seminar, and two cohorts received no intervention (control group). Data on burnout risk, life satisfaction, stress, and knowledge about available help resources were collected via online questionnaires from n = 137 students before and after the curriculum module that contained the seminar.

RESULTS

Medical students who participated in the onsite seminar reported a reduction of some aspects of burnout, a decrease in stress, and an increase in knowledge about available help resources. No such effect was seen in the control group. Participants of the online seminar experienced a similar increase in knowledge about available help resources, but no changes in other outcomes.

CONCLUSIONS

The findings support the notion that the onsite seminar of 'Coping with stress' had a positive impact on medical students' mental health and is a useful addition to the medical curriculum by promoting mental health literacy.

TRIAL REGISTRATION

This research has been registered in the German Clinical Trial Registry with the registration number DRKS00018981 and the registration date 14/11/2019.

Effects of a mindfulness-based groupwork program on adolescents in a children's home

Mindfulness means being in the present, intentionally and without any judgment. Mindfulness helps people cope with challenging experiences such as trauma. Children's Homes in Türkiye are institutions that provide social care to young people with past traumatic experiences. This study aims at evaluating the effects of a mindfulness-based (MB) groupwork program with a group of residents in a Children's Home. An experimental pretest-posttest control group design was used. An eight-session MB training program was implemented with 21 female adolescents. There were 29 female adolescents in the control group. The MB groupwork program significantly increased the mindfulness levels of the group. However, its effect on the other variables could not be determined at a significant level. There were positive correlations between mindfulness, life satisfaction and subjective happiness, and a negative correlation with perceived stress. The results of this study showed that MB interventions increase mindfulness levels of adolescents in a Children's Home setting in Türkiye. Secondly, as mindfulness increased, life satisfaction and subjective happiness also increased while perceived stress decreased. MB interventions are recommended to be used in social work interventions with different groups since it can contribute to subjective well-being.

Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints

PURPOSE

Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary.

METHODS

Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed.

RESULTS

221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once.

CONCLUSIONS

Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.

The Impact of Mindful Learning on Subjective and Psychological Well-Being in Postgraduate Students

Mindful learning is widely known to improve learning outcomes, yet its association with students' well-being remains unexplored. This study aimed to investigate the impact of mindful learning on subjective well-being (SWB) and psychological well-being (PWB) in postgraduate students, using survey questionnaires and a randomized experimental design. In Study 1, correlation and regression analyses based on 236 postgraduate students revealed significant positive associations among mindful learning, SWB, and PWB. In Study 2, 54 students were randomly assigned to three groups: the experimental (which received Mindful Learning Coaching), active-, and blank control groups. The results from repeated-measures ANOVA showed that coaching significantly improved students' mindful learning. The participants' SWB and PWB significantly decreased in both the active- and blank control groups, whilst their SWB and PWB tended to increase in the experimental group. In conclusion, mindful learning, SWB, and PWB are significantly correlated, while the enhancement of mindful learning may be a protective factor in students' well-being.

Mindfulness to improve the mental health of university students. A systematic review and meta-analysis

Objectives

This systematic review and meta-analysis was to analyze the effects of a mindfulness program on mental health in university students.

Methods

A systematic review was conducted using the databases Pubmed, Scopus, Web of Science and CINAHL. The selected studies had to incorporate a mindfulness intervention in university students. The methodological quality of the collected articles was evaluated using the PEDro scale.

Results

We initially identified 321 studies, of which 21 were included in this review. The interventions focused on mindfulness with durations ranging from 8 weeks to 3 months. The results demonstrated significant effects of a mindfulness intervention on mental health in university students.

Conclusion

This systematic review and meta-analysis found that mindfulness is effective for improving the mental health of college students.

Systematic Review Registration

identifier: CRD42023441453.

A brief mind-body intervention to reduce pain and anxiety during prostate needle biopsy: a clinically integrated randomized controlled trial with 2-staged consent

OBJECTIVES

Many patients experience pain, anxiety, and discomfort with prostate biopsy, which may discourage enrollment in active surveillance programs or follow-up biopsy. Guided meditation can significantly reduce pain and anxiety during percutaneous biopsy. We sought to evaluate the effectiveness of a brief mind-body intervention on patient-reported outcomes after prostate biopsy.

METHODS AND MATERIALS

We performed a clinically-integrated randomized controlled trial of a brief mind-body intervention during biopsy compared to usual care at a single tertiary care center from 2018 to 2022. All patients offered transrectal ultrasound-guided prostate biopsy in the clinic with local anesthesia were eligible for enrollment. This clinically integrated trial was conducted simultaneously with a randomized controlled trial of 1-stage and 2-stage consent. The primary outcome was patient-reported pain, anxiety, discomfort, and tolerability on a visual-analog scale (0-10). A 15% improvement was prespecified as clinically relevant. We compared the proportion of men in each arm reporting a severe score (7-10) on any of the 4 scales using Fisher's exact test and then compared means for each scale separately using ANCOVA with randomization stratum (first vs. prior biopsy) as a covariate.

RESULTS

Of 263 eligible patients, 238 enrolled (119 per arm). One hundred seventy-two (72%) enrolled with 2-stage consent. A total of 37/94 (39%) and 38/102 (37%) patients randomized to usual care and intervention, respectively, reported severe scores in any of the 4 domains, a difference of 2.1% (95% confidence interval [CI] -13, 17%, P = 0.8). There was no evidence of a difference in mean postbiopsy anxiety (P = 0.3), discomfort (P = 0.09), pain (P = 0.4) or tolerability scores (P = 0.2).

CONCLUSIONS

A clinically meaningful benefit for this brief mind-body intervention during prostate biopsy is unlikely. Robust patient enrollment is feasible using 2-stage consent.

Common mental health problems in medical students and junior doctors - an overview of systematic reviews

BACKGROUND

Common mental health problems (CMHP) are prevalent among junior doctors and medical students, and the COVID-19 pandemic has brought challenging situations with education disruptions, early graduations, and front-line work. CMHPs can have detrimental consequences on clinical safety and healthcare colleagues; thus, it is vital to assess the overall prevalence and available interventions to provide institutional-level support.

AIMS

This overview summarises the prevalence of CMHPs from existing published systematic reviews and informs public health prevention and early intervention practice.

