Mindfulness-Based Interventions Among Adolescents With Chronic Diseases in Clinical Settings: A Systematic Review

Monday, 30 October 2017

Hiba Abujaradeh, MSN
Department of health promotion and development/ School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
Cecilia Therese Kahle, SN
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
Mary Lou Klem, PhD, MLIS
Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
Susan M. Cohen, PhD
Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA

Background: There is growing evidence of the efficacy of mindfulness based interventions (MBI) to improve psychological and physical well-being among healthy adolescents who were recruited from school settings (Jones et al., 2013; Zenner, Herrnleben-Kurz, & Walach, 2014; Zoogman, Goldberg, Hoyt, & Miller, 2014). However, to date, no systematic review has focused on the effectiveness of MBIs among adolescents with chronic diseases in clinical settings.

The purpose of this systematic review is to determine the state of empirical research related to the benefits/efficacy of MBIs implemented among adolescents (12-18 years) with chronic diseases in clinical settings.

Methods: An electronic search was conducted in December 2016 using PubMed, CINAHL, and PsycINFO databases. Inclusion criteria were peer-reviewed articles published in English, participants aged 12-18 years, mindfulness was the primary intervention in a clinical setting among adolescents with chronic diseases, and variables were psychological outcomes relevant to adolescents who suffer chronic diseases such as anxiety, depression, stress, emotional regulation and coping, quality of life (QOL), sleep problems, and pain as well as physiological outcomes such as heart rate, blood pressure, and glycosylated hemoglobin. No restrictions were applied on publication date. Two reviewers independently evaluated articles for inclusion. Conflicts were resolved with the assistance of the senior author. Of the 1564 obtained records, 62 articles were considered for full text screening; and 14 articles met our inclusion criteria and were included in this review.

Results: Mindfulness programs included mindfulness based stress reduction (MBSR) and mindfulness based cognitive therapy (MBCT) adapted for children and adolescents. Study samples consisted of adolescents with psychiatric disorders (4), chronic pain (3), depression (2), anxiety (1), autism spectrum disorders (1), cancer (1), cardiac problems (1), and headache (1). Five studies were randomized controlled trials and 9 were interventional studies while 8 had only one group and one had two groups. While the majority of studies examined psychological outcomes such as depression, anxiety, QOL, and mindfulness, only one study examined physiological outcomes (cortisol). For the most reported outcomes for the RCTs, adolescents in MBI studies had significant improvement in a variety of measures such as depression (Cohen’s D= .16-.56), anxiety (Cohen’s D= .22-.54), and sleep (Cohen’s D= .22-0.9) over the participants in the control group. For one group interventional studies, adolescents showed significant improvement after intervention for variety of outcomes such as depression (Cohen’s D=.05-79), anxiety (Cohen’s D=.48-.50), and mindfulness (Cohen’s D=.11-.66).

Conclusion: The majority of MBI studies conducted in clinical settings engaged adolescents with psychological disorders. MBIs were found to improve psychological outcomes. The preliminary findings of this systematic review show that future research should focus on the effectiveness of MBIs among adolescents with chronic diseases such as diabetes, cancer, heart diseases, cystic fibrosis, and asthma to reduce psychological distress, and to increase the focus on physiological outcomes. In future, RCTs with large samples are needed to establish the efficacy of MBI with adolescents.