An umbrella review of meta-analyses of school-based Mindfulness Based Interventions (MBIs)

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Methods: Searches were conducted in PubMed, PsycINFO, CINAHL, ERIC, and Cochrane databases to end 2024. Eligibility criteria included controlled trials of school-based MBIs for children and adolescents aged 5–18 yrs, and peer reviewed publication. Data extraction followed PRISMA Guidelines, with AMSTAR-2 and GRADE used to measure quality. Pooled effect sizes were analysed using random-effects models, and meta-regression analyses for moderator effects. The review protocol was pre-registered with PROSPERO. Results: Six meta-analyses, covering a total of 110 primary studies and 28,910 participants, met inclusion criteria. MBIs showed small but statistically significant effects for wellbeing (g = 0.13), mindfulness (g = 0.11), and anxiety (g = 0.11), but no effect for depression (g = 0.05). Quality of included reviews ranged from critically low to moderate (AMSTAR-2). GRADE assessments indicated very low certainty of evidence across all outcomes, primarily due to risk of bias, inconsistency, and imprecision. Limitations: Results were limited by the small number of meta-analyses included in the umbrella review ( k = 6), variation in methodological quality of primary studies, and lack of follow-up data in some meta-analyses. Conclusion: School-based MBIs are associated with very small improvements in wellbeing, mindfulness, and anxiety, but not depression, for children and adolescents in the general school population. However, the evidence is limited and inconsistent, with a need for further high-quality RCTs in this field. Registration: PROSPERO CRD42025636892 Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Mindfulness-Based Interventions (MBIs) have been found to be an effective tool for enhancing resilience (O’Connor et al., 2023 ), reducing anxiety and depression, and improving wellbeing for the adult population (Khoury et al., 2013 ). The concept of mindfulness is based on Zen meditation, and was adapted for use with clinical populations by Jon Kabat-Zinn, who developed the influential Mindfulness Based Stress Reduction Programme (MBSR) some 40 years ago (Kabat-Zinn, 1982 ) and continued to integrate mindfulness with other mind and body approaches such as yoga since then (Kabat-Zinn, 2013 ). The core elements of mindfulness have variously been described as attention, intention and attitude (Shapiro et al., 2006 ), or attention and awareness, cultivation, person-centredness and ethical-mindedness (Nilsson & Kazemi, 2016 ). Kabat-Zinn has defined mindfulness as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, 2003 , p. 145). While mindfulness interventions for child and adolescent populations are still relatively new, emerging in the past twenty years, there is good evidence of their effectiveness with a range of clinical and non-clinical populations (Zoogman et al., 2015 ). There have been adaptations of now widely implemented, evidence-based MBIs such as Mindfulness Based Cognitive Therapy (MBCT) (Segal et al., 2002 ) for the child and adolescent population, named MBCT-C (Semple et al., 2010 ), as well as new MBIs which are tailored for the child and adolescent population, such as MindUp (Schonert-Reichl et al., 2015 ). Given the extensive and ever-increasing number of MBIs being developed, leading experts in the field of mindfulness, including Kabat-Zinn, came together in 2017 to develop a framework to facilitate the identification of an MBI, ‘what a mindfulness programme is and what it is not’ (Crane et al., 2017 , p. 990). They used the analogy of warp and weft, with the ‘warp’ being the essential elements and ‘weft’ the adaptations to a particular context and/or population. They proposed that an MBI must be based upon theories and practices across ‘contemplative traditions, science and the major disciplines of medicine, psychology and education’, while variable elements (‘the weft’) could include duration and programme structure (p. 992). Crane et al ( 2017 ) identified ‘first-generation’ mindfulness based programmes such as MBSR and MBCT, which have systematic training in mindfulness meditation practices as a defining feature. As the implementation of mindfulness-based programmes for young people has grown, so too has the research base, with a number of meta analyses carried out focusing on aspects of impact, such as the factors contributing to intervention effectiveness (Carsley et al., 2018 ) and intervention efficacy (Kallapiran et al., 2015 ), or examining by study type, such as the randomized controlled trial (Dunning et al., 2019 ). Previous systematic reviews have reported mixed findings. One of the earliest systematic review of school-based MBIs, in 2016, reviewed 28 MBIs and reported that many of the studies had positive findings, as measured by outcomes such as emotional regulation, social skills, classroom engagement, coping and positive affect, and reduced reported levels of negative outcomes such as depression, anxiety and suicidal ideation (Felver et al., 2016 ). Felver et al commented that the literature in this area had many limitations and made a series of recommendations as to how that might be addressed, including more use of experimental research design, using active control conditions, reporting full details of student characteristics, and the use of existing MBIs, commenting on the wide range and variation in MBIs, which made comparison difficult. Another systematic review in 2016 (Black, 2015 ) also commented on the increasing implementation of MBIs with children and adolescents and called for more research, arguing that although there was now a substantial evidence base for benefits of MBIs for adult populations, this couldn’t be assumed to be the case for children too, given the cognitive, social and emotional differences between adults and children. In considering effectiveness, reviewers explored changes in positive indicators such as social-emotional learning, academic outcomes, cognition (Maynard et al., 2017 ) and wellbeing (Carsley et al., 2018 ; Dunning et al., 2022 ), and negative indicators such as depression and/or anxiety (Dunning et al., 2022 ; Zoogman et al., 2015 ). The issue of whether the evidence base points to a difference in effects for clinical and non-clinical populations is also unclear, with some reviewers finding evidence of reduced psychopathology, regarding anxiety and depression, for clinical populations (Zoogman et al., 2015 ). A developmental perspective has also been considered, with some reviewers noting that children do not yet have the meta-cognitive abilities which are shown to play a role in the process of change which mindfulness engenders (Greenberg & Harris, 2012 ). An umbrella review, or synthesis and meta-analysis of existing meta-analyses, is a relatively recent methodological tool that is increasingly being used to synthesise learnings in different fields. When a rigorous methodological approach is taken, the umbrella review can be a useful source of information for clinicians and decision makers, facilitating a clear understanding of a broad topic (Aromataris, 2015). In this case, an umbrella review is being carried out in order to assess the overall strength of the evidence base for school-based MBIs with the child and adolescent population. The current systematic review The aim of this umbrella review is to carry out a meta-analytic synthesis of existing meta-analyses of school-based MBIs to determine the impact of these programmes on positive outcomes (well-being and mindfulness) and negative outcomes (depression and anxiety) for the child and adolescent population. Whereas in a standard meta-analysis, the unit of analysis is a primary study or single piece of research, the analytical unit here is the meta-analysis. The review addressed the following five research questions: How large is the evidence base on the effects of school-based MBIs? What is the quality of the evidence base for the effects of school-based MBIs? What effect do school-based MBIs have on positive outcomes (well-being and mindfulness) and negative outcomes (depression and anxiety)? Are the effects of school-based MBIs sustained over time? What variables moderate the effects of school-based MBIs on positive and negative outcomes? Method This umbrella review and meta-analysis employed best practice methodological guidelines to maximise rigour, transparency and reproducibility (Aromataris, 2015; Hennessy et al., 2019 ). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement (Page et al., 2021 ) was followed, and the review pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42025636892) to minimise bias and reduce duplication (National Institute for Health and Care Research). The only deviations from the pre-registered review were: the addition of mindfulness as an outcome variable; a minor change to the screening stage, whereby all studies, rather than a sample of 25%, were independently screened by two reviewers; the decision not to sum AMSTAR-2 scores to produce an overall quality score, instead calculating an overall quality rating based on scores for critical and non-critical criteria, to be consistent with the AMSTAR-2 developer recommendations (Shea et al., 2017 ); the addition of the application of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess certainty of the evidence; and a slight amendment of the title of the review for greater clarity. Eligibility criteria Eligibility criteria were developed using the PICOS (population intervention comparison outcome and study type) framework (Methley et al., 2014 ). Inclusion criteria Types of participants Participants in the primary studies reviewed by the meta-analysis were children aged between 5 and 18 years, and could be from clinical or non-clinical populations. Types of interventions : Mindfulness based Interventions in the primary studies had to feature mindfulness as a core component, with the intervention delivered in a school or similar setting, within school hours. There were no other limits set on the mode of delivery or who delivered the intervention. We categorised MBIs into two types: