“Effectiveness and Cost-Effectiveness of Universal School-Based Mindfulness Training Compared With Normal School Provision in Reducing Risk of Mental Health Problems and Promoting Well-Being in Adolescence: the MYRIAD Cluster Randomized Controlled Trial”, Willem Kuyken, Susan Ball, Catherine Crane, Poushali Ganguli, Benjamin Jones, Jesus Montero-Marin, Elizabeth Nuthall, Anam Raja, Laura Taylor, Kate Tudor, Russell M. Viner, Matthew Allwood, Louise Aukland, Darren Dunning, Tríona Casey, Nicola Dalrymple, Katherine De Wilde, Eleanor-Rose Farley, Jennifer Harper, Nils Kappelmann, Maria Kempnich, Liz Lord, Emma Medlicott, Lucy Palmer, Ariane Petit, Alice Philips, Isobel Pryor-Nitsch, Lucy Radley, Anna Sonley, Jem Shackleford, Alice Tickell, Sarah-Jayne Blakemore, The MYRI A. D. Team, Obioha C. Ukoumunne, Mark T. Greenberg, Tamsin Ford, Tim Dalgleish, Sarah Byford, J. Mark G. Williams2022-07 (depression, meditation)⁠:

Background: Systematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health.

Objective: The My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU).

Method: MYRIAD was a parallel group, cluster-randomized controlled trial. 85 eligible schools consented and were randomized 1:1 to TAU (43 schools, 4,232 students) or SBMT (42 schools, 4,144 students), stratified by school size, quality, type, deprivation and region. Schools and students (mean (SD); age range=12.2 (0.6); 11–14 years) were broadly UK population-representative. 43 schools (n = 3,678 pupils; 86.9%) delivering SBMT, and 41 schools (n = 3,572; 86.2%) delivering TAU, provided primary end-point data. SBMT comprised 10 lessons of psychoeducation and mindfulness practices. TAU comprised standard social-emotional teaching. Participant-level risk for depression, social-emotional-behavioural functioning and well-being at 1 year follow-up were the co-primary outcomes. Secondary and economic outcomes were included.

Results: Analysis of 84 schools (n = 8,376 participants) found no evidence that SBMT was superior to TAU at 1 year. Standardized mean differences (intervention minus control) were: 0.005 (95% CI −0.05 to 0.06) for risk for depression; 0.02 (−0.02 to 0.07) for social-emotional-behavioural functioning; and 0.02 (−0.03 to 0.07) for well-being. SBMT had a high probability of cost-effectiveness (83%) at a willingness-to-pay threshold of £20 000 per quality-adjusted life year. No intervention-related adverse events were observed.

Conclusion: Findings do not support the superiority of SBMT over TAU in promoting mental health in adolescence.

Clinical implications: There is need to ask what works, for whom and how, as well as considering key contextual and implementation factors.

Trial registration: Current controlled trials ISRCTN86619085. This research was funded by the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z).