METHODS

Four electronic databases were searched from 2012 to identify systematic reviews on the prevalence of CMHPs and/or interventions to tackle them.

RESULTS

Thirty-six reviews were included: 25 assessing prevalence and 11 assessing interventions. Across systematic reviews, the prevalence of anxiety ranged from 7.04 to 88.30%, burnout from 7.0 to 86.0%, depression from 11.0 to 66.5%, stress from 29.6 to 49.9%, suicidal ideation from 3.0 to 53.9% and one obsessive-compulsive disorder review reported a prevalence of 3.8%. Mindfulness-based interventions were included in all reviews, with mixed findings for each CMHP.

CONCLUSIONS

The prevalence of CMHPs is high among junior doctors and medical students, with anxiety remaining relatively stable and depression slightly increasing during the COVID-19 pandemic. Future research on mindfulness-based interventions is required for a resilient and healthy future workforce.

PRISMA/PROSPERO

the researchers have followed PRISMA guidance. This overview was not registered with PROSPERO as it was conducted as part of an MSc research project.

The effectiveness of mindfulness training in improving medical students' stress, depression, and anxiety

INTRODUCTION

There is growing interest in Mindfulness-based Stress Reduction (MBSR) program to combat mental distress in medical students. In Saudi Arabia, literature is insufficient about MBSR and its effectiveness. This study aims to measure the effectiveness of MBSR in improving mindful state, stress, anxiety, and depression in medical students. Also, the study explores the association between the attendance rate of MBSR sessions and its effectiveness. Lastly, the study examines gender differences in response to MBSR.

METHODS

This is a stratified randomized controlled study of 84 medical students from two medical schools in Riyadh, Saudi Arabia. They were recruited voluntarily from November 2018 to April 2021, and allocated to MBSR and waitlist groups using a stratified randomization method based on gender. MBSR group received eight weeks of sessions through audiovisual materials. An online survey utilizing validated questionnaires assessing stress, mindfulness, anxiety, and depression was used to evaluate both groups pre-program (time 0), post-program (time 1), and three months later (time 2).

RESULTS

Seventy-one participants completed the post-test (time 1). There were no differences between study groups at time 0 and 1. However, in 41 subjects who completed the follow-up test (time 2), the anxiety dropped significantly in MBSR group (mean difference (MD), -3.935; 95% CI, -7.580 to -0.290). Furthermore, attending more MBSR sessions was inversely correlated with depression (r, -0.556; P, 0.002), and anxiety (r, -0.630; P, 0.000). Compared to their baseline, males in MBSR group improved in stress (MD, 3.08; 95% CI, 0.30 to 5.86), anxiety (MD, 4.91; 95% CI, 3.32 to 6.50), and mindfulness (MD, -0.58; 95% CI, -1.01 to -0.15), while females improved in stress (MD, 2.64; 95% CI, 0.02 to 5.26).

CONCLUSION

Despite the study being interrupted by the stressful COVID-19 outbreak, the findings suggest that MBSR improved psychological outcomes when participants commit to the program.

A systematic review of the strength of evidence for the most commonly recommended happiness strategies in mainstream media

We conducted a systematic review of the evidence underlying some of the most widely recommended strategies for increasing happiness. By coding media articles on happiness, we first identified the five most commonly recommended strategies: expressing gratitude, enhancing sociability, exercising, practising mindfulness/meditation and increasing nature exposure. Next, we conducted a systematic search of the published scientific literature. We identified well-powered, pre-registered experiments testing the effects of these strategies on any aspect of subjective wellbeing (that is, positive affect, negative affect and life satisfaction) in non-clinical samples. A total of 57 studies were included. Our review suggests that a strong scientific foundation is lacking for some of the most commonly recommended happiness strategies. As the effectiveness of these strategies remains an open question, there is an urgent need for well-powered, pre-registered studies investigating strategies for promoting happiness.

Mental and Physical Health Impacts of Mindfulness Training for College Undergraduates: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Universities increasingly offer mindfulness-based programs (MBPs) to improve student health and reduce their impact on overburdened psychological services. It is critical for evidence-based policy to determine for what health outcomes mindfulness programs are effective and under what conditions. Objectives were to: (a) perform a comprehensive analysis of the effects of mindfulness interventions on physical, mental, and behavioral health outcomes in college undergraduate students, and (b) examine moderators of intervention effects to identify factors that may help improve existing university mindfulness programs and guide the design of new programs.

Method

Systematic searches of five databases identified MBP randomized controlled trials for undergraduate students, measuring any health outcome. Analyses using robust variance estimation focused on standardized mean differences for outcomes between groups and modeled through coded study features.

Results

The 58 studies in the review primarily focused on mental health with fewer assessments of physical health or health behaviors. Overall, mindfulness interventions significantly outperformed both active and inactive controls (ps<.05), with the most marked effects on anxiety symptoms, depressive symptoms, and mindfulness; greater success appeared for clinical populations. Online programs performed equivalent to in-person, and non-MBP programs were equivalent to MBP programs after controlling for other factors. Publication bias and other quality issues also emerged.

Conclusions

Mindfulness programs improve well-being in college students, with the strongest evidence for reducing anxiety and depressive symptoms. More studies utilizing stronger methods are needed to evaluate mindfulness programs' effects on additional health outcomes and online interventions in clinical populations.

A student-driven mindfulness curriculum for first-year osteopathic medical students: a pilot study

CONTEXT

Medical education is stressful and can adversely affect the health and well-being of students. Although mindfulness-based interventions (MBIs) have been successfully utilized in other settings, little is known about the use of student-led interventions in undergraduate medical education.

OBJECTIVES

The objectives of this study are to assess student satisfaction with four student-selected and student-led mindfulness activities incorporated into mandatory small-group sessions, the immediate impact of these activities on student stress levels, and student use of these activities outside the mindfulness sessions.

