Impact of Mindfulness-Based Interventions on Depression Discussion Paper

The clinical issues of interest revolve around mindfulness and depression, focusing on investigating the effectiveness of mindfulness-based interventions to address depression. According to Barr et al. (2019), the mindfulness practice is rooted in contemplative practices, showing promises of promoting mental well-being and, in turn, offering an alternative approach to the traditional therapeutic interventions for individuals struggling with depression. The application of mindfulness practice has increasingly been recognized for its positive impact on mental health, including the ability to improve a person’s ability to address and manage depression. Undertaking this research on the effectiveness of mindfulness in addressing depression provides a foundation for better and improved intervention for treating patients with depression, among other mental issues. Impact of Mindfulness-Based Interventions on Depression Discussion Paper

To build on the proposed research, a search of relevant articles and scholarly material was performed in the library, resulting in multiple results. Getting relevant and recent articles was not an easy process. The initial search using the terms ‘Mindfulness’, depression and ‘Mindfulness-Based Interventions’ yielded more than 1500 results. While some related to the topic or issue in question, quite a good number were not focused on the specific relationship or impact of mindfulness interventions and depression. In turn, there was the need to refine the search with additional terms or Boolean operators.

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Refinement with Boolean Operators was adopted in the subsequent searches, which helped narrow the focus. The search query has been modified to include connectors such as ‘And’, ‘and not’ or ‘OR’. This helped reduce the number of articles significantly, as well as the number of irrelevant articles. For example, in this case, the search terms were changed to ‘mindfulness AND depression interventions’, which helped to reduce the number while giving relevant search results.

Further refinement on the search of the articles adopted a specificity approach, adding more terms to the search keywords such as effectiveness and outcomes in addressing depression, for example, mindfulness-based interventions in stress or depression reduction. To help increase the relevance of the search results, additional filters were used, including time of publication, which was limited to 5 years since publication, and type of resource, i.e. books, scholarly articles, videos, etc. The number resulting from the search was reduced to about 20. More so, synonyms were incorporated to capture articles addressing the same topic but utilizing different terminologies. The filtration based on peer-reviewed and scholarly articles helped improve search results’ quality and relevance. Impact of Mindfulness-Based Interventions on Depression Discussion Paper

To help address rigor and effectiveness, the search adopted controlled vocabulary, i.e. medical subject hearing or MeSH terms. This was adopted to shift from solely depending on free text terms to include standardized MeSH terms, which helps increase the accuracy and relevance of the search results. For example, using mindfulness and depression as MeSH terms. Additionally, truncation and wildcards were used, which helped capture variations of terms. This helped capture the diversity in how researchers describe the focused concepts. Other practices included searching multiple databases, combining Boolean operators strategically, and checking database-specific indexes and filters while setting clear inclusion and exclusion criteria. By incorporating these strategies, the database search can be refined, enhancing the rigor and effectiveness of exploring the relationship between mindfulness interventions and depression outcomes. These steps contribute to a more systematic and thorough review of the existing literature, forming a solid foundation for developing a PICOT question.

PICOT Question: In adults (P), how does the implementation of mindfulness-based interventions (I) compared to traditional therapeutic interventions (C) influence the reduction of depressive symptoms (O) over six months (T)?

Explanation:

• Population (P): Adults
• Intervention (I): Mindfulness-based interventions
• Comparison (C): Traditional therapeutic interventions
• Outcome (O): Reduction of depressive symptoms
• Time (T): Over six months Impact of Mindfulness-Based Interventions on Depression Discussion Paper

The purpose of this PICOT inquiry is to examine how well mindfulness-based therapies work in lowering adult depression symptoms over a given period in comparison to standard therapy methods. Adults are the well-defined demographic, and mindfulness-based therapies are the intervention of interest. By using established therapy procedures in the comparison group, it is possible to assess the relative effectiveness of mindfulness techniques. The goal is to lessen depression symptoms, which is in line with the relevant clinical condition. The six-month period set aside provides a fair amount of time to watch for any changes and evaluate if the benefits will last. This research topic offers a precise and well-defined framework for the investigation, facilitating the examination of the effects of mindfulness-based therapies on depression in a focused manner.

References

Barr, N., Davis, J. P., Diguiseppi, G., Keeling, M., & Castro, C. (2019). Direct and indirect effects of mindfulness, PTSD, and depression on self-stigma of mental illness in OEF/OIF veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 14(6). https://doi.org/10.1037/tra0000535Links to an external site.

Cerna, C., Demarzo, M., García, F. E., Aravena, V., & Wlodarczyk, A. (2021). Brief Mindfulness Therapy and Mental Health in People Exposed to a Recent Stressful Event: A Study of Multiple Cases with Follow-Up. Journal of Contemporary Psychotherapy, 51(2), 117–124. https://doi.org/10.1007/s10879-020-09483-3Links to an external site.

Elliot, A. J., Gallegos, A. M., Moynihan, J. A., & Chapman, B. P. (2019). Associations of mindfulness with depressive symptoms and well-being in older adults: the moderating role of neuroticism. Aging & mental health, 23(4), 455–460. https://doi.org/10.1080/13607863.2017.1423027Links to an external site.