Structured MBIs which are based on the ‘first generation’ MBIs; and Other MBIs, which involve one or a small number of elements of first generation MBIs, or have additional components such as social emotional learning. Comparison Groups The control group could be an Inactive Intervention (II), such as no-treatment or waiting list control (WLC), or an Alternative Intervention (AI) such as treatment as usual or an evidence-based therapeutic treatment (such as cognitive behaviour therapy). Outcome Measures: The primary outcome variable for this meta-analysis was well-being, with mindfulness, depression and anxiety secondary variables. Systematic reviews were included if the studies they reviewed measured at least one of the four variables, and if the meta-analyses’ inclusion criteria stipulated the use of validated outcome measures. A wide range of measures was deemed acceptable. For example, self-report measures for subjective and/or psychological wellbeing might include the Stirling Children's Wellbeing Scale (SCWS) (Liddle, 2015 ) or the Positive and Negative Affect Scale (PANAS) (Watson et al., 1988 ); mindfulness the Mindful Attention Awareness Scale (MAAS) (Brown & Ryan, 2003 ); anxiety the State Trait Anxiety Inventory (STAI) (Marteau & Bekker, 2020 ); and depression the Depression Anxiety Stress Scale (DASS) (Lovibond & Lovibond, 1995 ) or Revised Children’s Anxiety and Depression Scale (RCADS-25) (Ebesutani et al., 2012 ). Study type A key inclusion criterion was that the meta-analysis must involve only controlled studies. While randomised controlled studies are regarded as the gold standard for systematic reviews, non-randomised controlled studies were also included as they can provide useful information, once quality and risk of bias is considered in the analysis (McKenzie, 2023). Furthermore, non-RCTs can be clinically useful in an emerging field such as mindfulness given the length of time that RCTs can take, and moderator analyses can be carried out to explore potential differences between RCT and non-RCT results in a meta-analysis (Sperling et al., 2025 ). The meta-analysis must also have been published in a peer-reviewed journal, in the English language. The peer review process involves an assessment of a study or review across all aspects of the paper, including quality, objectivity, study/review design, limitations and strengths, by a person who has expertise in the field to which the study or review, and constitutes a valuable check to ensure that research published in that journal is truthful, valid and accurate (Steer & Ernst, 2021 ). Exclusion criteria Meta-analyses of uncontrolled studies which reported pre and post results for the intervention group but had no control group were excluded. Meta-analyses which included primary studies in which mindfulness was a secondary rather than primary component (e.g. Dialectical Behavior Therapy, Acceptance Commitment Therapy) were also excluded. Search strategy and selection process The search strategy involved searches of five electronic databases: PubMed, PsycINFO, Education Resource Information Centre (ERIC), The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Database of Systematic Reviews (CDSR). The specified dates were from January 2000 to end December 2024. Keywords included mindfulness, programmes, school-based, child, adolescent, wellbeing, depression and anxiety. The search string specified the paper Title and Abstract, with search terms including (mindfulness*) AND (program* OR intervention* OR therap*) AND (school*) AND (child* OR adolesc* OR young* OR youth*) AND (wellbeing* OR well-being OR anxiety OR depress*) AND (meta-analys* OR meta analys* OR meta-synth* OR meta synth*). See Appendix A of Supplementary Information for further details. Reference lists of reviews which passed the initial screening were manually reviewed and meta-analyses potentially meeting eligibility criteria put forward for screening (Aromataris & Riitano, 2014 ). PROSPERO was searched for ongoing or recently completed systematic reviews, and Mindfulness and Journal of Positive Psychology journals for the years 2020-end 2024 were manually searched. References of all articles identified in searches were uploaded by the primary researcher to Covidence (Covidence Systematic Review software). Covidence facilitates the uploading of search results, screening at abstract and full text stages, multiple reviewer assessment, and resolution of any reviewer disagreements. Two researchers independently conducted full screening at abstract and full text screening stages, with reference to the agreed inclusion and exclusion criteria. Any disagreements were discussed and resolved by consensus. On three occasions, there was consultation with a third researcher to clarify the inclusion or exclusion of Odgers et al (2020) with regard to setting, and Dunning et al ( 2019 ) (Dunning et al., 2019 ) and Galla et al (2024) with regard to study overlap. It was decided that as the majority of primary studies reviewed in Odger et al’s (2020) meta-analysis had been conducted in school settings, it would be included in the current review. It was decided that as all but three primary studies in Dunning et al ( 2019 ) were included in Dunning et al ( 2022 ), and those three studies had not been peer-reviewed, it would be excluded; and that although Galla et al’s (2024) meta-analysis reviewed a subset of Dunning et al’s ( 2022 ) meta-analysis it would be included as it had extracted additional data from the primary studies. Data extraction and quality assessment An Excel codebook was created to facilitate data extraction and quality assessment of the included reviews. Data were extracted on review characteristics and outcome variables. Review characteristics included review design (inclusion of RCT only, or RCT + non-RCT), mode of delivery of interventions in the primary studies included in the review (face-to-face, online, both) and duration of intervention (mean number of hours), number of primary studies, number of participants in treatment and control groups, number of studies/comparisons with active control groups, number of studies/comparisons with inactive control groups, mean age, and gender (number of females). Key extracted data included standardized mean difference effect sizes and 95% confidence intervals and the number of primary studies on which these were based for well-being, mindfulness, anxiety, and depression at post-treatment and follow-up for all studies, primary studies with active control groups, and primary studies with inactive control groups. All effect sizes were keyed so that positive values indicated greater well-being or fewer symptoms in the intervention group compared with the control group. Where effect sizes for multiple indices of an outcome variable were reported, the effect size for the broadest index (for example total wellbeing) was extracted, or the average effect size was computed for a number of indices of similar breadth (e.g., subjective well-being and psychological well-being). A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) was used to assess and rate the methodological quality of each review (Shea et al., 2017 ). AMSTAR-2 assesses each review against 16 criteria, which are classified as either critical or non-critical. A second reviewer conducted data extraction and quality assessment for a randomly selected sample of 33% of records. An inter-rater reliability assessment was conducted with Cohen’s Kappa Coefficient of Agreement (Cohen, 1960 ). Any disagreements were resolved through discussion and consensus. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence in the included reviews (Guyatt et al., 2008 ), following the system set out in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins, 2024). This approach assesses the quality of evidence and strength of recommendations in five domains: risk of bias (design and delivery limitations), inconsistency (or heterogeneity), indirectness (PICOS), imprecision (number of events, confidence intervals), and publication bias; with certainty of evidence rated as very low, low, moderate or high (McKenzie, 2024 ). Data Analysis/Synthesis Using Comprehensive Meta-Analysis software (Borenstein, 2013), separate meta-analyses using the random-effects model were conducted on effect sizes from included meta-analyses for wellbeing, mindfulness, depression, and anxiety. Random rather than fixed effects analyses were conducted to take account of heterogeneity of scores on outcome variables (Borenstein, 2010). Hedges’ g pooled effect size magnitudes (Hedges, 1981 ) were interpreted using Cohen's convention of small (0.2), medium (0.5), and large (0.8) (Cohen, 1988 ). The statistical significance of heterogeneity of effect sizes was assessed with Cochran’s Q statistic, and the degree of heterogeneity determined with the I² statistic (Higgins & Thompson, 2002). Where there were data on more than 3 review moderators, meta-regression analyses were conducted on post-treatment data for the following continuous variables: mean age, % females, % health problems, intervention duration, % inactive control group and % non-RCT. The extent to which the inclusion of the same primary studies in multiple meta-analyses biased the results of the current meta-analysis was evaluated with the Corrected Cover Area (CCA) index (Pieper et al., 2014 ). To calculate CCA, a citation matrix was set up, with one meta-analysis per column, and all included primary studies in each meta-analysis listed, one per row. The rows were sorted alphabetically, duplicates removed, and a check mark made for each primary study included in each review. The citation matrix yielded three indices: k the total number of boxes in the citation matrix containing checkmarks; r, the number of rows (primary studies); and c, the number of columns (meta-analyses). These three indices were used to compute the CCA with the formula CCA = (k-r) /([rxc]-r), and interpreted using Pieper and colleagues’ ( 2014 ) criteria: 0–5 = slight, 6–10 = moderate, 11–15 = high, and > 15 = very high risk of overlap biasing second order meta-analytic results. An excel spreadsheet was used to list the interventions and sample