The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review

Abstract

Purpose: Positive effects have been reported after mindfulness-based interventions (MBIs) in diverse clinical and nonclinical populations. Primary care is a key health care setting for addressing common chronic conditions, and an effective MBI designed for this setting could benefit countless people worldwide. Meta-analyses of MBIs have become popular, but little is known about their efficacy in primary care. Our aim was to investigate the application and efficacy of MBIs that address primary care patients.

Methods: We performed a meta-analytic review of randomized controlled trials addressing the effect of MBIs in adult patients recruited from primary care settings. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines were followed. Effect sizes were calculated with the Hedges g in random effects models.

Results: The meta-analyses were based on 6 trials having a total of 553 patients. The overall effect size of MBI compared with a control condition for improving general health was moderate (g = 0.48; P = .002), with moderate heterogeneity (I(2) = 59; P <.05). We found no indication of publication bias in the overall estimates. MBIs were efficacious for improving mental health (g = 0.56; P = .007), with a high heterogeneity (I(2) = 78; P <.01), and for improving quality of life (g = 0.29; P = .002), with a low heterogeneity (I(2) = 0; P >.05).

Conclusions: Although the number of randomized controlled trials applying MBIs in primary care is still limited, our results suggest that these interventions are promising for the mental health and quality of life of primary care patients. We discuss innovative approaches for implementing MBIs, such as complex intervention and stepped care.

Keywords: complex interventions; meta-analysis; mindfulness-based interventions; practice-base research; primary care; randomized controlled trials.

Figure 1

Flow diagram of article selection. MBI = mindfulness-based intervention. Note: An article may have been excluded for multiple reasons. ^aReferences were fully screened to prevent missing studies.

Figure 2

Forest plot for the effect size of mindfulness-based intervention on outcomes overall, and for mental health and quality of life outcomes individually. AC = active control; BDI-IA = Beck Depression Inventory IA; POMS = Profile of Mood States; PC = passive control.