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

BackgroundSystematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health.ObjectiveThe My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU).MethodsMYRIAD was a...

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Published in:BMJ mental health 2022-08, Vol.25 (3), p.99-109
Main Authors: Kuyken, Willem, Ball, Susan, Crane, Catherine, Ganguli, Poushali, Jones, Benjamin, Montero-Marin, Jesus, Nuthall, Elizabeth, Raja, Anam, Taylor, Laura, Tudor, Kate, Viner, Russell M, Allwood, Matthew, Aukland, Louise, Dunning, Darren, Casey, Tríona, Dalrymple, Nicola, De Wilde, Katherine, Farley, Eleanor-Rose, Harper, Jennifer, Kappelmann, Nils, Kempnich, Maria, Lord, Liz, Medlicott, Emma, Palmer, Lucy, Petit, Ariane, Philips, Alice, Pryor-Nitsch, Isobel, Radley, Lucy, Sonley, Anna, Shackleford, Jem, Tickell, Alice, Blakemore, Sarah-Jayne, Team, The MYRIAD, Ukoumunne, Obioha C, Greenberg, Mark T, Ford, Tamsin, Dalgleish, Tim, Byford, Sarah, Williams, J Mark G
Format: Article
Language:English
Subjects:
Child & adolescent psychiatry
Child and Adolescent Mental Health
Child development
Core curriculum
Cost analysis
COVID-19
Depression & mood disorders
Disease prevention
Intervention
Learning
Mental depression
Mental disorders
Mental health
Mindfulness
Pandemics
Schools
Students
Teachers
Teaching
Teenagers
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Summary:BackgroundSystematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health.ObjectiveThe My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU).MethodsMYRIAD 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.FindingsAnalysis 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.ConclusionsFindings do not support the superiority of SBMT over TAU in promoting mental health in adolescence.Clinical implicationsThere is need to ask what works, for whom and how, as well as considering key contextual and implementation factors.Trial registrationCurrent controlled trials ISRCTN86619085. This research was funded by the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z).
ISSN:1362-0347
1468-960X
2755-9734
DOI:10.1136/ebmental-2021-300396