Korean Journal of Biological Psychiatry (생물정신의학)

The Korean Society of Biological Psychiatry (대한생물정신의학회)
권호 표지
DOI QR코드

DOI QR Code

The Therapeutic Effect of Mindfulness-Based Interventions on Depressive Symptoms in Patients With Major Depressive Disorder: A Meta-Analysis

주요우울장애 환자의 우울증상에 대한 마음챙김 기반의 치료적 개입의 효과에 관한 메타분석

  • Hannui Park (Department of Psychiatry, Kangwon National University School of Medicine) ;
  • Seyeon Hong (Department of Neuropsychiatry, Presbyterian Medical Center) ;
  • Euihyeon Na (Department of Neuropsychiatry, Presbyterian Medical Center) ;
  • Myoung-Nam Lim (Biomedical Research Institute, Kangwon National University Hospital) ;
  • Kanguk Lee (Department of Psychiatry, Kangwon National University School of Medicine)
  • 박한뉘 (강원대학교병원 정신건강의학과) ;
  • 홍세연 (예수병원 정신건강의학과) ;
  • 나의현 (예수병원 정신건강의학과) ;
  • 임명남 (강원대학교병원 의생명연구원) ;
  • 이강욱 (강원대학교병원 정신건강의학과)
  • Received : 2023.10.27
  • Accepted : 2024.02.27
  • Published : 2024.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives We conducted a meta-analysis of randomized controlled trials to investigate the therapeutic effects of mindfulness-based interventions on depressive symptoms in patients with major depressive disorder. Methods In February 2021, we searched Embase, MEDLINE, Cochrane Library, PsycINFO, CINAHL, and AMED. Under the guidance of the corresponding author, two evaluators independently reviewed and selected articles based on predetermined selection criteria. Results Based on the selection criteria, we systematically screened and included a total of 12 randomized controlled trials comprising 720 cases for the final analysis. Utilizing a random-effects model for data analysis, we determined the Hedges' g value to be 0.787, indicating a medium-sized effect according to Cohen's interpretation. The 95% confidence interval for the effect size ranged from 0.414 to 1.160 (p-value < 0.0001). Conclusions This study reveals the potential effectiveness of mindfulness-based interventions in treating depressive symptoms among patients with major depressive disorder.