METHODS

First-year osteopathic medical students voluntarily participated in weekly student-selected and student-led mindfulness activities once a week for 8 consecutive weeks during regularly scheduled class time. Activities included yoga postures, the 4-7-8 breathing technique, progressive muscle relaxation (PMR), and values affirmation. Each activity was completed twice during the 8 weeks. After each session, students could anonymously complete an electronic survey assessing participation, change in stress level, satisfaction with the activity, and mindfulness activities practiced outside the session. Survey questions included dichotomous, Likert-like, and multiple-choice responses. A chi-square test was utilized to analyze student responses from each week about the decrease in stress level, and satisfaction with the mindfulness activity, and student use of the activities outside the classroom. Wilcoxon rank sum tests were utilized to determine associations between outcomes, and a logistic regression model was utilized to determine relationships between the change in stress levels and other outcomes.

RESULTS

Of the 154 first-year medical students initially enrolled in the 2021-2022 academic year, 14 (9.1 %) to 94 (61.0 %) actively participated in the weekly mindfulness activities. Students indicated that the 4-7-8 breathing technique was the activity most practiced outside the mindfulness sessions (32.3 %, 43/133 total responses) across all weeks. The mindfulness activity with the highest percentage of reported decrease in stress level was the yoga postures in week 5 (94.8 %, 36/38), and both weeks of the yoga activities had the highest reported student satisfaction (95.7 %, 90/94 for week 1; 92.1 %, 35/38 for week 5). For students who answered the change in stress level question, the stress level decrease was related to participation in the weekly activity for weeks 1 through 7 (all p<0.03). For students who participated in mindfulness sessions, the odds of reporting a reduction in the stress level were 16.6 times (95 % CI, 6.8-47.2; p<0.001) that of students who did not participate. For those satisfied with the activities, the odds of reporting a reduction in stress level were 6.7 (95 % CI, 3.3-13.9; p<0.001).

CONCLUSIONS

Results suggested that the student-selected and student-led mindfulness activities may successfully reduce medical student stress in students who actively participate. However, additional research is needed to determine how to optimize mindfulness curricula implementation.

A randomized controlled trial of mindfulness-based stress reduction on academic resilience and performance in college students

OBJECTIVE

The transition into college can pose barriers for student success. We examined the impact of mindfulness-based stress reduction (MBSR) compared to an active and no treatment control group, respectively, on stressor appraisals, academic persistence, and performance in unversity students.

PARTICIPANTS

Students were randomly assigned to receive MBSR (n = 29), study skills active control (n = 27), or no treatment (n = 29).

METHOD

Participants reported stressor appraisals and academic persistence pre- and post-intervention. Semester grade point average (GPA) and enrollment was also obtained.

RESULTS

Academic stressor appraisals did not vary by group. MBSR was protective against depleted academic persistence, whereas academic persistence decreased in the control groups. Enrollment rates remained unchanged in the MBSR group, but increased in the active control relative to no treatment. Finally, GPA improved in the MBSR group, but not controls.

CONCLUSIONS

Findings suggest that MBSR confers some benefits for resilience in university students.

Behavioral and psychosocial factors related to mental distress among medical students

Introduction

Physicians die by suicide at rates higher than the general population, with the increased risk beginning in medical school. To better understand why, this study examined the prevalence of mental distress (e.g., depressive symptoms and suicide risk) and behavioral and psychosocial risk factors for distress, as well as the associations between mental distress and risk factors among a sample of medical students in a pre-COVID-19-era.

Methods

Students enrolled in a large California medical school in 2018-2019 (N = 134; 52% female) completed questionnaires assessing sociodemographic characteristics, depression and suicide family history, health behaviors, and psychosocial wellbeing. Assessment scores indexing mental distress (e.g., depressive symptoms, thoughts of suicide in the past 12 months, suicide risk, and history of suicidality) and risk factors (e.g., stress, subjective sleep quality, alcohol use, impostor feelings, and bill payment difficulty) were compared across biological sex using chi-squared tests, and associations between mental distress and risk factors were determined through logistic regression.

Results

Elevated mental distress indicators were observed relative to the general public (e.g., 16% positive depression screen, 17% thought about suicide in previous 12 months, 10% positive suicide risk screen, and 34% history of suicidality), as well as elevated risk factors [e.g., 55% moderate or high stress, 95% at least moderate impostor feelings, 59% poor sleep quality, 50% screened positive for hazardous drinking (more likely in females), and 25% difficulty paying bills]. A positive depression screen was associated with higher stress, higher impostor feelings, poorer sleep quality, and difficulty paying bills. Suicidal ideation in the previous 12 months, suicide risk, and a history of suicidality were independently associated with higher levels of impostor feelings.

Discussion

Higher scores on assessments of depressive symptoms and suicidal thoughts and behaviors were related to several individual-level and potentially modifiable risk factors (e.g., stress, impostor feelings, sleep quality, and bill payment difficulties). Future research is needed to inform customized screening and resources for the wellbeing of the medical community. However, it is likely that the modification of individual-level risk factors is limited by the larger medical culture and systems, suggesting that successful interventions mitigate suicide risk for medical providers need to address multiple socio-ecological levels.

Economic Evaluation Alongside a Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy in Healthy Adults

Purpose

This study aimed to conduct an economic evaluation of mindfulness-based cognitive therapy (MBCT) in healthy participants by performing cost-utility analysis (CUA) and cost-benefit analysis (CBA).

Patients and Methods

CUA was carried out from a healthcare sector perspective and CBA was from the employer's perspective in parallel with a randomized controlled trial. Of the 90 healthy participants, 50 met the inclusion criteria and were randomized to the MBCT group (n = 25) or wait-list control group (n = 25). In the CUA, intervention costs and healthcare costs were included, while the mean difference in the change in quality-adjusted life years (QALYs) between the baseline and 16-week follow-up was used as an indicator of effect. Incremental cost-effectiveness ratio (ICER) was produced, and uncertainty was addressed using non-parametric bootstrapping with 5000 replications. In the CBA, the change in productivity losses was reflected as a benefit, while the costs included intervention and healthcare costs. The net monetary benefit was calculated, and uncertainty was handled with 5000 bootstrapping. Healthcare costs were measured with the self-report Health Service Use Inventory. The purchasing power parity in 2019 was used for currency conversion.

Results

In the CUA, incremental costs and QALYs were estimated at JPY 19,700 (USD 189) and 0.011, respectively. The ICER then became JPY 1,799,435 (USD 17,252). The probability of MBCT being cost-effective was 92.2% at the threshold of 30,000 UK pounds per QALY. The CBA revealed that MBCT resulted in increased costs (JPY 24,180) and improved work productivity (JPY 130,640), with a net monetary benefit of JPY 106,460 (USD 1021). The probability of the net monetary benefit being positive was 69.6%.

