Willem Kuyken, Susan Ball, Catherine Crane, Poushali Ganguli, Benjamin Jones, Jesus Montero-Marin, Elizabeth Nuthall, Anam Raja, Laura Taylor, Kate Tudor, Russell M Viner, Matthew Allwood, Louise Aukland, Darren Dunning, Tríona Casey, Nicola Dalrymple, Katherine De Wilde, Eleanor-Rose Farley, Jennifer Harper, Nils Kappelmann, Maria Kempnich, Liz Lord, Emma Medlicott, Lucy Palmer, Ariane Petit, Alice Philips, Isobel Pryor-Nitsch, Lucy Radley, Anna Sonley, Jem Shackleford, Alice Tickell, Sarah-Jayne Blakemore, The Myriad Team, Obioha C Ukoumunne, Mark T Greenberg, Tamsin Ford, Tim Dalgleish, Sarah Byford, J Mark G Williams
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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.</p><p><strong>Findings: </strong>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.</p><p><strong>Conclusions: </strong>Findings do not support the superiority of SBMT over TAU in promoting mental health in adolescence.</p><p><strong>Clinical implications: </strong>There is need to ask what works, for whom and how, as well as considering key contextual and implementation factors.</p><p><strong>Trial registration: </strong>Current controlled trials ISRCTN86619085. 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引用次数: 0
摘要
背景：系统性综述表明，校本正念训练（SBMT）有望促进学生的心理健康：我在青春期的复原力（MYRIAD）试验评估了正念训练与常规教学（TAU）相比的有效性和成本效益：MYRIAD是一项分组随机对照试验。85所符合条件的学校表示同意，并按学校规模、质量、类型、贫困程度和地区，以1:1的比例随机分配到TAU（43所学校，4232名学生）或SBMT（42所学校，4144名学生）。学校和学生（平均（标清）；年龄范围=12.2（0.6）；11-14 岁）在英国人口中具有广泛代表性。43所学校（学生人数=3678；86.9%）提供了SBMT，41所学校（学生人数=3572；86.2%）提供了TAU，并提供了主要终点数据。SBMT包括10节心理教育和正念练习课。TAU包括标准的社会情感教学。参与者的抑郁风险、社会情感行为功能和随访 1 年的幸福感是共同主要结果。研究结果还包括次要结果和经济结果：对 84 所学校（8376 名参与者）进行分析后发现，没有证据表明在 1 年后，SBMT 优于 TAU。标准化平均差异（干预减去对照）为抑郁风险为 0.005 (95% CI -0.05 to 0.06)；社会情感行为功能为 0.02 (-0.02 to 0.07)；幸福感为 0.02 (-0.03 to 0.07)。在每质量调整生命年 20 000 英镑的支付意愿阈值下，SBMT 具有很高的成本效益概率（83%）。没有观察到与干预相关的不良事件：结论：在促进青少年心理健康方面，研究结果不支持SBMT优于TAU：临床意义：有必要询问什么方法有效、对谁有效、如何有效，并考虑关键的背景和实施因素：试验登记：当前对照试验 ISRCTN86619085。本研究由威康信托基金会（WT104908/Z/14/Z 和 WT107496/Z/15/Z）资助。
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.
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).
期刊介绍：
Evidence-Based Mental Health alerts clinicians to important advances in treatment, diagnosis, aetiology, prognosis, continuing education, economic evaluation and qualitative research in mental health. Published by the British Psychological Society, the Royal College of Psychiatrists and the BMJ Publishing Group the journal surveys a wide range of international medical journals applying strict criteria for the quality and validity of research. Clinicians assess the relevance of the best studies and the key details of these essential studies are presented in a succinct, informative abstract with an expert commentary on its clinical application.Evidence-Based Mental Health is a multidisciplinary, quarterly publication.
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