Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial
Open accessAbstract
Background: Systematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health. Objective: The My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU). Methods: MYRIAD was a parallel group, cluster-randomised controlled trial. Eighty-five eligible schools consented and were randomised 1:1 to TAU (43 schools, 4232 students) or SBMT (42 schools, 4144 students), stratified by school size, quality, type, deprivation and region. Schools and students (mean (SD); age range=12.2 (0.6); 11–14 years) were broadly UK population-representative. Forty-three schools (n=3678 pupils; 86.9%) delivering SBMT, and 41 schools (n=3572; 86.2%) delivering TAU, provided primary end-point data. SBMT comprised 10 lessons of psychoeducation and mindfulness practices. TAU comprised standard social-emotional teaching. Participant-level risk for depression, social-emotional-behavioural functioning and well-being at 1 year follow-up were the co-primary outcomes. Secondary and economic outcomes were included. Findings: Analysis of 84 schools (n=8376 participants) found no evidence that SBMT was superior to TAU at 1 year. Standardised mean differences (intervention minus control) were: 0.005 (95% CI −0.05 to 0.06) for risk for depression; 0.02 (−0.02 to 0.07) for social-emotional-behavioural functioning; and 0.02 (−0.03 to 0.07) for well-being. SBMT had a high probability of cost-effectiveness (83%) at a willingness-to-pay threshold of £20 000 per quality-adjusted life year. No intervention-related adverse events were observed. Conclusions: Findings do not support the superiority of SBMT over TAU in promoting mental health in adolescence. Clinical implications: There is need to ask what works, for whom and how, as well as considering key contextual and implementation factors. Trial registration: Current controlled trials ISRCTN86619085 . This research was funded by the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z).
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A recent trial did not support mindfulness as a universal intervention in schools for the primary outcomes of risk for depression, social-emotional-behavioural functioning, and wellbeing.
“Although a recent trial did not support mindfulness as a universal intervention in schools for the primary outcomes of risk for depression, social-emotionalbehavioural functioning, and wellbeing, 98”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [98]
A large cluster randomised controlled trial of a universal school-based mindfulness programme found no evidence for the superior effectiveness of mindfulness compared with teaching as usual in reducing the risk of mental health problems and promoting wellbeing, although engagement was low and acceptability was mixed.
“That study found no evidence for the superior effectiveness of mindfulness compared with teaching as usual in reducing the risk of mental health problems and promoting wellbeing, although engagement was low and acceptability was mixed.”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [98]
Where there was evidence of a difference between treatment groups in the universal school-based mindfulness trial, outcomes were marginally worse for the mindfulness group across hyperactivity and inattention, panic disorder, obsessive-compulsive disorder, emotional symptoms, and mindfulness skills.
“Where there was evidence of a difference between treatment groups, outcomes were marginally worse for the mindfulness group (ie, across the domains of hyperactivity and inattention, panic disorder, obsessive-compulsive disorder, emotional symptoms, and mindfulness skills).”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [98]
A universal school-based mindfulness programme was neither more effective nor more cost-effective than standard teaching based on the coprimary outcomes (risk for depression, social-emotional-behavioural functioning, and wellbeing), although evidence suggested some cost-effectiveness when quality-adjusted life-years were used as the measure of benefit.
“Similarly, a universal school-based mindfulness programme was neither more effective nor more costeffective than standard teaching based on the coprimary outcomes (risk for depression, social-emotionalbehavioural functioning, and wellbeing), although evidence suggested some cost-effectiveness when qualityadjusted life-years were used as the measure of benefit.”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [98]
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- Authors
- Kuyken, W., Ball, S., Crane, C., Ganguli, P., Jones, B., Montero-Marin, J., Nuthall, E., Raja, A., Taylor, L., Tudor, K., Viner, R. M., Allwood, M., Aukland, L., Dunning, D., Casey, T., Dalrymple, N., De Wilde, K., Farley, E.-R., Harper, J., Kappelmann, N., Kempnich, M., Lord, L., Medlicott, E., Palmer, L., Petit, A., Philips, A., Pryor-Nitsch, I., Radley, L., Sonley, A., Shackleford, J., Tickell, A., Blakemore, S.-J., Team, T. M., Ukoumunne, O. C., Greenberg, M. T., Ford, T., Dalgleish, T., Byford, S., & Williams, J. M. G.
- Affiliations
- Warneford Hospital (GB)
- University of Exeter (GB)
- King's College London (GB)
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- University College London (GB)
- MRC Cognition and Brain Sciences Unit (GB)
- University of Cambridge (GB)
- Pennsylvania State University (US)
- Corresponding author
- Kuyken, Willem
- ORCID
- Kuyken, Willem
- Ball, Susan
- Crane, Catherine
- Ganguli, Poushali
- Montero-Marin, Jesus
- Nuthall, Elizabeth
- Raja, Anam
- Taylor, Laura
- Tudor, Kate
- Viner, Russell M
- Aukland, Louise
- Dunning, Darren
- Casey, Tríona
- Dalrymple, Nicola
- Farley, Eleanor-Rose
- Kappelmann, Nils
- Kempnich, Maria
- Lord, Liz
- Medlicott, Emma
- Palmer, Lucy
- Pryor-Nitsch, Isobel
- Radley, Lucy
- Sonley, Anna
- Tickell, Alice
- Blakemore, Sarah-Jayne
- Ukoumunne, Obioha C
- Greenberg, Mark T
- Ford, Tamsin
- Dalgleish, Tim
- Byford, Sarah
- Williams, J Mark G
- Venue
- Evidence Based Mental Health
- Publisher
- BMJ
- Published
- 2022-07-12
- Volume
- 25
- Issue
- 3
- Pages
- 99-109
- ISSN
- 1362-0347 (ISSN-L)
- 1468-960X
- PMC
- PMC9340028
- OpenAlex
- W4285094133
- Cited by
- 285
- References
- 9
- Citations by year
- 2026: 69 · 2025: 83 · 2024: 65 · 2023: 43 · 2022: 25
- FWCI
- 49.32
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Evidence-Based Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Open Research Exeter (University of Exeter) (submittedVersion, cc-by)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Apollo
- Funders
- Wellcome Trust (WT104908/Z/14/Z, WT107496/Z/15/Z)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Social Sciences › Education › Early Childhood Education and Development
- Keywords
- adolescent mental health, depression risk, youth welfare, cost-effectiveness, psychoeducation, implementation factors, school-based intervention, quality-adjusted life years, willingness-to-pay threshold
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