Conclusion

The results suggested that MBCT may be more cost-effective from a healthcare sector perspective and may be cost-beneficial from the employer's perspective.

Individual participant data systematic review and meta-analysis of randomised controlled trials assessing adult mindfulness-based programmes for mental health promotion in non-clinical settings

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

Study protocol for a randomised controlled trial investigating the effects of Mindfulness Based Stress Reduction on stress regulation and associated neurocognitive mechanisms in stressed university students: the MindRest study

BACKGROUND

Stress-related disorders are a growing public health concern. While stress is a natural and adaptive process, chronic exposure to stressors can lead to dysregulation and take a cumulative toll on physical and mental well-being. One approach to coping with stress and building resilience is through Mindfulness-Based Stress Reduction (MBSR). By understanding the neural mechanisms of MBSR, we can gain insight into how it reduces stress and what drives individual differences in treatment outcomes. This study aims to establish the clinical effects of MBSR on stress regulation in a population that is susceptible to develop stress-related disorders (i.e., university students with mild to high self-reported stress), to assess the role of large-scale brain networks in stress regulation changes induced by MBSR, and to identify who may benefit most from MBSR.

METHODS

This study is a longitudinal two-arm randomised, wait-list controlled trial to investigate the effects of MBSR on a preselected, Dutch university student population with elevated stress levels. Clinical symptoms are measured at baseline, post-treatment, and three months after training. Our primary clinical symptom is perceived stress, with additional measures of depressive and anxiety symptoms, alcohol use, stress resilience, positive mental health, and stress reactivity in daily life. We investigate the effects of MBSR on stress regulation in terms of behaviour, self-report measures, physiology, and brain activity. Repetitive negative thinking, cognitive reactivity, emotional allowance, mindfulness skills, and self-compassion will be tested as potential mediating factors for the clinical effects of MBSR. Childhood trauma, personality traits and baseline brain activity patterns will be tested as potential moderators of the clinical outcomes.

DISCUSSION

This study aims to provide valuable insights into the effectiveness of MBSR in reducing stress-related symptoms in a susceptible student population and crucially, to investigate its effects on stress regulation, and to identify who may benefit most from the intervention.

TRIAL REGISTRATION

Registered on September 15, 2022, at clinicaltrials.gov, NCT05541263 .

Understanding students' motivations for participating in a mindfulness course: a qualitative analysis of medical students' views

OBJECTIVES

Improving medical students' wellbeing and empowerment through curricular activities is a topic of interest worldwide. Mindfulness-based interventions (MBIs) are increasingly implemented in medical education often as part of elective courses. To better understand training outcomes and adjust curriculum to students' needs, we will explore why will medical students participate in meditation-based education?

METHODS

We analyzed 29 transcripts from the first session of an 8-week MBSR program offered to medical students in French. Transcripts were coded and analyzed using a qualitative content thematic analysis and the constant comparison method.

RESULTS

Analyses resulted in three themes describing students' motivation: (1) Medical education and the physician's role, i.e. improving interpersonal skills, acquiring skills oriented toward a more integrative medicine, being more productive in a highly competitive context. (2) Caring for my health i.e. aiming at stress reduction, emotion regulation, and improving self-compassion. (3) A quest for meaning, i.e. optimizing meaning of care, and meaning of life.

CONCLUSION

The results highlight the congruence between the perceived motivations and the evidence on the effect of mindfulness on self-care, the development of humanistic medical skills, and the meaning of care. Some findings raise the issue of the limits of using mindfulness to enhance one's productivity. Notably, participants articulated the need for self-care as in mindfulness training, with the ability to care for others.

Profiles of Military Medical Students' Well-being, Burnout, and Retention

BACKGROUND

Well-being concerns among medical students are more prevalent than their age-matched peers in the United States. It remains unknown, however, if individual differences in well-being exist among U.S. medical students serving in the military. In this study, we sought to identify profiles (i.e., subgroups) of well-being in military medical students and examine the associations between these well-being profiles and burnout, depression, and intended retention in military and medical fields.

METHODS

Using a cross-sectional research design, we surveyed military medical students and then conducted latent class analysis to explore profiles of well-being, and applied the three-step latent class analysis method to assess predictors and outcomes of well-being profiles.

RESULTS

Heterogeneity in well-being was identified among the 336 military medical students surveyed, portraying medical students' falling into three distinct subgroups: High well-being (36%), low well-being (20%), and moderate well-being (44%). Different subgroups were associated with different risks of outcomes. Students in the subgroup of low well-being were at the highest risk of burnout, depression, and leaving medicine. In contrast, students in the moderate well-being group were at the highest risk of leaving military service.

CONCLUSIONS

These subgroups may be clinically important as burnout, depression, and intention to leave medical field and/or military service occurred with varying likelihoods among medical students across the different well-being subgroups. Military medical institutions may consider improving recruitment tools to identify the best alignment between students' career goals and the military setting. Besides, it is crucial for the institution to address diversity, equity, and inclusion issues that may lead to alienation, anxiety, and a sense of wanting to leave the military community.

Exploring the effects of a mindfulness-based intervention in university students: MindKinder adult version program (MK-A)

This study aimed to evaluate the effects of the mindfulness-based intervention MindKinder Adult version (MK-A) program on dispositional mindfulness, trait emotional intelligence, mental health, and emotional regulation difficulties in university students. A quasi-experimental design of repeated measures pretest-posttest with a control group was used. The sample consisted of 137 university students (67.9% women, with a mean age of 19.94 years). Participants were randomly assigned to the experimental group (n = 69) and the control group (n = 68). Results showed that the program stimulated a significant improvement in dispositional mindfulness, describing, non-reactivity, trait emotional intelligence, mental health and emotional confusion in the experimental group. Given the obtained results, we consider the importance and incorporation of these mindfulness-based programs in university students. Due to the general characteristics of this population, having resources that lead to improvements, such as those obtained in this study, can be of great help since, in general, we find ourselves in a context, the university, in which students are subject to high levels of stress and anxiety. Finally, the implications of these findings are discussed.

