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.
Por:
Kuyken W, Ball S, Crane C, Ganguli P, Jones B, Montero J, Nuthall E, Raja A, Taylor L, Tudor K, Viner RM, Allwood M, Aukland L, Dunning D, Casey T, Dalrymple N, De Wilde K, Farley ER, Harper J, Kappelmann N, Kempnich M, Lord L, Medlicott E, Palmer L, Petit A, Philips A, Pryor-Nitsch I, Radley L, Sonley A, Shackleford J, Tickell A, Blakemore SJ, Team TM, Ukoumunne OC, Greenberg MT, Ford T, Dalgleish T, Byford S and Williams JMG
Publicada:
1 ago 2022
Ahead of Print:
12 jul 2022
Categoría:
Psychiatry and mental health
Resumen:
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).
Filiaciones:
Kuyken W:
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
Ball S:
NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
Ganguli P:
King's College London, King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
Jones B:
NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
Montero J:
Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
Viner RM:
Population, Policy & Practice Research Programme, UCL Great Ormond St. Institute of Child Health, London, UK
Dunning D:
Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
Blakemore SJ:
Department of Psychology, University of Cambridge, Cambridge, UK
UCL Institute of Cognitive Neuroscience, London, UK
Ukoumunne OC:
NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
Greenberg MT:
Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
Ford T:
Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
Dalgleish T:
Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
Byford S:
King's College London, King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
Green Published, hybrid
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