Keywords

References

  1. Malhi GS, Mann JJ. Depression. Lancet 2018;392:2299-2312. https://doi.org/10.1016/S0140-6736(18)31948-2
  2. Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 2006;163:1905-1917. https://doi.org/10.1176/ajp.2006.163.11.1905
  3. Thase ME, Friedman ES, Biggs MM, Wisniewski SR, Trivedi MH, Luther JF, et al. Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: a STAR*D report. Am J Psychiatry 2007;164:739-752. https://doi.org/10.1176/ajp.2007.164.5.739
  4. Wells KB, Burnam MA, Rogers W, Hays R, Camp P. The course of depression in adult outpatients. Results from the medical outcomes study. Arch Gen Psychiatry 1992;49:788-794. https://doi.org/10.1001/archpsyc.1992.01820100032007
  5. Ormel J, Oldehinkel AJ, Nolen WA, Vollebergh W. Psychosocial disability before, during, and after a major depressive episode: a 3-wave population-based study of state, scar, and trait effects. Arch Gen Psychiatry 2004;61:387-392. https://doi.org/10.1001/archpsyc.61.4.387
  6. Gu MS. Depression Patients Exceed One Million Annually, Medical Expenses Surpass 500 Billion Won. Newsis [Internet]. 2024 Jan 10 [cited 2024 Jan 14]. Available from: https://www.newsis.com/view/?id=NISX20240110_0002587446&cID=10204&pID=10200.html.
  7. Baer R, Crane C, Miller E, Kuyken W. Doing no harm in mindfulness-based programs: conceptual issues and empirical findings. Clin Psychol Rev 2019;71:101-114. https://doi.org/10.1016/j.cpr.2019.01.001
  8. van der Velden AM, Kuyken W, Wattar U, Crane C, Pallesen KJ, Dahlgaard J, et al. A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clin Psychol Rev 2015;37:26-39. https://doi.org/10.1016/j.cpr.2015.02.001
  9. Alsubaie M, Abbott R, Dunn B, Dickens C, Keil TF, Henley W, et al. Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: a systematic review. Clin Psychol Rev 2017;55:74-91. https://doi.org/10.1016/j.cpr.2017.04.008
  10. Holzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci 2011;6:537-559. https://doi.org/10.1177/1745691611419671
  11. Leyland A, Rowse G, Emerson LM. Experimental effects of mindfulness inductions on self-regulation: systematic review and metaanalysis. Emotion 2019;19:108-122. https://doi.org/10.1037/emo0000425
  12. Zhang D, Lee EKP, Mak ECW, Ho CY, Wong SYS. Mindfulness-based interventions: an overall review. Br Med Bull 2021;138:41-57. https://doi.org/10.1093/bmb/ldab005
  13. Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev 2011;31:1032-1040. https://doi.org/10.1016/j.cpr.2011.05.002
  14. Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. 1st ed. New York: Guilford Press;2002. p.409.
  15. Kuyken W, Warren FC, Taylor RS, Whalley B, Crane C, Bondolfi G, et al. Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: an individual patient data meta-analysis from randomized trials. JAMA Psychiatry 2016;73:565-574. https://doi.org/10.1001/jamapsychiatry.2016.0076
  16. Heeren A, Van Broeck N, Philippot P. The effects of mindfulness on executive processes and autobiographical memory specificity. Behav Res Ther 2009;47:403-409. https://doi.org/10.1016/j.brat.2009.01.017
  17. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol 2010;78:169-183. https://doi.org/10.1037/a0018555
  18. Goldberg SB, Tucker RP, Greene PA, Davidson RJ, Wampold BE, Kearney DJ, et al. Mindfulness-based interventions for psychiatric disorders: a systematic review and meta-analysis. Clin Psychol Rev 2018;59:52-60. https://doi.org/10.1016/j.cpr.2017.10.011
  19. Reangsing C, Lauderman C, Schneider JK. Effects of mindfulness meditation intervention on depressive symptoms in emerging adults: a systematic review and meta-analysis. J Integr Complement Med 2022;28:6-24. https://doi.org/10.1089/jicm.2021.0036
  20. Johannsen M, Nissen ER, Lundorff M, O'Toole MS. Mediators of acceptance and mindfulness-based therapies for anxiety and depression: a systematic review and meta-analysis. Clin Psychol Rev 2022;94:102156.
  21. Wang YY, Li XH, Zheng W, Xu ZY, Ng CH, Ungvari GS, et al. Mindfulness-based interventions for major depressive disorder: a comprehensive meta-analysis of randomized controlled trials. J Affect Disord 2018;229:429-436. https://doi.org/10.1016/j.jad.2017.12.093
  22. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates;1988. p.75-108.
  23. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-560. https://doi.org/10.1136/bmj.327.7414.557