Increased Effect Sizes in a Mindfulness- and Yoga-Based Intervention After Adjusting for Response Shift with Then-Test

Objectives

Response shift refers to variations in self-reported evaluations at different times from changes in one’s internal standards, values, and meanings. The current study explored the utility of the then-test to detect a potential mindfulness-based response shift occurrence during a mindfulness- and yoga-based intervention for student musicians, and to ascertain to what extent effect sizes could differ when adjusting for it.

Method

Participants (n = 31) completed the Five Facet Mindfulness Questionnaire (FFMQ) halfway through the intervention (Time 1-FFMQ), post-intervention (Time 2-FFMQ), and immediately after Time 2-FFMQ with a then-test approach that asked participants to rate the FFMQ based on retrospective reflections on their mindfulness at Time 1 (then-test-FFMQ). Paired t-tests and Hedges’ g effect sizes were computed to estimate three potential effects: response shift (Time 1-FFMQ minus then-test-FFMQ), the conventional intervention effect (Time 2-FFMQ minus Time 1-FFMQ), and the effect after adjusting for response shift (i.e., actual intervention effect = Time 2-FFMQ minus then-test-FFMQ).

Results

Response shift was significant for the FFMQ Observe subscale (g = 0.41) and total scale (g = 0.37). The adjusted scores in all subscales (Observe, g = 0.47; Describe, g = 0.25; Act Aware, g = 0.40; Non-judge, g = 0.28; Non-react, g = 0.57) and total scale (g = 0.60) achieved significance and yielded larger effect sizes than the conventional results, for which only Act Aware (g = 0.28), Non-react (g = 0.36), and total scale (g = 0.28) were significant.

Conclusions

Notwithstanding some methodological limitations, this study lends support to the utility of the then-test to quantify response shift. When adjusting for it, effect sizes from a mindfulness- and yoga-based intervention were generally amplified.

Preregistration

This study was not preregistered.

Bringing Needed Change to Medical Student Well-Being: A Call to Expand Accreditation Requirements

Issue: Noting high rates of burnout, depression, and suicidality among medical students, academic medical communities are trying to identify preventive and curricular measures that protect and promote student well-being. To date, the effectiveness of these efforts is unclear. In addition, evidence increasingly suggests that the major drivers of distress appear to be factors within the social, learning, and work environments. Specific to medical schools in the United States, neither the Liaison Committee on Medical Education nor the Commission on Osteopathic College Accreditation include accreditation standards regarding well-being curricula and, as such, these curricula are not well-integrated into students' medical school experience. Current accreditation standards also do not specifically require institutions to assess or address systemic factors of the learning environment that negatively affect student well-being. Evidence: This paper proposes expanding current Liaison Committee on Medical Education and Commission on Osteopathic College Accreditation standards on professionalism to incorporate well-being as a core component of professional identity formation by requiring individual and institutional-level actions. Proposed changes to accreditation standards include (1) institutional assessment of the impact of the learning environment on student well-being; (2) continuous quality improvement efforts to address structural factors associated with student well-being and modification of practices that impair student well-being; and (3) integrated curriculum with related assessment to educate students on empirically-supported strategies for well-being. Implications: Refining undergraduate medical education accreditation standards in the United States to include language specific to student well-being will facilitate long overdue changes to the learning environment. In the end, the goal is not just to improve medical student well-being, but to provide a workforce better equipped for a sustainable and meaningful career.

Mediating Role of Emotional Intelligence in the Relationship between Anxiety Sensitivity and Academic Burnout in Adolescents

(1) Background: Increased stress and study overload during adolescence could be related to academic burnout. Anxiety sensitivity of students seems to affect burnout levels, while emotional intelligence enables emotion management under stressful conditions. The objective of this study is to analyze the roles of anxiety sensitivity and emotional intelligence in academic burnout. (2) Methods: In this quantitative cross-sectional study conducted in Spain, the sample comprised 1287 high school students aged 14 to 18 who filled out the Maslach Burnout Inventory-General Survey, the Spanish version adapted for high school students of the Anxiety Sensitivity Index-3, and Brief Emotional Intelligence Inventory. (3) Results: Anxiety sensitivity was significantly higher in cynicism and emotional exhaustion. Furthermore, the mediation analysis showed that high anxiety sensitivity directly affected student exhaustion, cynicism, and efficacy levels. These effects were mediated mainly through stress management but also through the effect of stress management on mood, both emotional intelligence factors. (4) Conclusions: The academic changes that occur during high school hinder engagement and performance. Promoting the development of emotional skills would enable young people to manage their emotions when they become overwhelming and diminish their lack of interest and exhaustion in the classroom.

How are Medical Institutions Supporting the Well-being of Undergraduate Students? A Scoping Review

INTRODUCTION

Medical students experience significant stress and impacts on mood due to multiple factors. Unmitigated stress impacts both physical and mental health while increasing the risk of unethical behavior. It is important for medical institutions to identify strategies that effectively reduce perceived stress and improve the well-being of their students.

METHODS

The authors undertook a scoping review of the literature to identify strategies implemented by medical educational programs to improve the well-being of medical students.

RESULTS

Of 1068 articles identified, 19 studies met the inclusion criteria. Interventions were categorized as mindfulness-based programs, reflection groups, curriculum changes, and 'miscellaneous.' All studies assessed outcomes of student stress/resilience, as well as additional domains including academic performance, mental health, and interpersonal skills. Some also assessed the acceptability of the intervention to students.

CONCLUSIONS

Despite the heterogeneity of interventions and outcome measures, a clear theme emerged that institutionally-provided strategies to promote student well-being tend to be effective when students opt into the program. It was noted that adding mandatory content or activities to a medical program without creating adequate space or support for it can have the opposite effect. Further high quality intervention studies involving randomization, blinding and rigorous controls are warranted.

The global prevalence of burnout among general practitioners: a systematic review and meta-analysis

BACKGROUND

Burnout among general practitioners (GPs) has attracted the attention of more and more researchers. An adequate understanding the prevalence and related factors of burnout to prevent and reduce burnout is necessary. This study systematically measured the global prevalence of burnout among GPs.

