Cited by 69Mindfulness and Compassion InterventionsReligion, Spirituality, and PsychologyPsychological Well-being and Life Satisfaction

Mindfulness-based interventions among people of color: A systematic review and meta-analysis

Open access
Sun, Shufang, Goldberg, Simon B., Loucks, Eric B., Brewer, Judson A.·2022·Psychotherapy Research

Abstract

Objective In the United States, people of color (POC) are disproportionately affected by various sources of stress and prevalent mental and physical health issues that may benefit from Mindfulness-based Interventions (MBIs). However, effects of MBIs for POC are unclear. This meta-analysis examines the efficacy of MBIs through randomized controlled trials (RCTs) that included predominately POC (≥75% of the sample). Method: Random effects models were used to synthesize effect sizes. A total of 24 RCT samples were analyzed. Results: Samples were on average 94.4% POC and predominantly from low-income backgrounds (total N = 2,156). At post-treatment, MBIs yielded small but statistically superior outcomes to active controls (Hedges’ g = 0.11) and inactive controls (g = 0.26). Compared to active controls, MBIs’ effects on well-being were smaller than their effects on other outcome types. Compared to inactive controls, MBIs that focused on non-clinical populations and had higher proportion of POC had larger effect sizes. Attrition rates of MBIs did not differ from other active conditions in outpatient settings. Conclusion: Findings provide modest, preliminary empirical support for MBIs among POC. We discuss main findings, limitations, and implications for future MBI research for health promotion among POC.

Integrity signals

Registry

Crossref · 10.1080/10503307.2021.1937369

Cites

101 of 101 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 24 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Among the 17 studies that reported income, 14 (82.4%) had samples that were predominantly low-income.

    “Among the 17 studies that reported participants’ income level, 14 studies (82.4%) indicated the sample was predominately low-income (see Supplemental Material Table 3).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Compared with active controls, MBIs produced significantly smaller effects on well-being than on other outcome types (B = −0.33, 95% CI [−0.65, −0.01]).

    “MBIs yielded significantly smaller effects in well-being than other outcomes when compared to active controls (B = −0.33, 95%CI = [- .65, - .01]; Supplemental Materials Table 8).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In outpatient settings, participants assigned to MBIs were not more likely to drop out than those in active control conditions (OR = 0.97, 95% CI [0.57, 1.64], p = .91).

    “Participants randomized to MBIs were no more likely to drop out than the control group (OR = 0.97, 95%CI = [0.57, 1.64], p = .91).”
    Quote in the paperNot a substantial claim
  • Findingown data

    The superiority of MBIs over active and inactive controls remained statistically significant after false discovery rate correction (adjusted p = .004 and .007, respectively).

    “Results remained significant after FDR correction (p values adjusted as .004 and .007, correspondingly).”
    Quote in the paperSubstantial claim
  • Findingown data

    After trim-and-fill adjustment with four imputed studies, MBIs remained significantly superior to inactive controls (adjusted g = 0.45, 95% CI [0.24, 0.65], p < .001).

    “as well as to inactive controls with the addition of four imputed studies and adjusted omnibus effect size, g = 0.45, 95%CI = [0.24, 0.65], p < .001.”
    Quote in the paperSubstantial claim
  • May combine two claims. 18
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 10
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    Findingreasoning

    The final meta-analytic sample consisted of 22 randomized controlled trials that yielded 24 comparisons, with 16 comparing MBIs to active controls and 8 comparing MBIs to inactive controls.

    “Therefore, a total of 22 studies were included in the meta-analysis, and among them, two studies compared an MBI to both an active and an inactive control, yielding 24 comparisons. Thus, the final sample included 16 studies that compared an MBI to an active control and 8 studies that compared an MBI to an inactive control.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    At post-treatment, MBIs were superior to inactive controls across all outcomes, with a small effect size (Hedges' g = 0.26, 95% CI [0.07, 0.45], p = .007).

    “as well as inactive control conditions (k = 8, g = 0.26, 95%CI = [0.07, 0.45], p = .007).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    The meta-analytic sample included 2,156 participants and was on average 94.4% people of color, with study-level proportions ranging from 77.5% to 100%.

    “The sample had a total of 2,156 participants and was 94.4% POC (range = [77.5%, 100%]).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    At post-treatment, MBIs were modestly superior to active controls across all outcomes, with a small effect size (Hedges' g = 0.11, 95% CI [0.04, 0.18], p = .002).

    “When aggregated across all outcomes, MBIs were shown to be overall modestly superior to active control conditions (k = 16, g = 0.11, 95%CI = [0.04, 0.18], p = .002)”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Between-study heterogeneity was low for active-control comparisons (I2 = 0.00%) and moderate for inactive-control comparisons (I2 = 54.03%).