sizes of primary studies, with an indication of which reviews had included which primary study. For all the four dependent variables (wellbeing, mindfulness, depression and anxiety) Egger’s test (Sterne & Egger, 2005) and trim and fill procedures (Duval, 2005) were used to detect and normalise funnel plot asymmetry (Peters et al., 2008) and determine the impact of publication bias on current meta-analysis results. Results Systematic review selection The search strategy yielded a total of 73 potential papers, with that number reduced to 53 after duplicates were removed, and 20 when abstracts were screened. Full-text articles were then reviewed, with 14 excluded. References for the included and excluded studies are set out in Appendix B of Supplementary Information, grouped by reason for exclusion (e.g. incorrect study design, incorrect outcomes, incorrect intervention etc), and AMSTAR-2 scores of the included reviews in supplementary Table 2.S.1 in Appendix C of Supplementary Information. The flow of information and reasons for exclusion are set out in the PRISMA flowchart (Fig. 1 ). A. total of 6 reviews with meta-analyses met inclusion criteria. Data extraction Data were extracted as set out above. A second rater extracted data for 33% of the included reviews. The rater scores were uploaded to IBM SPSS Statistics software (Version 27) and the Cohen’s Kappa statistic was run to test inter-rater reliability. The result ( ķ = 0.925) indicated high agreement (Fleiss et al., 2003 ). Systematic review characteristics The characteristics of the 6 included reviews are presented in Table 1 . The reviews were published between 2018 and 2024. All included a meta-analysis. Four of the six reviews involved only RCTs, while two included non-RCTs in their analysis. The reviews evaluated 170 primary studies. When duplicates were removed, there were a total of 110 primary studies, with a total of 28,910 participants. Review characteristics are presented in Table 1 , and summary details in Table 2 . Participants The mean age of participants ( N = 28,910) was 12.17 years ( SD = 1.94, range = 5-18y). In all 6 reviews the majority of participants of the included primary studies were in good health. On average, 10.8% of primary studies contained children with physical or mental health problems. The mean number of participants in the reviewed primary studies was 263 participants ( SD = 911, range = 14–8,376), with the primary studies ranging from MBIs delivered to small groups of children to major multi-school projects. The smallest sample involved an MBI delivered to a clinical group of children with generalised anxiety in Iran ( N = 14) (Dehghani et al., 2014 ) and the largest the My Resilience in Adolescence (MYRIAD) Trial, a major project which involved 85 schools in the United Kingdom ( N = 8,376) (Kuyken et al., 2022 ). Primary studies were carried out throughout the world, with the majority carried out in Western, high-income countries such as the US, Canada, Europe and Australia, with other locations including countries in Asia and Africa. Interventions : The majority of interventions which were evaluated in the systematic reviews’ primary studies were structured MBIs (n = 74), classified here as Type 1; with the remainder falling into a broader category of mindfulness activities/programmes with additional components (n = 36), classified here as Type 2. Interventions are listed in Table 1 , where the review had provided an intervention name. Type 1 interventions included Mindfulness Based Stress Reduction (MBSR) (Cohen et al., 2021 ; Sibinga et al., 2013 ; Sibinga et al., 2016 ), Mindfulness-based Cognitive Therapy (MBCT) (Atkinson & Wade, 2015 ; Semple et al., 2010 ), Learning to Breathe (Lam & Seiden, 2020 ), dot.be (Lassander et al., 2021 ), MindKinder (Moreno-Gómez & Cejudo, 2019 ), and Taming the adolescent mind (Tan & Martin, 2015 ). Type 2 interventions included Guided mindfulness (Solar, 2018 ), Mindfulness meditation (Wimmer et al., 2016 ), Mindfulness oriented meditation (Crescentini et al., 2016 ), MindUP (Schonert-Reichl et al., 2015 ), Integrative Contemplate Pedagogy (Britton et al., 2014 ) and the Gaia Project (Ghiroldi et al., 2020 ). Primary studies were consulted where there was a lack of clarity as to the categorisation for this paper, and categorisation then made. Carsley (2018) had grouped interventions into: Established mindfulness programmes (which were categorised in this paper as Type 1); and Various mindful activities, Mindfulness-based yoga and Other (which were categorised in this paper as Type 2). The mean duration of all interventions was 10.4 hours ( SD = 7.43, range 0.3–40.5). On average 67% of primary studies in meta-analyses involved structured MBI interventions. The mean duration of this type of intervention was 10.8 hours ( SD = 7.04, range = 2–41). Comparison conditions The number of comparisons between MBI treatment and Active Intervention (IA) comparison groups was 66. Active interventions included educational activities such as study skills, emotional literacy, life skills, curriculum as usual; relaxation activities such as progressive muscle relaxation or relaxation; or mind-body activities such as hatha yoga. There were 91 comparisons between MBI treatments and wait list control groups. On average 54.41% ( SD = 18.6) of primary studies had inactive control groups. The percentage of primary studies which had an inactive control group ranged from 25% (Carsley et al, 2018 ) to 75% (Odgers et al, 2020). Outcomes : Post-intervention data were available in 83% of meta-analyses for anxiety; in 66% of meta-analyses for wellbeing and depression; and in 50% of meta-analyses for mindfulness. Follow-up data from more than 3 studies were not available for any of the 4 outcome variables, and so were not analysed. Kander et al (2024) outcomes were grouped as Therapeutic processes and Therapeutic outcomes. Their variables were mapped to the current variables as: Positive Emotion and self appraisal variable taken as Wellbeing; Negative emotion and subjective distress as Depression; Internalizing problems as Anxiety; and Mindfulness as Mindfulness. Table 1 Review characteristics Author & Date K-Total Design No. studies follow-up data Total N in primary studies %Female Mean Age Interventions Outcome measures AMSTAR-2 rating Type 1 Structured MBI Type 2 Multi-component MBI/Mindfulness Activities Carsley, 2018 24 RCT & non-RCT 9 3,977 60 13yrs *Included MBSR, MBCT, Dot.be *Included Mindfulness oriented meditation, MindUP, Attention Academy, Mindfulness yoga, ICP Mental health & wellbeing Critically low Dunning, 2022 1 65 RCT only 23 20,138 NK 12yrs MBSR (x6), MBCT (x6), Learning to Breathe (x7), Dot.be (x8), Mindful Awareness Practice, Meditacion Fluir, Pause Breathe Smile, Mindfulness Kindness Curriculum, Breathing Awareness Meditation, Mymind, Mindfulness Prescription for ADHD, Mindfulness matters, Mindfulness skills training, Mission Meditation, MindKinder, Mindfulness Emotional Intelligence, Pawsb, Mindfulness Eating Awareness, Mindfulness based substance abuse treatment. Kamalayan Curriculum, ICP, Mindfulness CBT, MindUP, Unlearning, Gaia, Guided mindfulness, Power source, Mindful schools, Attention academy, Story-based mindfulness, Gaia Wellbeing, Mindfulness, Depression, Anxiety/stress, Attention, Executive functions, Negative behaviour, Social behaviour Moderate Fulambarkar, 2023 9 RCT only 0 5,046 45 14yrs MBSR (x4), MBCT, Learning to breathe (x3), Dot.be None Anxiety, Depression, Stress Low Galla, 2024 2 20 RCT only 12 16,558 NK 14yrs MBSR (x3), MBCT, Learning to Breathe, Meditacion Fluir, Dot.be (x8), Mindfulness Eating Awareness, Breathing Awareness Meditation, ICP, Unlearning Wellbeing, Mindfulness, Depression, Anxiety/stress, Attention, Executive functions, Negative behaviour, Social behaviour Low Kander, 2024 32 RCT & non-RCT 0 3,640 NK 9yrs MBSR, MBCT, Mindful Awareness Practice, Mindfulness Kindness Curriculum, Pause breathe smile, Mindkeys, Mindful moments, Mindfulness enhancement programme Mindfulness-based social and emotional learning, Living mindfully primary programme, MindUP, ICP, Mindfulness oriented meditation, Mindfulness meditation, Gaia, Mindfulness based activities, Mindful schools, Call to care Therapeutic processes & Therapeutic outcomes. (A range of variables. under each heading) Low Odgers, 2020 20 RCT only 7 1,582 NK 11yrs MBSR (x5), MBCT (x6), Learning to breathe, Meditacion Fluir, Mindkinder, Mindfulness emotional intelligence, Audio-guided MBI, Dot.be Mindful breathing, Mindfulness in schools, Neuro-feedback MBI, Mindfulness yoga Anxiety Moderate Note: Where an intervention was featured in the review more than twice, the number of times is indicated. Not all interventions are listed as some interventions were only named MBI. *Carsley did not give the names of interventions Dunning stated 66 studies in their review, but only provided details of 65. Galla stated 22 studies in their review, with one piece of primary research broken into three studies. For this paper, it was treated as one study. ICP = Integrative Contemplative Pedagogy, NK = Not Known. Table 2 Summary review characteristics Variables Frequency Mean Range SD % Meta-analysis characteristics Total number of meta-analyses ( k ) 6 Total number of primary studies (N ps ) 110 Range = 9–65 Total no of participants in primary studies reviewed N = 28,910 Number of participants in individual primary studies M = 263 SD = 911 Range = 14–8,376 Participant characteristics Age M = 12.17y SD = 1.94 Range = 5–18y % Female¹ ( k = 2) M = 52.5% SD = 10.61 Range = 45–60% Health status Mainly healthy participants (k = 6) 6 100% % primary studies of children with health problems ( k = 5) M = 10.8% Range = 0–33% Interventions Type 1: Structured MBI in primary studies N = 74 67% Type 2: Other MBIs in primary studies N = 36 33 % Duration ( k = 6) Mean duration (hours) M = 10.4 SD = 7.43 Range = 0.3–40.5 Comparison groups % inactive control group M = 54.41% SD = 18.60 Range = 25–75% Outcomes Number of meta-analyses with post-treatment data ( k = 6) (% based on k = 6) Wellbeing 4 66% Mindfulness 3 50% Depression 4 66% Anxiety 5 83% Study design Trial design ( k = 6) RCT only 4 