METHODS

Eligible original studies were identified from the PubMed, Ovid Embase, Ovid Medline (R), and Web of science databases. We searched the full-time period available for each database, up to 30 September 2021. The adjusted prevalence rate was estimated using a random-effects meta-analysis. The heterogeneity was evaluated using I2 statistic. Differences by study-level characteristics were estimated via subgroup analyses and meta-regression.

RESULTS

A total of 16 cross-sectional studies with 7,595 participants were included. The pooled burnout rate showed 37%, 28%, and 26% of general GPs suffer from high emotional exhaustion (EE), high depersonalization (DP), and low personal exhaustion (PA), respectively. Groups comparisons found that high EE, high DP, and low PA rate data obtained from 2001 to 2009, high DP rate data obtained from Europe, low PA rate data obtained from high-quality studies had much higher rates.

CONCLUSIONS

This study demonstrated the prevalence of burnout in the GPs and alert health managers to tailor their strategies to retain this community. Targeted initiatives are needed to provide adequate GPs' well-being and maintain primary health care.

Burnout, negative emotions, and wellbeing among social workers in China after community lockdowns during the COVID-19 pandemic: Mediating roles of trait mindfulness

Objective

This study aimed to investigate burnout situation of social workers (SWs) who experienced the COVID-19 pandemic-related community lockdown 1 year before, and to assess the protective value of trait mindfulness (TM) in states of burnout.

Method

We surveyed the burnout, trait mindfulness, negative emotions (NEs) and wellbeing (WB) of 182 social workers provided services to Wuhan lockdowns community by COVID-19 one year before. Burnout were measured using the Maslach Burnout Inventory-Human Services Survey; TM using the Mindful Attention Awareness Scale; NEs using the Depression Anxiety and Stress Scale-21; and WB using the General Wellbeing Schedule. We also performed correlation regression analysis and mediation test for burnout, TM, NEs, and WB.

Results

Among the 182 respondents, 75 (41.2%) still suffered from severe burnout. TM was negatively correlated with burnout (r = -0.623), negatively correlated with NEs (r = -0.560), and positively correlated with WB (r = 0.617). Burnout had a significantly positive correlation with NEs (r = 0.544) and a significantly negative correlation with WB (r = -0.666). Further, WB had significantly negative correlation with NEs (r = -0.758). After controlling for age, gender, marital status, educational level, and years of employment, burnout had a significantly positive predictive effect on NEs (β = 0.509), whereas TM had a significantly negative predictive effect on NEs (β = -0.334). TM played a partial mediating role in the effect of burnout on NEs, with a mediating effect and effect ratio of 0.088 and 39.7%, respectively. Burnout had a significantly negative predictive effect on WB (β = -0.598), whereas TM had a significantly positive predictive effect on WB (β = 0.299). TM played a partial mediating role in the effect of burnout on NEs, with a mediating effect and effect ratio of -0.164 and 30.3%, respectively. WB had a significantly negative predictive effect on NEs (β = -0.711), and it played a partial mediating role in the effect of burnout on NEs, with a mediating effect and effect ratio of 0.185 and 83.3%, respectively.

Conclusion

The current levels of burnout among local SWs remained high 1 year after the community lockdowns. TM played a mediating role in the relationship between burnout, NEs, and WB. Concomitantly, WB played a mediating role in the relationship between burnout and NEs. Therefore, in the context of burnout, TM is a protective factor for reducing emotional stress and risks of developing psychiatric disorders through the enhancement of WB.

Comparison of two different mindfulness interventions among health care students in Finland: a randomised controlled trial

We investigated the short- and long-term effects of two different evidence-based mindfulness training on students' stress and well-being. A randomised controlled trial with three measurement points (baseline, post-intervention, and 4 months post-intervention) was conducted among undergraduate students of medicine, dentistry, psychology, and logopaedics at the University of Helsinki. The participants were randomly assigned into three groups: (1) face-to-face mindfulness training based on the Mindfulness Skills for Students course (n = 40), (2) a web-based Student Compass program using Mindfulness and Acceptance and Commitment therapy (n = 22), and (3) a control group that received mental health support as usual (n = 40). The primary outcome was psychological distress measured using the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). Secondary outcomes included hair cortisol concentrations and a wide range of well-being indicators. Psychological distress increased in all the groups from baseline to post-intervention, but significantly less so in the intervention groups than in the control group. At 4-month follow-up, were found no differences between the primary outcomes of the control and intervention groups, but the participants who continued practising mindfulness at least twice a week were less stressed than the others. Our results suggest that participating in a mindfulness course may mitigate health care students' psychological distress during the academic year, but only if the participants continue practising mindfulness at least twice a week.

A scoping review of interventions using occupation to improve mental health or mental wellbeing in adolescent populations

Introduction

Occupation-based interventions could help to address a growing mental health crisis among young people and adolescents. To develop new interventions and avoid research waste, a review of the academic literature is needed that systematically identifies and describes interventions designed to improve the mental health and wellbeing of 11–25 year-olds.

Aim

The scoping review aims to systematically review the academic, literature to identify and describe key characteristics of intervention studies using occupation to improve adolescents’ and young people’s mental health and wellbeing, exploring the range of interventions, reviewing reporting quality and illuminating gaps for further research.

Method

An iteratively developed scoping review protocol informs a systematic database search and review of the literature. Core characteristics are extracted and described, using the TIDIER guidelines and the CASP assessment tool.

Results

Five occupational therapy-based interventions, and 69 other occupation-based studies representing a wide breadth of approaches, outcomes and settings were identified.

Conclusions

Robust development, testing and reporting of occupation-based and occupation-focused intervention studies to promote and support mental health and wellbeing in adolescents and young people are needed. Interventions should be co-designed, developmentally appropriate and scaffold development. However, better agreement is needed about core outcomes measurement in this area.

Parental care and depressive symptoms among Chinese medical students: roles of empathy and gender

BACKGROUND

Medical students in China who face the dual pressure of study and employment tend to experience subclinical depressive symptoms. Parental care plays an important direct and indirect role in the psychological development of medical students, and the extent and mechanism of this role urgently need to be studied and discussed.

