BACKGROUND: The COVID-19 pandemic significantly impacted the mental health of frontline healthcare workers (HCWs), but solid evidence on psychological interventions for HCWs remains limited.
OBJECTIVE: Whether an adjusted therapist-assisted Mindfulness-based Stress Reduction group intervention (adjusted MBSR) is superior to a minimal self-guided mindfulness-based intervention (self-guided MBI) in improving mental health of HCWs during the COVID-19 pandemic.
DESIGN: Randomized controlled trial.
PARTICIPANTS: 201 frontline HCWs (47 physicians, 120 nurses, 34 supporting staff); enrollment between June 2020 and September 2021.
INTERVENTIONS: A 4-week adjusted MBSR with eight biweekly 1.5-h sessions; or a 4-week self-guided MBI with 24 mindfulness/compassion exercises.
MEASURES: Primary outcome was the Patient Health Questionnaire - Somatic, Anxiety and Depressive Symptom Scales (PHQ-SADS) at 6-month follow-up. Secondary outcomes included posttraumatic symptoms, insomnia, alcohol use, repetitive negative thinking, mental well-being, posttraumatic growth, mindfulness, and self-compassion at post-intervention and 3- and 6-month follow-up.
KEY RESULTS: At 6-month follow-up, the adjusted MBSR was not superior to the self-guided MBI (mean difference (SE) PHQ-SADS, 0.23 (1.03), P=0.82). Both interventions showed similar within-group improvement in PHQ-SADS (Cohen's d between baseline and 6-month follow-up: adjusted MBSR -0.78 (95% CI -1.07; -0.48), self-guided MBI -0.72 (95% CI -1.01; -0.43)). Secondary outcomes showed that symptom trajectories differed between groups for PHQ-SADS (intervention*time F(3, 420)=3.99, P=0.008), with greater reduction at post-intervention for adjusted MBSR, and posttraumatic growth (intervention*time F(3, 350)=5.32, P=0.001), with exclusive increase post-intervention in adjusted MBSR. Both interventions showed comparable significant within-group improvements on posttraumatic symptoms, insomnia, repetitive negative thinking, mental well-being, mindfulness, and self-compassion.
CONCLUSIONS: The adjusted MSBR was not superior to the self-guided MBI; both were accompanied by significant reductions of depressive, anxiety, and somatic symptoms after 4 weeks of treatment which was sustained at 6-month follow-up. Further research is needed to investigate the possible role of MBIs to support HCWs involved in future healthcare crises.
TRIAL REGISTRATION: ClinicalTrials.gov NCT04720404; onderzoekmetmensen.nl/en NL73793.091.20.
| Specialty Area | Score |
|---|---|
| Hospital Doctor/Hospitalists | |
| Internal Medicine |
This study from a single center in the Netherlands sought to study whether mindfulness practices improved mental health (MH) in front-line healthcare workers during the Covid-19 pandemic. Although IRB did not approve a control group, the authors compared psychologist-led instruction vs self-instruction using mindfulness techniques. The results show that there was no significant difference between the groups, but there was a significant improvement in MH outcomes of both groups pre- and post- treatment. It should be noted that participants were 94% women and only 23% physicians. What is missing are data from a similar group who did not use mindfulness and their outcomes as the pandemic progressed (i.e., control group) and whether provider adaptation would have happened in the absence of formal mindfulness practices. Nonetheless, this study shows that during a worldwide pandemic, teaching mindfulness techniques to health care providers may improve symptoms of depression and anxiety.
Mental health for healthcare workers (including hospitalists) is too frequently ignored and investment by leadership is often insufficient to meet the need. The efficacy of self-guided MBI might be appealing, and the non-inferiority suggests this could be reasonably brought into other institutions.
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