66% RCT & non-RCT 2 33% %non-RCT ( k = 6) M = 4.84% Range = 0–31% 1. Data on gender were missing in four meta-analyses Review quality The AMSTAR-2 scores for the 6 meta-analyses ranged from critically low to moderate quality, using a system of scoring based on the AMSTAR-2 tool guidelines (Shea et al., 2017 ). See Table S1 in Appendix C of Supplementary Information for AMSTAR-2 scores and rating system applied. All reviews demonstrated rigor in their quantitative synthesis of results of primary studies, including their use of meta-analytic techniques, measuring risk of bias in primary studies, addressing risk of bias in the interpretation of results, and likewise for publication bias. Areas of weakness were the lack by Carsley et al. ( 2018 ), Galla et al. (2024) and Fulambarkar et al. (2023) of pre-registration of their systematic reviews, and the fact that none of the reviews provided the list of excluded studies with reasons for exclusion. A non-critical item which no review met was the reporting of funding for the studies included in their meta-analysis, although all reported any funding or potential conflicts of interest for their own papers. In reviewing the evidence, it is important that a meta-analysis gives careful consideration to the quality of the primary studies (Sperling et al., 2025 ). Galla et al (2024) did not carry out their own quality assessment, instead accepting Dunning et al’s ( 2022 ) when using their data. The other reviews all used a quality assessment tool, and reported the results for included studies. Dunning et al ( 2022 ), Odgers et al (2020) and Fulambarkar et al (2023) used Cochrane Collaboration’s Risk-of-Bias Tool V.2 (Sterne et al., 2019 ), each developing a scoring system to rate the quality of primary studies, while Carsley et al ( 2018 ) used JADAD’s criteria (Jadad et al., 1996 ), and Kander et al (2024) the What Works Clearinghouse (WWC) tool. All reviews commented on significant variations in study quality, and called for an increased number of well-designed RCTs. Four reviews assessed if study quality moderated effects, with differing findings. Dunning et al ( 2022 ) and Kander et al (2024) found a correlation between higher quality studies and lower effect sizes for some outcome variables, and also Carsley et al ( 2018 ) to a lesser extent, while Odgers et al (2020) found no moderating effect. Assessment of the credibility of the evidence, using the GRADE (Guyatt et al., 2008 ) approach, which involved a four level rating of Very low, Low, Moderate to High, found that credibility was in the Very low range across all four variables. See Table S2 in Appendix D of Supplementary Information. GRADE ratings for individual meta-analyses fell between Very low and Moderate ranges, although many fell within the Low or Very low range, with low scores primarily due to difficulties with imprecision, given that an umbrella review measures each domain at a meta-analytic level. Pooled effect sizes A series of random-effects meta-analyses were conducted to assess the impact of MBIs on four outcome domains at post-test: wellbeing, mindfulness, depression, and anxiety. See Figs. 2 to 5 for forest plot depictions of the individual and pooled effect sizes for each of the four variables of wellbeing, mindfulness, depression and anxiety. Table 3 sets out the pooled effect sizes and related statistics. At post-treatment, MBIs showed small, statistically significant effects for wellbeing, mindfulness and anxiety, but no statistically significant effects for depression. For the three variables with statistical significance, in order of decreasing values, the effects were as follows: wellbeing g = 0.128 [0.01, 0.25]; anxiety g = 0.112 [0.06, 0.17]; mindfulness g = 0.11 [0.01, 0.21]. There was no statistically significant effect for depression, with a very small effect size ( g = 0.05). Table 3 Pooled effect sizes and heterogeneity tests at post-treatment Effect size statistics Heterogeneity tests Outcome measures k g 95% CI LL 95% CI UL z Q I 2 All comparisons at post-test Wellbeing 4 0.128 0.010 0.246 2.120* 21.526*** 86.063 Mindfulness 3 0.110 0.006 0.214 2.080* 2.737 26.924 Depression 4 0.049 -0.013 0.110 1.550 4.968 39.613 Anxiety 5 0.112 0.056 0.167 3.924*** 4.279 6.510 Note : k = number of meta-analyses. g = Standardized mean difference effect size based on comparison of MBI and inactive or active intervention control groups. CI confidence interval. LL = Lower limit of confidence interval. UL = Upper limit of confidence interval. z = z test. Q = test of heterogeneity of effect sizes. I 2 = test of heterogeneity of effect sizes indicating percentage variation. * p < 0.05. ** p < 0.01. *** p < 0.001. Studies were considered outliers if their 95% confidence interval did not overlap with the 95% confidence interval of the pooled effect size. Heterogeneity tests From Table 3 , it may be seen that the distribution effect sizes for wellbeing showed significant ( p 75%) heterogeneity. Heterogeneity was somewhat lower for the other three variables with the I ² statistic ranging from to moderate ( I 2 25–50%) for mindfulness and depression, to mild ( I 2 < 25%) for anxiety However, results must be interpreted with caution given the small sample size. Table 4 Meta regression moderator analysis Outcome measure 95%CI Moderator k Beta LL UL Q p R 2 Wellbeing Age 4 -0.0331 -0.1005 0.0342 0.93 0.335 0.00 % female 1 - - - - - - % health problems 1 - - - - - - Intervention duration 4 0.0690 -0.051 0.1432 3.33 0.0679 0.57 % inactive control group 4 -0.0045 -0.0065 -0.0025 19.54*** 0.0000 1.00 % non-RCT 4 0.0075 0.0001 0.0150 3.95* 0.0470 0.61 Depression Age 4 -0.0047 -0.0471 0.0376 0.05 0.8267 0.00 % female 1 - - - - - - % health problems 4 0.0024 -0.0002 0.0049 3.33 0.0682 1.00 Intervention duration 4 -0.0083 -0.1341 0.1174 0.02 0.8970 0.00 % inactive control group 4 -0.0024 -0.0079 0.0030 0.76 0.3833 0.21 % non-RCT 4 -0.0006 -0.0075 0.0063 0.03 0.8642 0.00 Anxiety Age 5 -0.0232 -0.0610 0.0145 1.45 0.2282 1.00 % female 1 - - - - - - % health problems 5 0.0020 -0.0011 0.0052 1.61 0.2050 1.00 Intervention duration 5 0.0562 -0.0091 0.1216 2.85 0.0915 1.00 % inactive control group 5 -0.0006 -0.0076 0.0064 0.03 0.8663 0.00 % non-RCT 5 -0.0013 -0.0093 0.0067 0.10 0.7484 0.00 Note: k = Number of meta-analyses. Beta = regression coefficient from meta-regression. 95%CI = 95% confidence interval for meta-regression coefficient. LL = lower limit of confidence interval. UL = Upper limit of confidence interval. Q = Q test for meta-regression. p = probability level for Q test. R 2 = proportion of variance accounted for by moderator. * p < .05.** p < .01. *** p < .001. Where k < 4, it was not possible to carry out a moderator analysis. Moderator analyses Moderator analyses were conducted on post-treatment data, where there was sufficient data, for continuous variables of: age, %female, %health problems, intervention duration, %inactive control group and %non-RCT. Where k < 4, it was not possible to conduct moderator analyses. Table 4 sets out the results of moderator analyses. Wellbeing was the only variable which showed evidence of moderator effects, with greater effect sizes seen where there was a relatively higher proportion of non-RCTs, and lower effects sizes where there was a higher percentage of inactive control groups, with the moderating effect strongest for the latter. Review overlap The 6 meta-analytic reviews included in this paper covered a total of 110 primary studies. The meta-analysis by Galla (2024) involved the extraction of data from 32 of the 66 studies covered by Dunning’s (Dunning et al, 2022 ) meta-analysis. Galla’s meta-analysis was included because it ran a separate series of tests focused only on adolescents, which was deemed useful. The CCA Index was calculated to establish the potential risk of overlap bias, with the result of 0.30, indicating a slight risk of overlap bias, using Pieper’s method. Publication bias Egger’s test results were not significant for wellbeing (intercept = 3.64, t (2) = 1.69, p > .1), mindfulness (intercept = 0.62, t (1) = 0.19, p > .1), depression (intercept = 1.46, t (2) = 1.63, p > .1), or anxiety (intercept = 0.84, t (3) = 0.88, p > .1). This indicated that there was no funnel plot asymmetry, and that results of the current meta-analysis were not affected by publication bias. However, because there was a small number of reviews in this meta-analysis ( N = 3–5), publication bias test results must be interpreted with caution. Discussion The primary aim of this umbrella systematic review was to review the evidence base for school-based MBIs, exploring the scale, quality and findings of controlled trials in this area. The outcomes of interest to this paper were positive outcomes (wellbeing and mindfulness) and negative outcomes (anxiety and depression). Data were extracted from 6 systematic reviews with meta-analyses, which encompassed 110 primary studies and more than 28,000 children and adolescents. Children ranged in age from 5 years to 18 years, with a mean age of 12.17 years. While there was an overlap of primary studies in included reviews, the CCA Index (Pieper et al., 2014 ) indicated a low risk of overlap bias. There was a wide range of interventions represented in the primary studies, from frequently featured structured interventions such as MBSR, MBCT and Learning to Breathe, to more loosely structured MBIs such as Mindfulness meditation or MBIs with additional components, such as MindUP or ICP. The sample sizes of primary studies also varied very significantly, from single classes to major, multi-school projects. Almost all reviews had used a recognised methodological assessment tool to assess methodological quality of primary studies, and all noted a significant variation in quality and recommended an increase in the number of large well-designed RCTs. Several, although not all, reviews found an association between higher study quality and lower effect size for some outcomes. The AMSTAR-2 tool was used to assess methodological quality of reviews, with mixed evidence of rigour. Most reviews scored well on critical items such as detailed search strategy, use of PICOS, statistical tests used, reporting