Cochrane review: Mindfulness-based psychological interventions for improving mental well-being in medical students and junior doctors

Abstract

Background

Mindfulness interventions are increasingly popular as an approach to improve mental well‐being. To date, no Cochrane Review examines the effectiveness of mindfulness in medical students and junior doctors. Thus, questions remain regarding the efficacy of mindfulness interventions as a preventative mechanism in this population, which is at high risk for poor mental health.

Objectives
To assess the effects of psychological interventions with a primary focus on mindfulness on the mental well‐being and academic performance of medical students and junior doctors.

Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and five other databases (to October 2021) and conducted grey literature searches.

Selection criteria
We included randomised controlled trials of mindfulness that involved medical students of any year level and junior doctors in postgraduate years one, two or three. We included any psychological intervention with a primary focus on teaching the fundamentals of mindfulness as a preventative intervention. Our primary outcomes were anxiety and depression, and our secondary outcomes included stress, burnout, academic performance, suicidal ideation and quality of life.

Data collection and analysis
We used standard methods as recommended by Cochrane, including Cochrane's risk of bias 2 tool (RoB2).

Main results
We included 10 studies involving 731 participants in quantitative analysis.

Compared with waiting‐list control or no intervention, mindfulness interventions did not result in a substantial difference immediately post‐intervention for anxiety (standardised mean difference (SMD) 0.09, 95% CI ‐0.33 to 0.52; P = 0.67, I2 = 57%; 4 studies, 255 participants; very low‐certainty evidence). Converting the SMD back to the Depression, Anxiety and Stress Scale 21‐item self‐report questionnaire (DASS‐21) showed an estimated effect size which is unlikely to be clinically important. Similarly, there was no substantial difference immediately post‐intervention for depression (SMD 0.06, 95% CI ‐0.19 to 0.31; P = 0.62, I2 = 0%; 4 studies, 250 participants; low‐certainty evidence). Converting the SMD back to DASS‐21 showed an estimated effect size which is unlikely to be clinically important. No studies reported longer‐term assessment of the impact of mindfulness interventions on these outcomes.

For the secondary outcomes, the meta‐analysis showed a small, substantial difference immediately post‐intervention for stress, favouring the mindfulness intervention (SMD ‐0.36, 95% CI ‐0.60 to ‐0.13; P < 0.05, I2 = 33%; 8 studies, 474 participants; low‐certainty evidence); however, this difference is unlikely to be clinically important. The meta‐analysis found no substantial difference immediately post‐intervention for burnout (SMD ‐0.42, 95% CI ‐0.84 to 0.00; P = 0.05, I² = 0%; 3 studies, 91 participants; very low‐certainty evidence). The meta‐analysis found a small, substantial difference immediately post‐intervention for academic performance (SMD ‐0.60, 95% CI ‐1.05 to ‐0.14; P < 0.05, I² = 0%; 2 studies, 79 participants; very low‐certainty evidence); however, this difference is unlikely to be clinically important. Lastly, there was no substantial difference immediately post‐intervention for quality of life (mean difference (MD) 0.02, 95% CI ‐0.28 to 0.32; 1 study, 167 participants; low‐certainty evidence). There were no data available for three pre‐specified outcomes of this review: deliberate self‐harm, suicidal ideation and suicidal behaviour.

We assessed the certainty of evidence to range from low to very low across all outcomes. Across most outcomes, we most frequently judged the risk of bias as having 'some concerns'. There were no studies with a low risk of bias across all domains.

Authors' conclusions
The effectiveness of mindfulness in our target population remains unconfirmed. There have been relatively few studies of mindfulness interventions for junior doctors and medical students. The available studies are small, and we have some concerns about their risk of bias. Thus, there is not much evidence on which to draw conclusions on effects of mindfulness interventions in this population. There was no evidence to determine the effects of mindfulness in the long term.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013740.pub2/full

 

The review is from December 2021. Thought it could be of interest for some members of the forum. Even as a stress treatment, there might be some limitations to this practice and sometimes mindfulness in the Western world seems to be used mostly as a cheap band-aid that doesn't solve anything instead of bettering issues on a structural level which takes effort and probably cost money, but might actually improve things.

I believe the most absurd use of mindfulness as "problem solver" I've heard of are mindfulness-hubs in the Amazon "fulfilment centers" (the enormous storages where items are shipped from and the conditions for workers are very poor) to deal with stress among workers.
Yes, they are a real thing..
https://www.vice.com/en/article/wx5...-zenbooths-for-stressed-out-warehouse-workers

 

I expect that exactly zero people who were previously claiming this will stop saying it. If anything, I fully expect this to be cited several times as positive evidence, because the evidence itself is irrelevant, quotes can and will be cherry-picked, it is the essence of EBM.

Let's be frank: medicine is addicted to hopium and needs an intervention. It just won't stop on its own.