Does baseline psychiatric symptom severity predict well-being improvement in low-intensity mindfulness interventions?

Abstract

Regardless of baseline psychiatric symptom severity, individuals can improve from psychotherapy, including from low-intensity psychosocial treatments. We conducted a secondary analysis of a randomized trial of low-intensity mindfulness interventions to explore if and how specific indices of baseline symptom severity were associated with well-being trajectories during treatment and follow-up. In the original study, participants (N = 4, 411) with physical and mental health conditions were randomly assigned to one of two low-intensity mindfulness interventions (eight-session mindfulness-based cognitive therapy or a three-session mindfulness intervention). In this secondary analysis, we pooled across treatment groups and stratified participants into subgroups based on self-reported baseline levels of anxiety, depression, and social functioning. We used linear mixed effects models and descriptive trajectory plots to evaluate differences in well-being trajectories between subgroups. Baseline symptom severity was associated with well-being trajectory such that those with more severe anxiety, depression, or social functioning at baseline had generally lower well-being across time. All subgroups experienced initial improvement in well-being during the treatment period, though individuals with worse symptom severity tended not to sustain improvements and rebounded back towards baseline well-being levels during follow-up. These data suggest that, for individuals with more severe mental health symptoms, eight or three-session mindfulness-based interventions may still be clinically useful (as patients with more severe symptoms in this study were able to experience initial improvement in well-being from such interventions). However, for such patients, offering these mindfulness-based interventions for a longer duration may have prevented symptom rebounding.

Keywords: anxiety; depression; low-intensity treatments; social functioning.

Figure 1.. Well-being Trajectories by Baseline PROMIS Measure and Level.

Mean WHO-5 trajectories over study period by baseline PROMIS Anxiety subgroup (left), by baseline PROMIS Depression subgroup (middle), and by baseline PROMIS Ability to Participate in Social Roles subgroup (right). Points represent observed means, dashed lines represent linear mixed model-based means, and shaded regions represent model-based pointwise 95% confidence intervals. Linear mixed models included natural cubic splines to account for non-linear trends in mean WHO-5 trajectories.