Mobile Mindfulness Intervention for Psychological Distress Among Intensive Care Unit Survivors: A Randomized Clinical Trial.
Christopher E Cox, John A Gallis, Maren K Olsen, Laura S Porter, Tina M Gremore, Jeffrey M Greeson, Cynthia Morris, Marc Moss, Catherine L Hough
JAMA Internal Medicine July 1, 2024 DOI: 10.1001/jamainternmed.2024.0823 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized clinical trial Peer reviewed |
|---|---|
| Sample size | 247 |
| Population | Survivors of critical illness with elevated postdischarge symptoms of depression |
| Intervention | Mindfulness meditation |
| Duration | 1-month and 3-month follow-up |
| Topics | Meditation |
| Citations | 22 |
| Registration | NCT04038567 |
| Key findings | Twice-daily meditation via a mobile app was associated with lower depression scores at one and three months compared to once-daily meditation, while other intervention components showed no main effects. |
Abstract
Although psychological distress is common among survivors of critical illness, there are few tailored therapies. To determine the optimal method for delivering a mindfulness intervention via a mobile app for critical illness survivors. This randomized clinical trial used a 2 × 2 × 2 factorial design and was conducted at 3 sites among survivors of critical illness with elevated postdischarge symptoms of depression. The study was conducted between August 2019 and July 2023. Participants were randomized to 1 of 8 different groups as determined by 3 two-level intervention component combinations: intervention introduction method (mobile app vs therapist call), mindfulness meditation dose (once daily vs twice daily), and management of increasing symptoms (mobile app vs therapist call). The primary outcome was the 9-item Patient Health Questionnaire (PHQ-9) depression scale score (range, 0-27) at 1 month. Secondary outcomes included anxiety (7-item Generalized Anxiety Disorder) and posttraumatic stress disorder (Posttraumatic Stress Scale) symptoms at 1 and 3 months, adherence, and feasibility. General linear models were used to compare main effects and interactions of the components among intervention groups. A formal decisional framework was used to determine an optimized intervention version. A total of 247 participants (mean [SD] age, 50.2 [15.4] years; 104 [42.1%] women) were randomized. Twice-daily meditation compared with once-daily meditation was associated with a 1.2 (95% CI, 0.04-2.4)-unit lower mean estimated PHQ-9 score at 1 month and a 1.5 (95% CI, 0.1-2.8)-unit lower estimated mean score at 3 months. The other 2 intervention components had no main effects on the PHQ-9. Across-group adherence was high (217 participants [87.9%] using the intervention at trial conclusion) and retention was strong (191 [77.3%] and 182 [73.7%] at 1 and 3 months, respectively). A mindfulness intervention for survivors of critical illness that included an app-based introduction, twice-daily guided meditation, and app-based management of increasing depression symptoms was optimal considering effects on psychological distress symptoms, adherence, and feasibility. ClinicalTrials.gov Identifier: NCT04038567.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cited by 8
- The meditation app revolution. American Psychologist August 7, 2025
- Mobile App-Based Mindfulness Intervention for Addressing Psychological Distress Among Survivors of Hospitalization for COVID-19 Infection. CHEST critical care June 1, 2024
- Effectiveness of an online mindfulness based stress reduction intervention on psychological distress among patients with COVID19 after hospital discharge. Scientific Reports July 13, 2025
- A Critical Review and 10-Year Update on Prospects for a Clinical Science of Mindfulness-Based Intervention Mindfulness July 7, 2026
- The Role of Mindfulness in Hemodialysis Patients: A Scoping Review Mindfulness September 9, 2026
and 3 more in the library
Cites 3
- The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology 2003
- Mobile Mindfulness for Psychological Distress and Burnout among Frontline COVID-19 Nurses: A Pilot Randomized Trial Annals of the American Thoracic Society June 8, 2023
- Development and preliminary evaluation of a telephone-based mindfulness training intervention for survivors of critical illness. Annals of the American Thoracic Society February 1, 2014