conflicts of interest, and pre-registration of the systematic review protocol, but there were methodological weaknesses in some areas, in particular the lack of pre-registration of several reviews, and lack of publication of excluded studies by all reviews. Notably, all reviews failed to include a list of excluded studies and given that this is regarded by the AMSTAR-2 developers as a critical criterion, it had a significant effect on the review quality ratings. Marks were also lost for the critical criterion regarding search strategy (criterion 4) as most reviews had excluded grey literature and/or consultation with an expert in the field. However, there has been some criticism of a lack of clarity by the AMSTAR-2 developers with regard to this item as one of the review authors or co-authors might be regarded as an expert in the field (De Santis et al., 2023 ). The GRADE tool was used to assess the certainty of the evidence, with overall ratings falling in the Very low range. The primary reasons for this was heterogeneity among primary studies, small effect sizes, and wide confidence intervals which sometimes crossed the null. This finding resonates with the included review interpretations, all of which highlighted difficulties in these areas, commenting on the need for an increased number of rigorous RCTs in this field. A meta-analysis of review data found that school-based mindfulness programmes have significant, but very small or negligible effects on trait wellbeing, trait mindfulness and trait anxiety; and non-significant effects on trait depression; in school children who do not have clinical problems. It wasn’t possible to statistically evaluate if effects were maintained over time, as there was insufficient follow-up data. Results of moderator analyses on variables of age, gender, proportion inactive control groups, proportion of children with health problems, intervention duration, and proportion non-RCT showed no evidence of impact on effect, with the exception of wellbeing, where greater effect sizes were seen where there was a higher proportion of non-RCTs, and lower effect sizes where there was a higher proportion of inactive control groups. These results must be viewed with caution as, although 110 studies were effectively covered by the umbrella review, the statistical tests were on the six reviews which had reviewed those primary studies, making it a small sample size (Borenstein, 2010). When compared to other major reviews, the current paper’s findings regarding wellbeing were consistent with those included reviews which had measured wellbeing, with the exception of Dunning et al ( 2022 ). However, the current paper’s finding that MBIs have a positive effect on trait anxiety resonate with some of the included reviews (e.g. Dunning et al, 2022 and Galla et al (2024), but not others (e.g. Fulambarkar et al (2023). Additionally, there were differences in findings even where there was a relatively significant crossover of primary studies, such as Fulambarkar et al (2023) and Galla et al (2024), where six of the nine studies in Fulambarkar et al’s (2023) review were among the 22 studies in Galla et al (2024). An interesting finding of Galla et al’s (2024), which was not seen in other reviews, was that mindfulness decreased for adolescents following completion of an MBI for the MBI intervention group versus passive control. The authors described this as counter-intuitive and commented that there might be a possibility of a Type 1 error, also commenting on a related issue mentioned by several other researchers in this area, namely that the passive control groups used in research on schools-based MBIs often involve engagement in the school’s social and emotional learning curriculum, which in itself might have benefits. Given the amount of discussion in the field about age as a potential moderating variable, it might have been expected that this paper would have found evidence of age as a moderator, but this was not the case. The moderating effect seen with regard to non-RCTs is consistent with evidence that non-RCTs can tend to report greater effect sizes and be more prone to bias than RCTs (Anglemyer et al., 2014 ). The moderating effect relating to inactive control groups resonates with the findings of the MYRIAD trial (Kuyken et al, 2022 ), the largest primary study among the 110 in this review, with those authors commenting that inactive control was often the social and emotional learning curriculum, which therefore might have a positive impact on wellbeing and merit further research. There are a number of limitations to the current paper. Firstly, a relatively small number of meta-analyses met inclusion criteria and so the results of meta-analytic tests must be viewed with caution. While 110 primary studies were encompassed under the umbrella of this review, the effect size data was extracted from 6 reviews. Secondly, the four outcome variables which this paper focused on were not always directly measured by the reviews, a common limitation of umbrella reviews (Fernandez et al., 2025 ). While there was a direct correlation with the majority, there wasn’t a neat fit for two reviews (Carsley et al, 2018 , and Kander et al, 2024). Thirdly, state wellbeing was not measured by any of the reviews, and state wellbeing may capture the potential mechanisms of change regarding MBIs for children, namely the way in which mindfulness can support emotional regulation for children, which can have longer term benefits (Maynard et al., 2017 ). Fourthly, two of the reviews had not pre-registered the systematic protocol, and the review which used secondary data had not carried out its own quality assessment of primary studies. Fifthly, an umbrella review does not extract data from primary studies, so any human error that might have been made with data extraction by a review would effectively be carried forward to this paper. Limitations which apply to the included reviews would also, by definition, likewise apply to the umbrella review (Fusar-Poli, 2018 ). Finally, the umbrella review is a relatively new research tool and while this paper used methodological best practices as a guide, further benefits and limitations of this type of research will emerge over time. For example, the GRADE tool is a highly regarded tool for meta-analyses, but it was developed for meta-analyses of primary studies and there are some limitations in its application to umbrella reviews (Sadoyu et al., 2022 ). Given these limitations, the results of this paper, in particular the moderator analysis and Egger test publication bias results, should be interpreted with caution. There are a number of strengths to the current paper. Firstly, this is the first umbrella review to have been carried out on a rapidly expanding area of acknowledged importance for children’s health and wellbeing. A benefit of the umbrella review is the capacity to consider the broad evidence base by defining eligibility criteria and drawing on the findings of systematic reviews which meet those criteria, facilitating the inclusion of a significant amount of data. (Sadoyu et al., 2022 ). The conclusions drawn by this umbrella review are based on 110 studies involving over 27,000 children. The findings show that school-based MBIs may have very small but statistically significant positive effects on ‘trait’ wellbeing, mindfulness and anxiety variables, but not on depression. A further strength is the methodological rigour which was shown in this review, including the use of PRISMA guidelines, pre-registration of the protocol, and quality and credibility assessment tools of AMSTAR-2 and GRADE. In terms of implications for research policy and practice, this review has highlighted significant gaps in follow-up data for schools-based MBIs and in the reporting of gender by primary studies, areas which would merit addressing in future primary studies. The majority of studies encapsulated in this review were of general school populations, rather than clinical samples. There is a rationale for carrying out more research on the use of MBIs with clinical populations as the results of subgroup analyses of clinical groups within school populations, suggested that there may be different results for general and clinical populations. It would also be useful for researchers who are planning primary studies to consider the use of state wellbeing measures when measuring the potential effectiveness of schools-based MBIs, given the potential mechanisms of change of MBIs for children. Declarations Ethical standards The manuscript does not contain clinical studies or patient data. 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J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ , 372 , n71. https://doi.org/10.1136/bmj.n71 Pieper, D., Antoine, S. L., Mathes, T., Neugebauer, E. A. M., & Eikermann, M. (2014). Systematic review finds overlapping reviews were not mentioned in every other overview. Journal of Clinical Epidemiology , 67 (4), 368–375. https://doi.org/10.1016/j.jclinepi.2013.11.007 Sadoyu, S., Tanni, K. A., Punrum, N., Paengtrai, S., Kategaew, W., Promchit, N., Lai, N. M., Thakkinstian, A., Ngorsuraches, S., Bangpan, M., Veettil, S., & Chaiyakunapruk, N. (2022). Methodological approaches for assessing certainty of the evidence in umbrella reviews: A scoping review. PloS one , 17 (6), e0269009. https://doi.org/10.1371/journal.pone.0269009 Schonert-Reichl, K. A., Oberle, E., Lawlor, M. S., Abbott, D., Thomson, K., Oberlander, T. F., & Diamond, A. (2015). Enhancing cognitive and social-emotional development through a simple-to-administer mindfulness-based school program for elementary school children: A randomized controlled trial. Developmental psychology , 51 (1), 52–66. https://doi.org/10.1037/a0038454 Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse . Guilford Press. https://go.exlibris.link/0Hv0dMQx Semple, R. J., Lee, J., Rosa, D., & Miller, L. F. (2010). A randomized trial of mindfulness-based cognitive therapy for children: Promoting mindful attention to enhance social-emotional resiliency in children. Journal of Child and Family Studies , 19 (2), 218–229. https://doi.org/10.1007/s10826-009-9301-y Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology , 62 (3), 373–386. https://doi.org/10.1002/jclp.20237 Shea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Moran, J., Moher, D., Tugwell, P., Welch, V., Kristjansson, E., & Henry, D. A. (2017). AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ (Online) , 358 , j4008–j4008. https://doi.org/10.1136/bmj.j4008 Sibinga, E. M. S., Perry-Parrish, C., Chung, S., Johnson, S. B., Smith, M., & Ellen, J. M. (2013). School-based mindfulness instruction for urban male youth: A small randomized controlled trial. Preventive medicine , 57 (6), 799–801. https://doi.org/10.1016/j.ypmed.2013.08.027 Sibinga, E. M. S., Webb, L., Ghazarian, S. R., & Ellen, J. M. (2016). School-based mindfulness instruction: An RCT. Pediatrics (Evanston) , 137 (1), 1. https://doi.org/10.1542/peds.2015-2532 Solar, E. (2018). Mindfulness Meditation with High School Students Who Receive Special Education Services: Research Recommendations from a Pilot Study. Journal of the American Academy of Special Education Professionals , 146 , 161. Sperling, E. L., Khoury, B., Sutton, A., Price-Blackshear, M. A., & Bettencourt, B. A. (2025). Enhancing Rigor in Quantitative Meta-Analyses for Mindfulness Research: A Comprehensive Guide. Mindfulness , 16 (2), 315–331. https://doi.org/10.1007/s12671-025-02517-8 Steer, P. J., & Ernst, S. (2021). Peer review - Why, when and how. International Journal of Cardiology Congenital Heart Disease , 2 , 100083. https://doi.org/https://doi.org/10.1016/j.ijcchd.2021.100083 Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H. Y., Corbett, M. S., Eldridge, S. M., Emberson, J. R., Hernán, M. A., Hopewell, S., Hróbjartsson, A., Junqueira, D. R., Jüni, P., Kirkham, J. J., Lasserson, T., Li, T., & Higgins, J. P. T. (2019). RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ (Online) , 366 , l4898–l4898. https://doi.org/10.1136/bmj.l4898 Tan, L., & Martin, G. (2015). Taming the adolescent mind: a randomised controlled trial examining clinical efficacy of an adolescent mindfulness-based group programme. Child and Adolescent Mental Health , 20 (1), 49–55. https://doi.org/10.1111/camh.12057 Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and Validation of Brief Measures of Positive and Negative Affect: The PANAS Scales. Journal of personality and social psychology , 54 (6), 1063–1070. https://doi.org/10.1037/0022-3514.54.6.1063 Wimmer, L., Bellingrath, S., & von Stockhausen, L. (2016). Cognitive effects of mindfulness training: Results of a pilot study based on a theory driven approach. Frontiers in Psychology , 7 , 1037–1037. https://doi.org/10.3389/fpsyg.2016.01037 Zoogman, S., Goldberg, S. B., Hoyt, W. T., & Miller, L. (2015). Mindfulness interventions with youth: A meta-analysis. Mindfulness , 6 (2), 290–302. https://doi.org/10.1007/s12671-013-0260-4 Additional Declarations No competing interests reported. Supplementary Files SupplementaryInformationMindfulnessJournalsubmission.docx Cite Share Download PDF Status: Published Journal Publication published 18 Mar, 2026 Read the published version in Mindfulness → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6932647","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475580220,"identity":"e6d98a03-2984-4107-a51e-5ceb12b983e5","order_by":0,"name":"Sinead Grennan","email":"","orcid":"","institution":"University College Dublin","correspondingAuthor":false,"prefix":"","firstName":"Sinead","middleName":"","lastName":"Grennan","suffix":""},{"id":475580221,"identity":"f9acb67a-6f7b-4751-83a7-7f5357ce88e1","order_by":1,"name":"O'Dowd Annie","email":"","orcid":"","institution":"University College 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flow\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6932647/v1/a4f0efdf540c5fa812367336.png"},{"id":85616920,"identity":"a8c13150-a94e-4648-b94e-90365c00a863","added_by":"auto","created_at":"2025-06-29 14:40:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":134184,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eForest plot depicting the individual and summary effects for MBIs relative to controls for Wellbeing\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6932647/v1/213e56802d4aa49d0df70f3f.png"},{"id":85619300,"identity":"2479925a-2b8f-4de0-8f9e-5e10424d36a2","added_by":"auto","created_at":"2025-06-29 14:56:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":119627,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eForest plot depicting the individual and summary effects for MBIs relative to controls for Mindfulness\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6932647/v1/c71192ecc868a86acbf97f9a.png"},{"id":85616922,"identity":"61e450ac-76d6-42a8-9b42-1cff870fca29","added_by":"auto","created_at":"2025-06-29 14:40:16","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":131170,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eForest plot depicting the individual and summary effects for MBIs relative to controls for Depression\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6932647/v1/771e6f8fc1121c906635cb68.png"},{"id":85618078,"identity":"18aefa24-0667-48a8-a0d4-300872b4e25e","added_by":"auto","created_at":"2025-06-29 14:48:17","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":143493,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eForest plot depicting the individual and summary effects for MBIs relative to controls for Anxiety\u003c/em\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6932647/v1/358beb24ee18fcd76028c9be.png"},{"id":105224200,"identity":"64f980ed-97da-40d9-9827-57d02ade63ea","added_by":"auto","created_at":"2026-03-23 16:13:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2185102,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6932647/v1/27ca447a-88c2-4085-976a-ffae4979411d.pdf"},{"id":85618074,"identity":"85637dc2-77a6-4e8b-85dd-19ba220cc194","added_by":"auto","created_at":"2025-06-29 14:48:16","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":34286,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryInformationMindfulnessJournalsubmission.docx","url":"https://assets-eu.researchsquare.com/files/rs-6932647/v1/49d3db49e72f90f786d9d9ab.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"An umbrella review of meta-analyses of school-based Mindfulness Based Interventions (MBIs)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMindfulness-Based Interventions (MBIs) have been found to be an effective tool for enhancing resilience (O’Connor et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), reducing anxiety and depression, and improving wellbeing for the adult population (Khoury et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). The concept of mindfulness is based on Zen meditation, and was adapted for use with clinical populations by Jon Kabat-Zinn, who developed the influential Mindfulness Based Stress Reduction Programme (MBSR) some 40 years ago (Kabat-Zinn, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e1982\u003c/span\u003e) and continued to integrate mindfulness with other mind and body approaches such as yoga since then (Kabat-Zinn, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). The core elements of mindfulness have variously been described as attention, intention and attitude (Shapiro et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), or attention and awareness, cultivation, person-centredness and ethical-mindedness (Nilsson \u0026amp; Kazemi, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Kabat-Zinn has defined mindfulness as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2003\u003c/span\u003e, p. 145).\u003c/p\u003e \u003cp\u003eWhile mindfulness interventions for child and adolescent populations are still relatively new, emerging in the past twenty years, there is good evidence of their effectiveness with a range of clinical and non-clinical populations (Zoogman et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). There have been adaptations of now widely implemented, evidence-based MBIs such as Mindfulness Based Cognitive Therapy (MBCT) (Segal et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) for the child and adolescent population, named MBCT-C (Semple et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), as well as new MBIs which are tailored for the child and adolescent population, such as MindUp (Schonert-Reichl et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the extensive and ever-increasing number of MBIs being developed, leading experts in the field of mindfulness, including Kabat-Zinn, came together in 2017 to develop a framework to facilitate the identification of an MBI, ‘what a mindfulness programme is and what it is not’ (Crane et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, p. 990). They used the analogy of warp and weft, with the ‘warp’ being the essential elements and ‘weft’ the adaptations to a particular context and/or population. They proposed that an MBI must be based upon theories and practices across ‘contemplative traditions, science and the major disciplines of medicine, psychology and education’, while variable elements (‘the weft’) could include duration and programme structure (p. 992). Crane et al (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) identified ‘first-generation’ mindfulness based programmes such as MBSR and MBCT, which have systematic training in mindfulness meditation practices as a defining feature.