  24. de Jong M, Peeters F, Gard T, Ashih H, Doorley J, Walker R, et al. A randomized controlled pilot study on mindfulness-based cognitive therapy for unipolar depression in patients with chronic pain. J Clin Psychiatry 2018;79:15m10160.
  25. Szumska I, Gola M, Rusanowska M, Krajewska M, Zygierewicz J, Krejtz I, et al. Mindfulness-based cognitive therapy reduces clinical symptoms, but do not change frontal alpha asymmetry in people with major depression disorder. Int J Neurosci 2021;131:453-461. https://doi.org/10.1080/00207454.2020.1748621
  26. American Psychological Association. Clinical practice guideline for the treatment of depression across three age cohorts. Washington, DC: American Psychological Association;2019.
  27. Parikh SV, Quilty LC, Ravitz P, Rosenbluth M, Pavlova B, Grigoriadis S, et al. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 2. Psychological treatments. Can J Psychiatry 2016;61:524-539. https://doi.org/10.1177/0706743716659418
  28. Hofheinz C, Reder M, Michalak J. How specific is cognitive change? A randomized controlled trial comparing brief cognitive and mindfulness interventions for depression. Psychother Res 2020;30:675-691. https://doi.org/10.1080/10503307.2019.1685138
  29. Winnebeck E, Fissler M, Gartner M, Chadwick P, Barnhofer T. Brief training in mindfulness meditation reduces symptoms in patients with a chronic or recurrent lifetime history of depression: a randomized controlled study. Behav Res Ther 2017;99:124-130. https://doi.org/10.1016/j.brat.2017.10.005
  30. Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression. 2nd ed. New York: Guilford Press;2013.
  31. Baer R, Crane C, Montero-Marin J, Phillips A, Taylor L, Tickell A, et al. Frequency of self-reported unpleasant events and harm in a mindfulness-based program in two general population samples. Mindfulness (N Y) 2021;12:763-774. https://doi.org/10.1007/s12671-020-01547-8
  32. Goldberg SB, Lam SU, Britton WB, Davidson RJ. Prevalence of meditation-related adverse effects in a population-based sample in the United States. Psychother Res 2022;32:291-305. https://doi.org/10.1080/10503307.2021.1933646
  33. Schuling R, Huijbers MJ, van Ravesteijn H, Donders R, Cillessen L, Kuyken W, et al. Recovery from recurrent depression: randomized controlled trial of the efficacy of mindfulness-based compassionate living compared with treatment-as-usual on depressive symptoms and its consolidation at longer term follow-up. J Affect Disord 2020;273:265-273. https://doi.org/10.1016/j.jad.2020.03.182
  34. Cladder-Micus MB, Speckens AEM, Vrijsen JN, T Donders AR, Becker ES, Spijker J. Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: a pragmatic randomized controlled trial. Depress Anxiety 2018;35:914-924. https://doi.org/10.1002/da.22788
  35. Ahmadpanah M, Akbari T, Akhondi A, Haghighi M, Jahangard L, Sadeghi Bahmani D, et al. Detached mindfulness reduced both depression and anxiety in elderly women with major depressive disorders. Psychiatry Res 2017;257:87-94. https://doi.org/10.1016/j.psychres.2017.07.030
  36. Chiesa A, Castagner V, Andrisano C, Serretti A, Mandelli L, Porcelli S, et al. Mindfulness-based cognitive therapy vs. psycho-education for patients with major depression who did not achieve remission following antidepressant treatment. Psychiatry Res 2015;226:474-483. https://doi.org/10.1016/j.psychres.2015.02.003
  37. Chiesa A, Mandelli L, Serretti A. Mindfulness-based cognitive therapy versus psycho-education for patients with major depression who did not achieve remission following antidepressant treatment: a preliminary analysis. J Altern Complement Med 2012;18:756-760. https://doi.org/10.1089/acm.2011.0407
  38. Manicavasagar V, Perich T, Parker G. Cognitive predictors of change in cognitive behaviour therapy and mindfulness-based cognitive therapy for depression. Behav Cogn Psychother 2012;40:227-232. https://doi.org/10.1017/S1352465811000634
  39. Michalak J, Schultze M, Heidenreich T, Schramm E. A randomized controlled trial on the efficacy of mindfulness-based cognitive therapy and a group version of cognitive behavioral analysis system of psychotherapy for chronically depressed patients. J Consult Clin Psychol 2015;83:951-963. https://doi.org/10.1037/ccp0000042
  40. Musa ZA, Soh KL, Mukhtar F, Soh KY, Oladele TO, Soh KG. Effectiveness of mindfulness-based cognitive therapy among depressed individuals with disabilities in Nigeria: a randomized controlled trial. Psychiatry Res 2021;296:113680.