Effects of mindfulness meditation on anxiety, depression, stress, and mindfulness in nursing students: a meta-analysis and trial sequential analysis of randomized controlled trials

Abstract Objective The aim of this study was to assess the effectiveness of mindfulness meditation (MM) on anxiety, depression, stress and mindfulness in nursing students.

Methods: A comprehensive search and screening procedures were conducted to locate all MM interventions implemented with nursing students. For randomized controlled trials (RCTs) in accordance with the inclusion criteria, a search was conducted in PubMed, Embase, Web of Science, Medline, PsycINFO, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), China Biology Medicine (CBM), Chinese National Knowledge Infrastructure (CNKI) and Wanfang. Databases were retrieved from inception through August 2018. Additional studies were identified through hand searches and Internet searches. Two reviewers collected relevant data of eligible articles according to the data extraction tables. Based on Cochrane Handbook, critical appraisal of the methodological quality was assessed by two other reviewers. An Excel form was used to extract main characteristics of included RCTs. Meta-analysis and trial sequential analysis (TSA) were carried out using software RevMan 5.3 and TSA 0.9.

Results: Five RCTs with 257 nursing students were included. Only two studies were assessed as high quality and three studies were evaluated as moderate quality. Meta-analysis showed that, comparing with the control group, MM could significantly improve anxiety (SMD = −0.45, 95% CI −0.73 to −0.17, P = 0.001) and stress (SMD = −0.69, 95% CI −0.97 to −0.40, P < 0.001). TSA results confirmed that the outcome of the merger is credible. It could also significantly improve depression level of nursing students after 8 weeks intervention duration (SMD = −0.70, 95% CI −1.14 to −0.26, P = 0.002). However, there was no beneficial effect on depression level of nursing students with 1 week intervention duration (SMD = 0.09, 95% CI −0.42 to 0.59, P = 0.74) and its effects on mindfulness level of nursing students also did not show statistical significance (SMD = 0.37, 95% CI −0.04 to 0.77, P = 0.07). No definitive conclusions were drawn from the TSA.

Conclusions: The results of this meta-analysis indicated that MM could effectively reduce the level of anxiety and stress of nursing students. TSA confirmed that the results of meta-analysis are credible. For depression, it could also significantly improve depression of nursing students with 8 weeks intervention, but there was no significant effect on nursing students with 1 week intervention duration. There was also no beneficial effect on mindfulness level of nursing students. However, TSA indicated that the accumulated evidence is still inconclusive. We suggest that more well-designed clinical trials with large sample and higher quality would be required in future to draw a definitive conclusion.