\u003c/p\u003e \u003cp\u003eAs the implementation of mindfulness-based programmes for young people has grown, so too has the research base, with a number of meta analyses carried out focusing on aspects of impact, such as the factors contributing to intervention effectiveness (Carsley et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and intervention efficacy (Kallapiran et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), or examining by study type, such as the randomized controlled trial (Dunning et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevious systematic reviews have reported mixed findings. One of the earliest systematic review of school-based MBIs, in 2016, reviewed 28 MBIs and reported that many of the studies had positive findings, as measured by outcomes such as emotional regulation, social skills, classroom engagement, coping and positive affect, and reduced reported levels of negative outcomes such as depression, anxiety and suicidal ideation (Felver et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Felver et al commented that the literature in this area had many limitations and made a series of recommendations as to how that might be addressed, including more use of experimental research design, using active control conditions, reporting full details of student characteristics, and the use of existing MBIs, commenting on the wide range and variation in MBIs, which made comparison difficult. Another systematic review in 2016 (Black, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) also commented on the increasing implementation of MBIs with children and adolescents and called for more research, arguing that although there was now a substantial evidence base for benefits of MBIs for adult populations, this couldn’t be assumed to be the case for children too, given the cognitive, social and emotional differences between adults and children. In considering effectiveness, reviewers explored changes in positive indicators such as social-emotional learning, academic outcomes, cognition (Maynard et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and wellbeing (Carsley et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Dunning et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and negative indicators such as depression and/or anxiety (Dunning et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Zoogman et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The issue of whether the evidence base points to a difference in effects for clinical and non-clinical populations is also unclear, with some reviewers finding evidence of reduced psychopathology, regarding anxiety and depression, for clinical populations (Zoogman et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). A developmental perspective has also been considered, with some reviewers noting that children do not yet have the meta-cognitive abilities which are shown to play a role in the process of change which mindfulness engenders (Greenberg \u0026amp; Harris, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAn umbrella review, or synthesis and meta-analysis of existing meta-analyses, is a relatively recent methodological tool that is increasingly being used to synthesise learnings in different fields. When a rigorous methodological approach is taken, the umbrella review can be a useful source of information for clinicians and decision makers, facilitating a clear understanding of a broad topic (Aromataris, 2015). In this case, an umbrella review is being carried out in order to assess the overall strength of the evidence base for school-based MBIs with the child and adolescent population.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe current systematic review\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe aim of this umbrella review is to carry out a meta-analytic synthesis of existing meta-analyses of school-based MBIs to determine the impact of these programmes on positive outcomes (well-being and mindfulness) and negative outcomes (depression and anxiety) for the child and adolescent population. Whereas in a standard meta-analysis, the unit of analysis is a primary study or single piece of research, the analytical unit here is the meta-analysis.\u003c/p\u003e \u003cp\u003eThe review addressed the following five research questions:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow large is the evidence base on the effects of school-based MBIs?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat is the quality of the evidence base for the effects of school-based MBIs?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat effect do school-based MBIs have on positive outcomes (well-being and mindfulness) and negative outcomes (depression and anxiety)?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAre the effects of school-based MBIs sustained over time?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat variables moderate the effects of school-based MBIs on positive and negative outcomes?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003cp\u003e\u003c/p\u003e "},{"header":"Method","content":"\u003cp\u003eThis umbrella review and meta-analysis employed best practice methodological guidelines to maximise rigour, transparency and reproducibility (Aromataris, 2015; Hennessy et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement (Page et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) was followed, and the review pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42025636892) to minimise bias and reduce duplication (National Institute for Health and Care Research). The only deviations from the pre-registered review were: the addition of mindfulness as an outcome variable; a minor change to the screening stage, whereby all studies, rather than a sample of 25%, were independently screened by two reviewers; the decision not to sum AMSTAR-2 scores to produce an overall quality score, instead calculating an overall quality rating based on scores for critical and non-critical criteria, to be consistent with the AMSTAR-2 developer recommendations (Shea et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2017\u003c/span\u003e); the addition of the application of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess certainty of the evidence; and a slight amendment of the title of the review for greater clarity.\u003c/p\u003e\u003cp\u003e \u003cb\u003eEligibility criteria\u003c/b\u003e \u003c/p\u003e\u003cp\u003eEligibility criteria were developed using the PICOS (population intervention comparison outcome and study type) framework (Methley et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cb\u003eInclusion criteria\u003c/b\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eTypes of participants\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eParticipants in the primary studies reviewed by the meta-analysis were children aged between 5 and 18 years, and could be from clinical or non-clinical populations.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003eTypes of interventions\u003c/em\u003e: Mindfulness based Interventions in the primary studies had to feature mindfulness as a core component, with the intervention delivered in a school or similar setting, within school hours. There were no other limits set on the mode of delivery or who delivered the intervention. We categorised MBIs into two types: Structured MBIs which are based on the ‘first generation’ MBIs; and Other MBIs, which involve one or a small number of elements of first generation MBIs, or have additional components such as social emotional learning.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eComparison Groups\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe control group could be an Inactive Intervention (II), such as no-treatment or waiting list control (WLC), or an Alternative Intervention (AI) such as treatment as usual or an evidence-based therapeutic treatment (such as cognitive behaviour therapy).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eOutcome Measures: The primary outcome variable for this meta-analysis was well-being, with mindfulness, depression and anxiety secondary variables. Systematic reviews were included if the studies they reviewed measured at least one of the four variables, and if the meta-analyses’ inclusion criteria stipulated the use of validated outcome measures. A wide range of measures was deemed acceptable. For example, self-report measures for subjective and/or psychological wellbeing might include the Stirling Children's Wellbeing Scale (SCWS) (Liddle, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) or the Positive and Negative Affect Scale (PANAS) (Watson et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e1988\u003c/span\u003e); mindfulness the Mindful Attention Awareness Scale (MAAS) (Brown \u0026amp; Ryan, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2003\u003c/span\u003e); anxiety the State Trait Anxiety Inventory (STAI) (Marteau \u0026amp; Bekker, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2020\u003c/span\u003e); and depression the Depression Anxiety Stress Scale (DASS) (Lovibond \u0026amp; Lovibond, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e1995\u003c/span\u003e) or Revised Children’s Anxiety and Depression Scale (RCADS-25) (Ebesutani et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eStudy type\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eA key inclusion criterion was that the meta-analysis must involve only controlled studies. While randomised controlled studies are regarded as the gold standard for systematic reviews, non-randomised controlled studies were also included as they can provide useful information, once quality and risk of bias is considered in the analysis (McKenzie, 2023). Furthermore, non-RCTs can be clinically useful in an emerging field such as mindfulness given the length of time that RCTs can take, and moderator analyses can be carried out to explore potential differences between RCT and non-RCT results in a meta-analysis (Sperling et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe meta-analysis must also have been published in a peer-reviewed journal, in the English language. The peer review process involves an assessment of a study or review across all aspects of the paper, including quality, objectivity, study/review design, limitations and strengths, by a person who has expertise in the field to which the study or review, and constitutes a valuable check to ensure that research published in that journal is truthful, valid and accurate (Steer \u0026amp; Ernst, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cb\u003eExclusion criteria\u003c/b\u003e \u003c/p\u003e\u003cp\u003eMeta-analyses of uncontrolled studies which reported pre and post results for the intervention group but had no control group were excluded. Meta-analyses which included primary studies in which mindfulness was a secondary rather than primary component (e.g. Dialectical Behavior Therapy, Acceptance Commitment Therapy) were also excluded.