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Meta-Analysis
. 2023 Oct 5;18(10):e0286387.
doi: 10.1371/journal.pone.0286387. eCollection 2023.

The effect of mindfulness interventions on stress in medical students: A systematic review and meta-analysis

Edie L Sperling  1   2 , Jennifer M Hulett  2   3 , LeeAnne B Sherwin  2 , Sarah Thompson  2 , B Ann Bettencourt  4
Affiliations
Meta-Analysis

The effect of mindfulness interventions on stress in medical students: A systematic review and meta-analysis

Edie L Sperling et al. PLoS One. .

Abstract

Background: Medical students have high levels of stress, which is associated with higher incidents of burnout, depression, and suicide compared to age-matched peers. Mindfulness practices have been shown to reduce stress among medical students.

Purpose: The purpose of this systematic review and meta-analysis was to examine if mindfulness interventions have an overall effect on stress outcomes in the high-stress population of medical students globally, particularly given the wide variety of interventions. Any intervention designed to promote mindfulness was included.

Methods: A comprehensive literature search was completed to include multiple databases, ancestry, and hand-searching and 35 studies were included. Standardized mean difference effect sizes (ES) were synthesized across studies using a random-effects model for changes in stress levels in medical students ≥ 18. Moderator analyses were performed to explore variations in effects by participant and intervention characteristics.

Results: Mindfulness interventions significantly improved stress among medical students in both the two-arm studies (d = 0.370, k = 19, n = 2,199, 95% CI 0.239-0.501, p < .001) and one-arm pre-post studies (d = 0.291, k = 30, n = 18 (two cohorts from Dyrbye et al), 95% CI 0.127-0.455, p = 0.001). Moderator analyses found trends in less hours and less required practice resulted in better improvement in stress.

Conclusions: This study further confirms that despite a wide variety of mindfulness interventions for medical students around the world, they produce an overall small-to-moderate effect on stress reduction. Future research looking at the most effective protocols for high-stress medical students would be beneficial.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram for study selection.
Fig 2
Fig 2. Risk of bias using RoB 2: A revised tool for assessing risk of bias in randomized trials for the RCT studies included in the meta-analysis [77].
Fig 3
Fig 3. Summary statistics and forest plot with weighted means indicating the effect size, for the two-arm and RCTs in the meta-analysis.
Fig 4
Fig 4. Summary statistics and forest plot with weighted means indicating the effect size, for the one-arm studies.
Fig 5
Fig 5. Funnel plot for publication bias for the two-arm and RCTs in the meta-analysis.
Fig 6
Fig 6. Funnel plot for publication bias of the one-arm studies in the meta-analysis.
See this image and copyright information in PMC

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