Powers, A., Lathan, E. C., Dixon, H. D., Mekawi, Y., Hinrichs, R., Carter, S., Bradley, B., & Kaslow, N. J. (2022). Primary care-based mindfulness intervention for posttraumatic stress disorder and depression symptoms among Black adults: A pilot feasibility and acceptability randomized controlled trial. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0001390Links to an external site.

Roubinov, D. S., Epel, E. S., Coccia, M., Coleman-Phox, K., Vieten, C., Adler, N. E., Laraia, B., & Bush, N. R. (2022). Long-term effects of a prenatal mindfulness intervention on depressive symptoms in a diverse sample of women. Journal of consulting and clinical psychology, 90(12), 942–949. https://doi.org/10.1037/ccp0000776Links to an external site.

Walden University. (n.d.). What are filtered and unfiltered resources in nursing?. https://academicanswers.waldenu.edu/faq/73299Links to an external site.

Walden University Library. (n.d.). Keyword searching: Finding articles on your topic: Boolean terms. http://academicguides.waldenu.edu/library/keyword/boolean. http://academicguides.waldenu.edu/library/keyword/boolean

*These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

  Impact of Mindfulness-Based Interventions on Depression Discussion Paper

• Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

• Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

• Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

• Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

• Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

**Note on Conceptual Framework Impact of Mindfulness-Based Interventions on Depression Discussion Paper

• The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework

• Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.

• As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”

• Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature. Impact of Mindfulness-Based Interventions on Depression Discussion Paper

• Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.

References

The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing evidence-based practice: appendix C: evidence level and quality guide. https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf
Grant, C., & Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical framework in dissertation research: Creating the blueprint for your house. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.

Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. https://academicguides.waldenu.edu/library/conceptualframework

Module 4 Assessment: Evidence-Based Project, Part 3A: Critical Appraisal of Research

Full APA formatted citation of the selected article. Article #1 Article #2 Article #3 Article #4
Barr et al. (2019).

Goldberg et al. (2020) Powers et al. (2023) Roubinov et al. (2023)
Evidence Level *
(I, II, or III)
II-Cross sectional study-analytical I=Systematic review of RCTs I-Randomized controlled trial (RCT) II=Quasi experimental study-pre-and post-intervention
Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here). **

Not mentioned in the article
Not included. Not mentioned. Not mentioned Impact of Mindfulness-Based Interventions on Depression Discussion Paper
Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). This is a quantitative cross-sectional study to determine the direct and indirect effects of mindfulness on depression, post-traumatic stress disorder (PTSD), and self-stigma. Post-9/11 military veterans were included in the study. The survey focused on the impact of mindfulness on PTSD, depressive symptoms, and self-stigma. Military persons still in service but with PTSD or depression were excluded.

The study is a systematic review of RCTs on the acceptability and efficacy of mindfulness-based intervention in military veterans. Included studies were about mindfulness meditation. Articles about dialectical behavior therapy and acceptance and commitment therapy were excluded. An RCT to examine the feasibility and acceptability of a group-based mindfulness cognitive therapy among Black adults diagnosed with depression and PTSD. The study included Black adults who had earlier tested positive for PTSD and depression in an urban primary care setting. It excluded younger individuals and those with other mental health conditions. The study employed a quasi-experimental design to examine the effect of mindfulness intervention during prenatal on depressive symptoms in the postnatal period (8 years). Included participants were English-speaking, 18 to 45 years old, pregnant women expected to deliver in 8 weeks, low-income level, and with moderate-severe depressive symptoms based on PHQ-9. Non-English speaking persons and those with serious mental health conditions that could prevent participation were excluded
Sample/Setting Impact of Mindfulness-Based Interventions on Depression Discussion Paper

The number and characteristics of
patients, attrition rate, etc.

The study involved 577 military veterans. The participants had previously been diagnosed with depression and PTSD in three American cities. The results are based on 577 responses from participants who completed the surveys.

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20 studies and 898 participants. The studies were selected from various databases Medline, Psych INFO, and CINAHL. 1484 articles were searched but only 20 studies were included after applying inclusion and exclusion criteria. Participants had mental health conditions, including PTSD, depression, and anxiety.
26 Black adults with depression and PTSD participated in the study from randomization to post-intervention assessment. The participants were drawn from a population of Black adult patients who visited the primary care clinic and were diagnosed with PTSD and depression. Initially, 42 (85% were women) adults consented to the study. However, only 75% completed (n=26). N=24 remained until a 1-month follow-up was done.
N=162 women expected to deliver within 2 weeks participated in the observational study. N=89 for the treatment group (mindfulness) and N=73 for the control arm. 86% of participants in the treatment group were retained during the intervention. There were 73% and 68% retention rates in the 5th and 8th years, respectively.
Major Variables Studied

