This project is ongoing and does not have results.
The Patient-Centered Outcomes Research Institute (PCORI) is partnering with the Agency for Healthcare Research and Quality (AHRQ) to develop a systematic evidence review on Mindfulness-Based Interventions for Mental Health in Children and Adolescents. The Academic Consortium for Integrative Medicine and Health and the American Academy of Pediatrics (AAP) intend to use the systematic evidence review to inform clinical practice guidance on this topic.
Pediatric mental health represents a pressing issue for patients, families and healthcare providers. Emerging evidence indicates that the prevalence of mental health conditions in youth has risen during the COVID-19 pandemic, with one recent estimate finding that up to one in five children and adolescents experience clinically significant depression, while as many as one in four may experience anxiety. Certain populations may also be at increased risk for elevated symptoms of depression, anxiety or stress, including children and adolescents with chronic conditions. Anxiety and depression in childhood can negatively impact social life, education, wellbeing, sleep and other aspects of daily life and can persist into adulthood, hence the pressing need to understand how to best manage these conditions.
Access to evidence-based treatments is important for managing mental health conditions in children and adolescents, but few receive such treatments, and even fewer access care through mental health professionals. Recommendations for the treatment of anxiety and depression in youth are limited to conventional therapies: medication and two forms of psychotherapy (cognitive-behavioral therapy and interpersonal psychotherapy). Integrative therapies, which are complementary or alternative therapies used alongside conventional treatment, are in common use among children in the United States, with nearly 12 percent of parents reporting the use of these therapies. Among the most common integrative therapies in use are mind-body practices, which include mindfulness-based interventions. Mindfulness-based interventions seek to improve well-being and health through self-regulation and attention to the present moment, often through practices such as meditation or relaxation techniques. Mindfulness-based interventions represent a potential mental health management strategy of high interest to youth and their families, and there is a growing body of evidence suggesting the efficacy and safety of their use.
Existing clinical practice guidelines from United States-based medical societies for the management of depression and anxiety in children and adolescents offer only recommendations for conventional treatments. Though a 2016 clinical report from the AAP on mind-body practices offers some insights on the use of mindfulness-based interventions – namely mindfulness-based stress reduction, meditation and guided imagery — the report is outdated and was not based on a systematic review. No clinical practice guidance offers specific recommendations for the use of mindfulness-based interventions for pediatric mental health.
Many recent systematic reviews assessing mindfulness-based interventions are dated, with the last literature searches having occurred two or more years ago, and are frequently narrow in scope (e.g., focused on anxiety or school-based interventions only). The most recent and comprehensive review combined analysis of all mindfulness-based interventions together and did not assess the effectiveness of specific therapies, did not include many of the most recent trials and did not grade the strength of evidence.
With a variety of mindfulness-based interventions available, patients, families and healthcare providers seek clarity on the range of safe and effective options. The lack of a guideline or recent and comprehensive systematic review, paired with accumulating evidence, indicates the need for a new review of the effectiveness of mindfulness-based interventions. The proposed review will aim to inform clinical practice guidance on mindfulness-based interventions for mental health in children and adolescents and inform decision making for physicians, patients and caregivers.
Proposed Key Questions (KQs)
KQ 1. What are the benefits and harms of mindfulness-based interventions for mental health in the general child and adolescent populations?
KQ 2. What are the benefits and harms of mindfulness-based interventions for mental health in children and adolescents diagnosed with anxiety or depression?
KQ 3. What are the benefits and harms of mindfulness-based interventions for mental health in children and adolescents with a chronic condition who are at risk for elevated symptoms of anxiety and depression?