PT  - JOURNAL ARTICLE
AU  - Willem Kuyken
AU  - Susan Ball
AU  - Catherine Crane
AU  - Poushali Ganguli
AU  - Benjamin Jones
AU  - Jesus Montero-Marin
AU  - Elizabeth Nuthall
AU  - Anam Raja
AU  - Laura Taylor
AU  - Kate Tudor
AU  - Russell M Viner
AU  - Matthew Allwood
AU  - Louise Aukland
AU  - Darren Dunning
AU  - Tríona Casey
AU  - Nicola Dalrymple
AU  - Katherine De Wilde
AU  - Eleanor-Rose Farley
AU  - Jennifer Harper
AU  - Nils Kappelmann
AU  - Maria Kempnich
AU  - Liz Lord
AU  - Emma Medlicott
AU  - Lucy Palmer
AU  - Ariane Petit
AU  - Alice Philips
AU  - Isobel Pryor-Nitsch
AU  - Lucy Radley
AU  - Anna Sonley
AU  - Jem Shackleford
AU  - Alice Tickell
AU  - Sarah-Jayne Blakemore
AU  - The MYRIAD Team
AU  - Obioha C Ukoumunne
AU  - Mark T Greenberg
AU  - Tamsin Ford
AU  - Tim Dalgleish
AU  - Sarah Byford
AU  - J Mark G Williams
TI  - Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial
AID  - 10.1136/ebmental-2021-300396
DP  - 2022 Aug 01
TA  - Evidence Based Mental Health
PG  - 99--109
VI  - 25
IP  - 3
4099  - http://mentalhealth.bmj.com//content/25/3/99.short
4100  - http://mentalhealth.bmj.com//content/25/3/99.full
SO  - Evid Based Ment Health2022 Aug 01; 25
AB  - Background Systematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health.Objective The My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU).Methods MYRIAD was a parallel group, cluster-randomised controlled trial. Eighty-five eligible schools consented and were randomised 1:1 to TAU (43 schools, 4232 students) or SBMT (42 schools, 4144 students), stratified by school size, quality, type, deprivation and region. Schools and students (mean (SD); age range=12.2 (0.6); 11–14 years) were broadly UK population-representative. Forty-three schools (n=3678 pupils; 86.9%) delivering SBMT, and 41 schools (n=3572; 86.2%) delivering TAU, provided primary end-point data. SBMT comprised 10 lessons of psychoeducation and mindfulness practices. TAU comprised standard social-emotional teaching. Participant-level risk for depression, social-emotional-behavioural functioning and well-being at 1 year follow-up were the co-primary outcomes. Secondary and economic outcomes were included.Findings Analysis of 84 schools (n=8376 participants) found no evidence that SBMT was superior to TAU at 1 year. Standardised mean differences (intervention minus control) were: 0.005 (95% CI −0.05 to 0.06) for risk for depression; 0.02 (−0.02 to 0.07) for social-emotional-behavioural functioning; and 0.02 (−0.03 to 0.07) for well-being. SBMT had a high probability of cost-effectiveness (83%) at a willingness-to-pay threshold of £20 000 per quality-adjusted life year. No intervention-related adverse events were observed.Conclusions Findings do not support the superiority of SBMT over TAU in promoting mental health in adolescence.Clinical implications There is need to ask what works, for whom and how, as well as considering key contextual and implementation factors.Trial registration Current controlled trials ISRCTN86619085. This research was funded by the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z).Data are available upon reasonable request. The baseline data and codebook from the MYRIAD Trial are available from Prof Kuyken (willem.kuyken@psych.ox.ac.uk) upon request (release of data is subject to an approved proposal and a signed data access agreement).