Efficacy and acceptability of mindfulness-based interventions for military veterans: A systematic review and meta-analysis

Author: Simon B Goldberg1, Kevin M Riordan2, Shufang Sun3, David J Kearney4, Tracy L Simpson4
Author Information:
1 University of Wisconsin-Madison, United States. Electronic address: sbgoldberg@wisc.edu.
2 University of Wisconsin-Madison, United States.
3 Brown University, United States.
4 VA Puget Sound Health Care System and University of Washington, United States.
Conference/Journal: J Psychosom Res
Date published: 2020 Aug 29
Other: Volume ID: 138 , Pages: 110232 , Special Notes: doi: 10.1016/j.jpsychores.2020.110232. , Word Count: 257


Background:
Military veterans report high rates of psychiatric and physical health symptoms that may be amenable to mindfulness-based interventions (MBIs). Inconsistent prior findings and questions of fit between MBIs and military culture highlight the need for a systematic evaluation of this literature.

Objective:
To quantify the efficacy and acceptability of MBIs for military veterans.

Data sources:
We searched five databases (MEDLINE/PubMed, CINAHL, Scopus, Web of Science, PsycINFO) from inception to October 16th, 2019.

Study selection:
Randomized controlled trials (RCTs) testing MBIs in military veterans.

Results:
Twenty studies (k = 16 unique comparisons, N = 898) were included. At post-treatment, MBIs were superior to non-specific controls (e.g., waitlist, attentional placebos) on measures of posttraumatic stress disorder (PTSD), depression, general psychological symptoms (i.e., aggregated across symptom domains), quality of life / functioning, and mindfulness (Hedges' gs = 0.32 to 0.80), but not physical health. At follow-up (mean length = 3.19 months), MBIs continued to outperform non-specific controls on general psychological symptoms, but not PTSD. MBIs were superior to specific active controls (i.e., other therapies) at post-treatment on measures of PTSD and general psychological symptoms (gs = 0.19 to 0.25). Participants randomized to MBIs showed higher rates of attrition than those randomized to control interventions (odds ratio = 1.98). Several models were not robust to tests of publication bias. Study quality and risk of bias assessment indicated several areas of concern.

Conclusions:
MBIs may improve psychological symptoms and quality of life / functioning in veterans. Questionable acceptability and few high-quality studies support the need for rigorous RCTs, potentially adapted to veterans.

Keywords: Acceptability; Depression; Meta-analysis; Military veterans; Mindfulness; PTSD.

PMID: 32906008 DOI: 10.1016/j.jpsychores.2020.110232

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