    “Heterogeneity was low for studies using active controls (I2 = 0.00%, 95%CI = [0.00%, 17.94%]) and moderate for studies using inactive controls (I2 = 54.03%, 95%CI = [8.55%, 85.50%]).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Among randomized controlled trials using inactive controls, mindfulness-based interventions for people of color were more effective in non-clinical samples than in clinical samples; this difference was not observed with active controls.

    “MBIs for POC were more effective in non-clinical compared to clinical samples (e.g., psychiatric, medical) among RCTs utilizing inactive controls (although, again, this did not appear for active controls).”
    Quote in the paperSubstantial claim
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    Findingown data

    Intervention duration, dosage, adaptation, and study quality were not significant moderators of treatment effects.

    “Intervention duration, dosage (number of weeks, number of minutes per week, total time engaged in treatment), adaptation, and study quality were not significant moderators of treatment effects (see Supplemental Materials Table 7).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    In comparisons with inactive controls, mindfulness-based interventions had larger effects in studies with a higher proportion of people of color than in studies with a lower proportion; this moderator effect was absent in comparisons with active controls.

    “Compared to inactive controls, MBIs were also more effective for studies with higher rather than lower proportions of POC, although this effect did not appear for comparisons with active controls.”
    Quote in the paperSubstantial claim
  • The quote only partly states this claim.

    Findingown data

    In this meta-analysis, mindfulness-based interventions did not differ from active control conditions in dropout or acceptability in outpatient settings.

    “Our synthesis on attrition suggests that MBIs did not differ from other active controls in acceptability in outpatient settings.”
    Quote in the paperSubstantial claim
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    Findingown data

    Most included studies used active controls (k = 16), and most of those controls were non-evidence-based treatments such as health education or support groups.

    “although the majority of studies used active controls (k = 16), most used non-evidence-based treatments (e.g., health education, support group).”
    Quote in the paperSubstantial claim
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    Premisecitation

    Cultural adaptation of psychological interventions improves treatment engagement and outcomes.

    “robust meta-analytic evidence suggesting that cultural adaptation improves treatment engagement and outcomes (Hall, Ibaraki, Huang, Marti, & Stice, 2016).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hall, Ibaraki, Huang, Marti, & Stice, 2016

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two authors separately rated each study's methodological quality with a modified Jadad scale.

    “The methodological quality of each study was independently assessed by the first two authors using a modified Jadad’s criteria (Jadad et al., 1996) that has been used in previous MBI research (Piet & Hougaard, 2011).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Jadad et al., 1996

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    • cites Piet & Hougaard, 2011

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The authors checked for publication bias using funnel plots and trim-and-fill analyses.

    “We assessed publication bias by visually inspecting funnel plots for asymmetry disaggregated by control condition (i.e., active, inactive). Models were also re-estimated using trim-and-fill methods that account for the asymmetric distribution of studies around an omnibus effect (Duval & Tweedie, 2000).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Duval & Tweedie, 2000

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The authors followed the PRISMA reporting guidelines for this meta-analysis.

    “This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (Moher, Liberati, Tetzlaff, Altman, & the PRISMA Group, 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moher, Liberati, Tetzlaff, Altman, & the PRISMA Group, 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    This review was preregistered in PROSPERO under CRD42019124968.

    “The study was registered in a public systematic review registry (PROSPERO; CRD42019124968).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    They used the Benjamini-Hochberg method to control the false discovery rate.

    “Following omnibus test, false discovery rate (FDR) correction was made using the Benjamini-Hochberg procedure.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Study design and conductown data

    The samples in the included studies were mostly from low-income backgrounds, and many participants had additional intersecting adversities such as incarceration or exposure to neighborhood violence.

    “included study samples were predominately from low-income backgrounds and many study participants had other intersecting adversities (e.g., incarceration, exposure to neighborhood violence).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationreasoning

    It remains unclear whether MBIs work for people of color, partly due to sparse research.

    “Thus, the efficacy of MBIs among POC is unclear, in part due to limited research.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two authors independently screened studies for inclusion and settled disagreements by consensus.

    “The first and second authors independently completed coding of potential eligible studies for inclusion. Both individuals are PhD-level psychologists with previous experience conducting meta-analyses. Disagreements were discussed until a consensus was reached.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Agreement between coders for inclusion and data extraction was good to excellent (kappas and ICCs above .60).

