Impact of App-Delivered Mindfulness Meditation on Functional Connectivity, Mental Health, and Sleep Disturbances Among Physician Assistant Students: Randomized, Wait-list Controlled Pilot Study

Abstract

Background: Health care provider and trainee burnout results in substantial national and institutional costs and profound social effects. Identifying effective solutions and interventions to cultivate resilience among health care trainees is critical. Although less is known about the mental health needs of physician assistants (PAs) or PA students, accumulating research indicates that they experience similarly alarming rates of burnout, depression, and emotional exhaustion. Mobile app-delivered mindfulness meditation may be an effective part of salubrious programming to bolster long-term resilience and health among PA students.

Objective: This study aims to examine the impact of app-delivered mindfulness meditation on self-reported mental health symptoms among PA students. A secondary aim is to investigate changes in brain connectivity to identify neurobiological changes related to changes in mental health symptoms.

Methods: We recruited PA students enrolled in their third semester of PA school and used a longitudinal, randomized, wait-list-controlled design. Participants randomized to the mindfulness group were provided 1-year subscriptions to the 10% Happier app, a consumer-based meditation app, and asked to practice every day for 8 weeks. Before randomization and again after completion of the 8-week program, all participants completed resting-state functional magnetic resonance imaging as well as self-report assessments of burnout, depression, anxiety, and sleep impairment. App use was acquired as a measure of mindfulness practice time.

Results: PA students randomized to the mindfulness group reported improvements in sleep impairment compared with those randomized to the wait-list control group (η_p²=0.42; P=.01). Sleep impairment decreased significantly in the mindfulness group (19% reduction; P=.006) but not in the control group (1% reduction; P=.71). There were no other significant changes in mental health for those randomized to app-delivered mindfulness. Across all students, changes in sleep impairment were associated with increased resting-state functional connectivity between the medial prefrontal cortex (a component of the default mode network) and the superior temporal gyrus, as well as between areas important for working memory. Changes in connectivity predicted categorical conversion from impaired to nonimpaired sleep in the mindfulness group.

Conclusions: This pilot study is the first to examine app-based mindfulness for PA students' mental health and investigate the impact of mindfulness on PA students' brain function. These findings suggest that app-delivered mindfulness may be an effective tool to improve sleep dysfunction and that it may be an important part of the programming necessary to reduce the epidemic of suffering among health profession trainees.

Keywords: connectivity; fMRI; meditation; mindfulness; mobile phone; resting state.

Figure 1

Results of principal components decomposition of Δconn matrix. (a) explained variance and cumulative explained variance for the first 14 principal axes. 13 components accounted for 99.99% of the explained variance in the delta matrix (Δconn), suggesting a large amount of multicollinearity across ROI-ROI connections. The recomposition of the Δconn matrix from the 13 selected components is shown in the inset. (b) within-group correlations between per-subject Δconn values and the 13 selected components, averaged across subjects within each group. (c) Primary contributors to each component based on the dot product of the original Δconn matrix and the 13-PC decomposition. Note the substantive contributions of posterior superior temporal, fusiform (t14), orbitofrontal, and default mode, dorsal attention, and salience-network components to components PC1 and PC2. These two components represented nearly one-third of the explained variance in the Δconn matrix. DAN: dorsal attention network; DMN: default mode network; PFC: prefrontal cortex; SN: salience network; STG: superior temporal gyrus.

Figure 2

Differences in sleep impairment by group (mindfulness vs waitlist) and visit (time 1, baseline; Time 2, >8 weeks). An asterisk (*) indicates significant differences in sleep impairment at P≤.05. PROMIS: Patient-Reported Outcomes Measurement Information System.