Abstract
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.
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.
| Original language | English |
|---|---|
| Pages (from-to) | 99-109 |
| Journal | Evidence Based Mental Health |
| Volume | 25 |
| Issue number | 3 |
| Early online date | 12 Jul 2022 |
| DOIs | |
| Publication status | Published - 1 Aug 2022 |
| Externally published | Yes |
Bibliographical note
Data availability statementData are available upon reasonable request. The baseline data and codebook from the MYRIAD Trial are available from Prof Kuyken ([email protected]) upon request (release of data is subject to an approved proposal and a signed data access agreement).
Funding
This research was funded in whole, or in part, by the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z) and supported by the National Institute for Health Research Clinical Research Network (NIHR CRN). For the purposes of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. Susan Ball, Ben Jones and Obi Ukoumunne were supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South West Peninsula. JMM has a “Miguel Servet” research contract from the ISCIII (CP21/00080). The funders of the study had no role in study design, data collection, analysis or interpretation nor in writing the paper. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The views expressed are those of the author(s) and not necessarily those of the funders.