    “Inter-rater reliabilities were in the good to excellent range (i.e., kappas and ICCs > .60; Cicchetti, 1994).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Cicchetti, 1994

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Interpretationown data

    This meta-analysis found weaker effects than prior MBI meta-analyses in psychiatric/medical, healthy adult, and youth samples.

    “Although these effects mirror the statistical significance seen in previous large-scale meta-analyses of MBI RCTs, the current effect size are smaller in magnitude compared to findings in other populations.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Goldberg et al., 2018

      Not checked in the free run.

    • cites Khoury et al., 2013

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    • cites Dunning et al., 2019

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  • May combine two claims.

    Premisecitation

    In the U.S., people of color face disproportionate structural inequalities and elevated rates of mental and physical health problems.

    “People of color (POC)1 in the United States (U.S.) are disproportionately affected by various structural inequalities such as mass incarceration (Wildeman & Wang, 2017), racism (Bailey et al., 2017), and housing and economic difficulties (Zimmerman & Anderson, 2019).”
    • Also stated in: § Conclusion: · plain
      “POC show high rates of psychological and physical health issues, such as depressive symptomology (Bailey, Mokonogho, & Kumar, 2019), risk of trauma exposure and Post-Traumatic Stress Disorder (PTSD) (Asnaani & Hall-Clark, 2017), hypertension and cardiovascular disease (Balfour, Rodriguez, & Ferdinand, 2015), and HIV/AIDS (Millett et al., 2012).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Wildeman & Wang, 2017

      Not checked in the free run.

    • cites Bailey et al., 2017

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    • cites Asnaani & Hall-Clark, 2017

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The moderator analyses in this review were exploratory and probably lacked sufficient statistical power.

    “Moderator analyses were exploratory in nature and likely underpowered (Hedges & Pigott, 2004).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hedges & Pigott, 2004

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The moderator tests were exploratory, not driven by prior hypotheses.

    “As there is limited prior meta-analytic research and theory regarding the use of MBIs for POC, moderator analyses were exploratory rather than based on a priori hypothesis.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Additional problems, including moderator confounding and ecological fallacy, might have influenced the findings.

    “Other errors such as confounding between moderators and ecological fallacy may also have affected results”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Effects in the mindfulness-based intervention literature may be inflated by researcher allegiance.

    “the possibility that effects in the MBI literature are inflated (e.g., due to researcher allegiance; Goldberg & Tucker, 2020)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Goldberg & Tucker, 2020

      Not checked in the free run.

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  • The paper relies on this without support.

    Research on mindfulness-based interventions for people of color is at an early stage.

    “Given the early stage of MBI research for POC and limited numbers of studies for subgroups of POC”
  • The paper relies on this without support.

    Many subgroups of people of color experience multiple adversities.

    “considering that many POC subgroups experience multiple adversities”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Two different mean ages are reported

    Minor

    The study-characteristics section gives a mean age of 23.2 years, while the limitations section describes the included sample as having a mean age of 18.6 years.

  • The outcome-moderator count does not match its list

    Minor

    The text says four outcome types had sufficient studies for moderator analysis, but immediately lists six types with six corresponding study counts.

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Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. American Psychological Association, APA Task Force on Race and Ethnicity Guidelines in Psychology. (2019). Race and ethnicity guidelines in psychology: Promoting responsiveness and equity. http://www.apa.org/about/policy/raceand-ethnicity-in-psychology.pdf
  2. Cooper, H. M., Hedges, L. V., & Valentine, J. C. (2009). The handbook of research synthesis and mean-analysis (2nd ed.). Russell Sage Foundation.
  3. 10.1177/174569162096877 · DOI

Cited by

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Authors
Sun, S., Goldberg, S. B., Loucks, E. B., & Brewer, J. A.
Affiliations
  • Brown University (US)
  • University of Wisconsin–Madison (US)
Corresponding author
Sun, Shufang
Venue
Psychotherapy Research
Published
2021-06-07
Volume
32
Issue
3
Pages
277-290
ISSN
  • 1050-3307 (ISSN-L)
  • 1468-4381
OpenAlex
W3168772374
Cited by
64
References
101
Citations by year
2026: 16 · 2025: 15 · 2024: 15 · 2023: 13 · 2022: 5
FWCI
1.10
Type
journal article
Language
en
Open access
Locations
  • Psychotherapy Research (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Center for Complementary and Integrative Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Health › Religion, Spirituality, and Psychology
  • Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
Keywords
mindfulness-based interventions, people of color, racial and ethnic minorities, intervention efficacy, well-being, attrition rates, health promotion, low-income populations, mental health
MeSH terms
Humans, Outpatients, Poverty, Racial Groups, Mindfulness

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