METHODS

After simple random sampling and screening of valid questionnaires, data from a total of 924 people were used. The participants completed the parental bonding instrument, self-rating depression scale, Chinese version of the Jefferson empathy scale-medical student edition and self-rating anxiety scale to evaluate parental care, empathy, depressive symptoms and anxiety. The data were statistically processed using a descriptive analysis, correlation analysis and test of moderated mediation.

RESULTS

Maternal care had a significant negative predictive effect on depressive symptoms among medical students. Strong maternal care can reduce the occurrence of depressive symptoms in medical students. Empathy played a positive mediating role such that both types of empathy could alleviate the effect of weak maternal care on the depressive symptoms of medical students. However, neither cognitive empathy nor affective empathy played a mediating role in the relationship between paternal care and depressive symptoms. Nevertheless, the relationship between maternal care and empathy was moderated by the medical students' gender.

CONCLUSIONS

The effect of this relationship on female medical students deserves special attention. The results of this study provide a reference and basis for the adjustment of medical education. This study could also help in the design of effective psychological intervention measures to reduce the degree of depressive symptoms and enhance personal empathy.

A Self-Managed Online Mindfulness Program in a University-Wide Learning Management System Orientation Site: A Real-World Ecological Validation Study

The efficacy of mindfulness-based interventions in randomised-controlled trials and large experimental studies has been demonstrated in university student populations. Whilst these investigations have provided insight into the nature of the delivery of mindfulness-based practices, there has been little research in the implementation of self-managed online student wellbeing and mindfulness programs at university. This ecological validation study conducted in 2020 evaluated a real-world implementation of a large, university-wide, online mindfulness-based program that was accessible fully online via the tertiary institutions’ Learning Management System (LMS) student orientation site. The total sample included 833 participants from a range of disciplines and faculties at Monash University, Australia. At the end of the study, 236 (28.3%) participants were retained and completed the follow-up survey. Participants had the option to engage with the fully self-managed online mindfulness program for a 12-week semester. The mindfulness practices were pre-recorded, audio-guided sessions, and 10–15 min in length. Baseline and end of semester questionnaires included the 14-item Warwick-Edinburgh Mental Wellbeing Scale, 10-item Perceived Stress Scale and the 18-item Five Facet Mindfulness Questionnaire. Participants who engaged with the mindfulness program over 3 or more weeks showed significant improvements in all three outcome measures, and all participants showed significant improvements in wellbeing at the end of semester. Learning analytics obtained via the LMS revealed that 58.6% (n = 489) had not logged into the mindfulness program at all, almost a third (31.0%, n = 259) logged into the program materials once or twice, and 10.2% (n = 85) of the whole sample engaged with the program actively, having logged in three or more times. The total number of student logins peaked in week 2, reduced between week 2 and week 7 and thereafter activity remained stable until the end of the semester. We hypothesise that the changes in wellbeing, stress and mindfulness at the end of the semester seen in the low engagement participants may partly be explained by the circumstances of COVID-19 restrictions improving. This study has revealed and discusses the complexities of student behaviour and implications for implementing an online mindfulness program in the real- world setting of a university.

Comparing Students of Medical and Social Sciences in Terms of Self-Assessment of Perceived Stress, Quality of Life, and Personal Characteristics

The aim of this study was to compare medical and social sciences students’ outcomes in terms of self-perceived stress, quality of life, and personality traits. We put particular emphasis on external and internal differences in students of specific fields–medicine, nursing, psychology, and pedagogy. In a survey, 1,783 students from Medical University of Gdańsk and University of Gdańsk participated in our study, of whom 1,223 were included in the final statistical analysis. All of them were evaluated using valid and reliable questionnaires–TIPI-PL, PSS-10, and a one-item scale of quality of life. Stress turned out to have a negative effect on quality of life, regardless of the type of field of study. Moreover, students from different fields varied in terms of personality factors: conscientiousness, agreeableness, openness to experience, and emotional stability. In conclusion, many students regardless of their field suffer from high stress and report low quality of life, which potentially further affects their academic performance and social life.

Effectiveness of mindfulness-based interventions on well-being and work-related stress in the financial sector: a systematic review and meta-analysis protocol

BACKGROUND

Work-related stress is a common phenomenon, often noticed in the employees of the finance sector. It mirrors counter effects on the wellness of employees, their mental well-being, and physical health. Mindfulness-based interventions (MBIs) raise awareness and attention to the present moment experiences by adopting coping skills. It is necessary to promote employee well-being and reduce work-related stress; hence, the need arises to associate between the level of mindfulness, employee well-being, and work-related stress. A systematic review on the effectiveness of MBIs in the finance sector is necessary to facilitate evidence for the future utility to reduce work-related stress and promote employee well-being.

METHODS

In this review, randomized controlled trials, non-randomized control trials, cohort, and cross-sectional and case-control studies that assess the effectiveness of MBIs on the employees in the finance sector will be considered. We propose to perform a literature search which will be conducted from the years 2000 to 2021 on CINAHL, Cochrane Library, ProQuest, PubMed, Scopus, and Web of Science. The search terms will include controlled and accessible terms such as mindfulness-based interventions, mindfulness training, workplace, employees, workers, well-being, employee wellness, occupational health, and finance sector. The outcomes will include the effect on employee well-being and reduction in work-related stress. Two researchers will independently conduct the screening and data extraction and assess the risk of bias. Based on the availability of data, a meta-analysis will also be performed. This protocol follows the Preferred Reporting Items for Systematic reviews and Meta-Analysis-Protocol (PRISMA-P) guidelines. "Assessing the Methodological Quality of Systematic Reviews" will be used to assess the quality of this review.

DISCUSSION

The review attempts to methodically analyse the effectiveness of MBIs among finance sector employees. It will foster to facilitate a detailed description and evidence-based overview of the effectiveness of MBIs on improving work-related stress, mindful awareness, and employee wellness and well-being in employees in the finance sector. The current study will provide an evidence base to researchers, academicians, and practitioners in the selection of mindfulness-based therapies for employees in the finance sector.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2021 CRD42021249782.