List and define dependent and independent variables Mindfulness intervention -independent variable Dependent variables:
Depressive symptoms- PTSD symptoms-
Level of self-stigma- Independent variable: Mindfulness-based interventions Dependent variables: Impact on Depressive and PTSD symptoms, mindfulness, and quality of life 8-week Group-based mindfulness cognitive therapy –independent variable. Dependent variables: Study retention rates, group satisfaction levels, treatment barriers as Independent variable- Mindfulness-based intervention
Dependent variables: Retention rates, and levels of depressive symptoms.
Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done). Structural equation modeling to analyze direct and indirect effects of mindfulness. The researcher analyzed the effect of mindfulness on three variables: PTSD, depression, and self-stigma. PRISMA model analysis for the systematic review
Meta-analysis to determine effect sizes Regression analysis was used to analyze quantitative measures while non-parametric tests were utilized in analyzing the qualitative measures (chi-square) Logistic regression analyzed the effect sizes of the intervention on depressive symptoms compared to baseline data.
Data Analysis Statistical or Impact of Mindfulness-Based Interventions on Depression Discussion Paper
Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data). Mindfulness led to reduced reported depression and PTSD symptoms. It also contributed to less stigma among veterans with PTSD. Mindfulness-based interventions (MBIs) improved depression, PTSD, and other psychological disorders, including mindfulness skills and quality of life in the treatment groups compared with the controls (Hedges’ gs=0.32-0.80). The retention rates were also high in MBI groups (odds ratio=1.98). The 8-week mindfulness-based intervention had high retention rates (75%). It also enhanced group satisfaction among Black adults in the treatment arm. The intervention also highlighted perceived barriers to treatment, including financial restraints. Improved retention rates over the study period (85% during the intervention to 68% in the 8 years). Declined depressive symptoms post-intervention (0.24 to 0.49).
Findings and Recommendations

General findings and recommendations of the research Mindfulness intervention reduces depressive symptoms, PTSD, and self-stigma. Further investigation should be conducted to study the associations between mindfulness, depression, PTSD, and self-stigma. Mindfulness-based interventions treat depression and PTSD, among other psychological conditions. The MBIs are also acceptable among adult patients. Group-based mindfulness intervention had high feasibility and acceptability among Black adults with PTSD and depression as evidenced by the retention rates and satisfaction levels. Further studies are required to establish the impact on depressive symptoms and PTSD. Mindfulness provided to pregnant women declines depressive symptoms during postpartum. More investigation is required to determine the efficacy of the intervention in other adult patient groups.
Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of the study?

What are the risks associated with the implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice? Impact of Mindfulness-Based Interventions on Depression Discussion Paper

The study’s findings support the effectiveness of mindfulness-based intervention on depression. The research is a level II evidence because is a cross-sectional study. The results can be generalized. However, implementation of the mindfulness could be challenged by the mental health practitioners’ knowledge of the intervention. Conducting staff training before implementing mindfulness intervention is recommended. Overall, the practice is feasible as it applies to all patients with depressive symptoms irrespective of the context and requires minimal resources to implement (staff training).

The findings of this systematic review are relevant to psychiatric practice because they provide filtered evidence on the application of mindfulness in treating depressive symptoms and its acceptability. The study is high-quality evidence as it involves a review of RCTs. However, the findings are from heterogeneous studies and cannot support the efficacy of MBIs on depression. Implementing the proposed practice would require adaptation to various contexts. It is a feasible intervention as shown by the retention rate.
The RCT is relevant to practice because the impact of mindfulness intervention is affected by its acceptability and feasibility. The evidence is high quality because it is an RCT but it could be biased because the results are based on a population whose majority were women. Gender is a determinant of healthcare interventions’ acceptability. Implementing mindfulness among adults with depressive symptoms in the male population could have different outcomes. Nonetheless, the findings indicate the intervention is feasible because it is adaptable to different clinical settings.
The findings contribute to the existing knowledge on the use of mindfulness in depression treatment. The study had a long follow-up study, allowing for the manifestation of the outcomes. However, it would be a challenge to implement and evaluate such a long study. The retention rates could be lower depending on the patient’s characteristics. The longer period of follow-up supports the efficacy of the intervention but it could be resource-intensive. Impact of Mindfulness-Based Interventions on Depression Discussion Paper

Key findings

Mindfulness-based interventions relieve depressive symptoms MBIs can manage depression compared with other non-mindfulness-based interventions. Mindfulness-based interventions have high acceptability and feasibility among adults with depression and PTSD. Mindfulness can address postpartum depression in reproductive women.

Outcomes

Reduced PTSD and depressive symptoms; Decreased self-stigma Improved depression, PTSD, and general psychological symptoms.
Increased retention Improved therapy retention, and group satisfaction. Identification of perceived barriers to inform intervention improvement. Improved retention and reduced depression symptoms.
General Notes/Comments
The study supports the use of mindfulness intervention in treating depression and addressing barriers to mental healthcare-seeking (self-stigma).

The findings contribute to the evidence on the effectiveness of MBIs on depression and PTSD. They also support its acceptability.
The study results indicate mindfulness-based intervention feasibility and acceptability. They support the significance of feasibility and acceptability studies.
The study supports the use of mindfulness to treat depression in vulnerable groups such as pregnant women. Impact of Mindfulness-Based Interventions on Depression Discussion Paper