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  • Do mindfulness-based programmes improve the cognitive skills, behaviour and mental health of children and adolescents? An updated meta-analysis of randomised controlled trials

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Systematic review
Do mindfulness-based programmes improve the cognitive skills, behaviour and mental health of children and adolescents? An updated meta-analysis of randomised controlled trials
  1. Darren Dunning1,
  2. Kate Tudor2,
  3. Lucy Radley2,
  4. Nicola Dalrymple2,
  5. Julia Funk1,3,
  6. Maris Vainre1,
  7. Tamsin Ford4,
  8. Jesus Montero-Marin2,5,
  9. Willem Kuyken2,
  10. Tim Dalgleish1,6
  1. 1 Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
  2. 2 Department of Psychiatry, University of Oxford, Oxford, UK
  3. 3 Institute of Clinical Psychology and Psychotherapy, Ludwig-Maximilians-University of Munich, Munich, Germany
  4. 4 Department of Psychiatry, University of Cambridge, Cambridge, UK
  5. 5 Teaching, Research and Inovation Unit, Parc Sanitari Sant Joan de Deu, Saint Boi de Llobregat, Spain
  6. 6 Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
  1. Correspondence to Dr Tim Dalgleish, University of Cambridge, Cambridge CB2 7EF, UK; tim.dalgleish{at}mrc-cbu.cam.ac.uk

Abstract

Question Mindfulness-based programmes (MBPs) are an increasingly popular approach to improving mental health in young people. Our previous meta-analysis suggested that MBPs show promising effectiveness, but highlighted a lack of high-quality, adequately powered randomised controlled trials (RCTs). This updated meta-analysis assesses the-state-of the-art of MBPs for young people in light of new studies. It explores MBP’s effectiveness in active vs passive controls; selective versus universal interventions; and studies that included follow-up.

Study selection and analysis We searched for published and unpublished RCTs of MBPs with young people (<19 years) in PubMed Central, PsycINFO, Web of Science, EMBASE, ICTRP, ClinicalTrials.gov, EThOS, EBSCO and Google Scholar. Random-effects meta-analyses were conducted, and standardised mean differences (Cohen’s d) were calculated.

Findings Sixty-six RCTs, involving 20 138 participants (9552 receiving an MBP and 10 586 controls), were identified. Compared with passive controls, MBPs were effective in improving anxiety/stress, attention, executive functioning, and negative and social behaviour (d from 0.12 to 0.35). Compared against active controls, MBPs were more effective in reducing anxiety/stress and improving mindfulness (d=0.11 and 0.24, respectively). In studies with a follow-up, there were no significant positive effects of MBPs. No consistent pattern favoured MBPs as a universal versus selective intervention.

Conclusions The enthusiasm for MBPs in youth has arguably run ahead of the evidence. While MBPs show promising results for some outcomes, in general, the evidence is of low quality and inconclusive. We discuss a conceptual model and the theory-driven innovation required to realise the potential of MBPs in supporting youth mental health.

  • Child & adolescent psychiatry

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/ebmental-2022-300464

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information.

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    Footnotes

    • JM-M, WK and TD are joint senior authors.

    • Twitter @MarisVainre

    • Contributors DD was responsible for leading the meta-analysis and the earlier meta-analysis that this updates. WK, TD and TF were responsible for securing funding for the larger MYRIAD programme of work to which this contributes. DD drafted the manuscript, with input from TD, JF, WK and JM-M. DD, KT, LR and ND conducted the literature search. DD conducted the analysis with support from JM-M. MV, JF, DD and JM-M conducted the risk-of-bias and GRADE evaluations. DD is study guarantor. All authors read and approved the final manuscript.

    • Funding This research was funded by Wellcome (WT104908/Z/14/Z and WT107496/Z/15/Z) and supported by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre. TD was funded by the UK Medical Research Council (Grant Reference: SUAG/043 G101400). JM-M has a 'Miguel Servet' research contract from the ISCIII (CP21/00080).

    • Disclaimer The funders had no role in study design, data collection, analysis or interpretation nor in writing the paper. The views expressed are those of the author(s) and not necessarily those of the funders.

    • Competing interests WK is the Director of the Oxford Mindfulness Centre and receives royalties for several books on mindfulness. JM-M is associated with the Oxford Mindfulness Centre.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.