Meta-Analysis
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World J Psychiatry. Apr 19, 2022; 12(4): 636-650
Published online Apr 19, 2022. doi: 10.5498/wjp.v12.i4.636
Effects of mindfulness-based intervention programs on sleep among people with common mental disorders: A systematic review and meta-analysis
Sunny Ho-Wan Chan, Danielle Lui, Hazel Chan, Kelly Sum, Ava Cheung, Hayley Yip, Chong Ho Yu
Sunny Ho-Wan Chan, Danielle Lui, Hazel Chan, Kelly Sum, Ava Cheung, Hayley Yip, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
Chong Ho Yu, School of Behavioral and Applied Science, Azusa Pacific University, Azusa, CA 91702, United States
Author contributions: Chan SHW conceived and guided the study; Lui D and Chan H carried out the literature searches; Chan H and Sum K extracted the data; Lui D and Yip H assessed the study quality; Yu CH, Lui D and Sum K performed the statistical analyses; Chan SHW, Lui D, Cheung A and Yip H wrote and revised the paper.
Conflict-of-interest statement: The authors declare having no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sunny Ho-Wan Chan, PhD, Assistant Professor, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Yau Tsim Mong District, Kowloon Peninsula, Hong Kong, China. sunny.hw.chan@polyu.edu.hk
Received: February 24, 2021
Peer-review started: February 24, 2021
First decision: April 21, 2021
Revised: April 24, 2021
Accepted: March 14, 2022
Article in press: March 14, 2022
Published online: April 19, 2022
Processing time: 412 Days and 23.8 Hours
ARTICLE HIGHLIGHTS
Research background

Sleep problems are particularly prevalent in people with depression or anxiety disorder. Although mindfulness has been suggested as an important component in alleviating insomnia, no comprehensive review and meta-analysis has been conducted to evaluate the effects of different kinds of mindfulness-based intervention (MBI) programs on sleep among people with depression or anxiety disorder.

Research motivation

The present study aimed to assess randomised controlled trials of various types of MBI programs for improving sleep problems in people with common mental disorders.

Research objectives

The main objective was to evaluate and update evidence of effectiveness of the different, latest and integrated MBI programs.

Research methods

We performed a systematic literature search on Embase, Medline, PubMed and PsycINFO databases from January 2010 to June 2020 for randomised controlled trials. Data were synthesized using a random-effects or a fixed-effects model to analyse the effects of various MBI programs on sleep problems among people with depression or anxiety disorder. The fixed-effects model was used when heterogeneity was negligible, and the random-effects model was used when heterogeneity was significant to calculate the standardised mean differences (SMDs) and 95% confidence intervals (CIs).

Research results

We identified 397 articles, of which 10 randomised controlled trials, involving a total of 541 participants, were included in the meta-analysis. Studies of internet mindfulness meditation intervention (IMMI), mindfulness meditation (MM), mindfulness-based cognitive therapy (MBCT), mindfulness-based stress reduction (MBSR) and mindfulness-based touch therapy (MBTT) met the inclusion criteria. The greatest effect sizes are reported in favour of MBTT, with SMDs of -1.138 (95%CI: -1.937 to -0.340; P = 0.005), followed by -1.003 (95%CI: -1.645 to -0.360; P = 0.002) for MBCT. SMDs of -0.618 (95%CI: -0.980 to -0.257; P = 0.001) and -0.551 (95%CI: -0.842 to -0.260; P = 0.000) were reported for IMMI and MBSR in the pooling trials, respectively. Significant effects on sleep problem improvement are shown in all reviewed MBI programs, except MM, in which its effect size was shown to be non-significant.

Research conclusions

This review presents a comprehensive meta-analysis of various forms of MBI programs on helping sleep problems among people with common mental disorders. We found that all MBI programs (in terms of MBTT, MBCT, IMMI and MBSR), except MM, are effective options to improve sleep problems among people with depression or anxiety disorder.

Research perspectives

The current meta-analysis suggests that solely utilizing MM may not be robust enough to improve sleep problems among people with depression or anxiety disorder. As a bidirectional relationship was revealed between sleep disturbance and common mental disorders, it seems that a more integrated approach should be considered in order to enhance robustness of the intervention effects.