Mindfulness-based programmes for mental health promotion in adults in non-clinical settings: protocol of an individual participant data meta-analysis of randomised controlled trials

INTRODUCTION

With mental ill health listed as a top cause of global disease burden, there is an urgent need to prioritise mental health promotion programmes. Mindfulness-based programmes (MBPs) are being widely implemented to reduce stress in non-clinical settings. In a recent aggregate-level meta-analysis we found that, compared with no intervention, these MBPs reduce average psychological distress. However, heterogeneity between studies impedes generalisation of effects across every setting. Study-level effect modifiers were insufficient to reduce heterogeneity; studying individual-level effect modifiers is warranted. This requires individual participant data (IPD) and larger samples than those found in existing individual trials.

METHODS AND ANALYSIS

We propose an IPD meta-analysis. Our primary aim is to see if, and how, baseline psychological distress, gender, age, education and dispositional mindfulness moderate the effect of MBPs on distress. We will search 13 databases for good-quality randomised controlled trials comparing in-person, expert-defined MBPs in non-clinical settings with passive controls. Two researchers will independently select, extract and appraise trials using the revised Cochrane risk-of-bias tool. Anonymised IPD of eligible trials will be sought from authors, who will be invited to collaborate.The primary outcome will be psychological distress measured using psychometrically validated questionnaires at 1-6 months after programme completion. Pairwise random-effects two-stage IPD meta-analyses will be conducted. Moderator analyses will follow a 'deft' approach. We will estimate subgroup-specific intervention effects. Secondary outcomes and sensitivity analyses are prespecified. Multiple imputation strategies will be applied to missing data.

ETHICS AND DISSEMINATION

The findings will refine our knowledge on the effectiveness of MBPs and help improve the targeting of MBPs in non-clinical settings. They will be shared in accessible formats with a range of stakeholders. Public and professional stakeholders are being involved in the planning, conduct and dissemination of this project.

PROSPERO REGISTRATION NUMBER

CRD42020200117.

"Flourish in the Clerkship Year": a Curriculum to Promote Wellbeing in Medical Students

The stresses of medical training can lead to burnout and other adverse outcomes. The Flourish curriculum was designed to mitigate negative effects of stress among clerkship students through debriefing and skills-building activities that foster practical wisdom: mindfulness, appreciative practice, story-telling/listening, and reflection. Students rated the curriculum highly, felt it addressed common concerns about clerkships, and were able to apply techniques from the curriculum to their clinical work. This framework can help students process their experiences and benefit from peer support, mentorship, and reflection. Fostering medical students' wisdom capacities for reflection and compassion may be protective against burnout during their training.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01522-z.

Mindfulness and Balanced Time Perspective: Predictive Model of Psychological Well-Being and Gender Differences in College Students

BACKGROUND

The aims of the study were to establish an adjustment model to analyze the relationship among mindfulness, balanced time perspective (BTP) and psychological well-being (PWB) in college students and to explore gender differences among the variables.

METHOD

The sample consisted of 380 college students, 220 women and 160 men, uniformly distributed according to the university's faculties.

RESULTS

The results indicate that the synergy between mindfulness and BTP predicts the variance of PWB by 55%. Regarding gender differences, it was found that women have a greater tendency towards Past Positive than men and men a higher tendency towards Present Hedonistic than women. In addition, in the group of women, a stronger relationship was found among the variables and, consequently, a greater predictive value for PWB (58%), displaying an enhanced disposition to high PWB compared to men.

CONCLUSIONS

Together, mindfulness and BTP promote optimal psychological functioning and alleviate or reduce discomfort. Thus, their promotion and training in universities is especially important given the high prevalence of anxiety and depressive symptoms in college students.

Mindfulness-based interventions reducing and preventing stress and burnout in medical students: A systematic review and meta-analysis

OBJECTIVE

Stress and burnout are serious problems that impair the well-being and academic performance of medical students. Published systematic reviews and meta-analyses on interventions to reduce the stress experienced by medical students did not conclude which interventions are the most effective due to the heterogeneity of the studies. To enhance the hierarchy of evidence, our study selected only randomized controlled studies. The aims were to obtain more reliable outcomes and to precisely summarize the specific interventions which effectively reduce the stress levels and burnout of medical students.

METHODS

We performed a systematic review and meta-analysis according to PRISMA guidelines. Medical databases (Embase, Ovid, and CINAHL) were searched for relevant randomized controlled studies published up to December 2019. Two treatment timepoints (postintervention, and the 6-month follow-up) were chosen. Stress measure outcomes were the main outcomes. A random effects model was used. An intention-to-treat analysis was conducted.

RESULTS

Six high-quality studies were found. They compared the efficacies of mindfulness-based interventions and clerkship as usual (N = 689). The stress measurement scores of each mindfulness-based intervention at postintervention were significantly better than those of the control groups, with medium effect size and low heterogeneity (95% CI 0.07-0.51; p = 0.01; I-squared index = 45%). At the 6-month follow-up, the mindfulness groups had significantly better results than the control groups, with medium effect size and negligible heterogeneity (95% CI 0.06-0.55; p = 0.02; I-squared index = 0%).

DISCUSSION

The results indicate that mindfulness-based interventions are effective in reducing subjective stress in medical students at both the short- and long-term intervention timepoints.

Effects of Mind-Body Interventions on Adolescents’ Cooperativeness and Emotional Symptoms

Background: Mind-body interventions may support the development of adolescents’ self-regulation and provide a protective effect against maladaptive outcomes, e.g., internalizing and externalizing problems. The present study aimed at evaluating the effects of mindfulness-oriented meditation training (MOM) and autogenic training (AT) on a group of healthy Italian adolescents’ character dimensions, emotional and behavioral difficulties. Methods: 72 adolescents were randomly assigned to MOM/AT conditions and tested before and after the 8-week trainings through self-report measures (Temperament and Character Inventory 125, TCI; Strengths and Difficulties Questionnaire for Adolescents, SDQ-A). Main analyses involved robust and repeated measures ANOVAs, carried out separately for character TCI and SDQ-A scales. Results: After trainings, we found increased levels of cooperativeness and reduced emotional symptoms. Changes in these dimensions were negatively correlated: the more participants increased in their cooperativeness the greater decrease they showed in emotional symptoms. Conclusion: Both MOM and AT enhanced a cooperative attitude in adolescents and helped reducing their emotional problems. Therefore, it may be useful to apply these mind-body interventions in school settings as they can have a protective effect on the well-being and psychosocial adjustment of youths, through fostering their character maturity and helping them to better regulate their emotions.