\u003c/p\u003e\u003cp\u003e \u003cb\u003eSearch strategy and selection process\u003c/b\u003e \u003c/p\u003e\u003cp\u003eThe search strategy involved searches of five electronic databases: PubMed, PsycINFO, Education Resource Information Centre (ERIC), The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Database of Systematic Reviews (CDSR). The specified dates were from January 2000 to end December 2024. Keywords included mindfulness, programmes, school-based, child, adolescent, wellbeing, depression and anxiety. The search string specified the paper Title and Abstract, with search terms including (mindfulness*) AND (program* OR intervention* OR therap*) AND (school*) AND (child* OR adolesc* OR young* OR youth*) AND (wellbeing* OR well-being OR anxiety OR depress*) AND (meta-analys* OR meta analys* OR meta-synth* OR meta synth*). See Appendix A of Supplementary Information for further details.\u003c/p\u003e\u003cp\u003eReference lists of reviews which passed the initial screening were manually reviewed and meta-analyses potentially meeting eligibility criteria put forward for screening (Aromataris \u0026amp; Riitano, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). PROSPERO was searched for ongoing or recently completed systematic reviews, and Mindfulness and Journal of Positive Psychology journals for the years 2020-end 2024 were manually searched.\u003c/p\u003e\u003cp\u003eReferences of all articles identified in searches were uploaded by the primary researcher to Covidence (Covidence Systematic Review software). Covidence facilitates the uploading of search results, screening at abstract and full text stages, multiple reviewer assessment, and resolution of any reviewer disagreements. Two researchers independently conducted full screening at abstract and full text screening stages, with reference to the agreed inclusion and exclusion criteria. Any disagreements were discussed and resolved by consensus. On three occasions, there was consultation with a third researcher to clarify the inclusion or exclusion of Odgers et al (2020) with regard to setting, and Dunning et al (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) (Dunning et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) and Galla et al (2024) with regard to study overlap. It was decided that as the majority of primary studies reviewed in Odger et al’s (2020) meta-analysis had been conducted in school settings, it would be included in the current review. It was decided that as all but three primary studies in Dunning et al (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) were included in Dunning et al (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and those three studies had not been peer-reviewed, it would be excluded; and that although Galla et al’s (2024) meta-analysis reviewed a subset of Dunning et al’s (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) meta-analysis it would be included as it had extracted additional data from the primary studies.\u003c/p\u003e\u003cp\u003e \u003cb\u003eData extraction and quality assessment\u003c/b\u003e \u003c/p\u003e\u003cp\u003e An Excel codebook was created to facilitate data extraction and quality assessment of the included reviews. Data were extracted on review characteristics and outcome variables. Review characteristics included review design (inclusion of RCT only, or RCT + non-RCT), mode of delivery of interventions in the primary studies included in the review (face-to-face, online, both) and duration of intervention (mean number of hours), number of primary studies, number of participants in treatment and control groups, number of studies/comparisons with active control groups, number of studies/comparisons with inactive control groups, mean age, and gender (number of females). Key extracted data included standardized mean difference effect sizes and 95% confidence intervals and the number of primary studies on which these were based for well-being, mindfulness, anxiety, and depression at post-treatment and follow-up for all studies, primary studies with active control groups, and primary studies with inactive control groups. All effect sizes were keyed so that positive values indicated greater well-being or fewer symptoms in the intervention group compared with the control group. Where effect sizes for multiple indices of an outcome variable were reported, the effect size for the broadest index (for example total wellbeing) was extracted, or the average effect size was computed for a number of indices of similar breadth (e.g., subjective well-being and psychological well-being).\u003c/p\u003e\u003cp\u003eA Measurement Tool to Assess Systematic Reviews (AMSTAR-2) was used to assess and rate the methodological quality of each review (Shea et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). AMSTAR-2 assesses each review against 16 criteria, which are classified as either critical or non-critical.\u003c/p\u003e\u003cp\u003eA second reviewer conducted data extraction and quality assessment for a randomly selected sample of 33% of records. An inter-rater reliability assessment was conducted with Cohen’s Kappa Coefficient of Agreement (Cohen, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e1960\u003c/span\u003e). Any disagreements were resolved through discussion and consensus.\u003c/p\u003e\u003cp\u003eThe Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence in the included reviews (Guyatt et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), following the system set out in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins, 2024). This approach assesses the quality of evidence and strength of recommendations in five domains: risk of bias (design and delivery limitations), inconsistency (or heterogeneity), indirectness (PICOS), imprecision (number of events, confidence intervals), and publication bias; with certainty of evidence rated as very low, low, moderate or high (McKenzie, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cb\u003eData Analysis/Synthesis\u003c/b\u003e \u003c/p\u003e\u003cp\u003eUsing Comprehensive Meta-Analysis software (Borenstein, 2013), separate meta-analyses using the random-effects model were conducted on effect sizes from included meta-analyses for wellbeing, mindfulness, depression, and anxiety. Random rather than fixed effects analyses were conducted to take account of heterogeneity of scores on outcome variables (Borenstein, 2010). Hedges’ g pooled effect size magnitudes (Hedges, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e1981\u003c/span\u003e) were interpreted using Cohen's convention of small (0.2), medium (0.5), and large (0.8) (Cohen, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1988\u003c/span\u003e). The statistical significance of heterogeneity of effect sizes was assessed with Cochran’s Q statistic, and the degree of heterogeneity determined with the I² statistic (Higgins \u0026amp; Thompson, 2002).\u003c/p\u003e\u003cp\u003eWhere there were data on more than 3 review moderators, meta-regression analyses were conducted on post-treatment data for the following continuous variables: mean age, % females, % health problems, intervention duration, % inactive control group and % non-RCT.\u003c/p\u003e\u003cp\u003eThe extent to which the inclusion of the same primary studies in multiple meta-analyses biased the results of the current meta-analysis was evaluated with the Corrected Cover Area (CCA) index (Pieper et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). To calculate CCA, a citation matrix was set up, with one meta-analysis per column, and all included primary studies in each meta-analysis listed, one per row. The rows were sorted alphabetically, duplicates removed, and a check mark made for each primary study included in each review. The citation matrix yielded three indices: k the total number of boxes in the citation matrix containing checkmarks; r, the number of rows (primary studies); and c, the number of columns (meta-analyses). These three indices were used to compute the CCA with the formula CCA = (k-r) /([rxc]-r), and interpreted using Pieper and colleagues’ (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) criteria: 0–5 = slight, 6–10 = moderate, 11–15 = high, and \u0026gt; 15 = very high risk of overlap biasing second order meta-analytic results. An excel spreadsheet was used to list the interventions and sample sizes of primary studies, with an indication of which reviews had included which primary study.\u003c/p\u003e\u003cp\u003eFor all the four dependent variables (wellbeing, mindfulness, depression and anxiety) Egger’s test (Sterne \u0026amp; Egger, 2005) and trim and fill procedures (Duval, 2005) were used to detect and normalise funnel plot asymmetry (Peters et al., 2008) and determine the impact of publication bias on current meta-analysis results.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSystematic review selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe search strategy yielded a total of 73 potential papers, with that number reduced to 53 after duplicates were removed, and 20 when abstracts were screened. Full-text articles were then reviewed, with 14 excluded. References for the included and excluded studies are set out in Appendix B of Supplementary Information, grouped by reason for exclusion (e.g. incorrect study design, incorrect outcomes, incorrect intervention etc), and AMSTAR-2 scores of the included reviews in supplementary Table\u0026nbsp;2.S.1 in Appendix C of Supplementary Information. The flow of information and reasons for exclusion are set out in the PRISMA flowchart (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). A. total of 6 reviews with meta-analyses met inclusion criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData extraction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were extracted as set out above. A second rater extracted data for 33% of the included reviews. The rater scores were uploaded to IBM SPSS Statistics software (Version 27) and the Cohen\u0026rsquo;s Kappa statistic was run to test inter-rater reliability. The result (\u003cem\u003eķ\u003c/em\u003e = 0.925) indicated high agreement (Fleiss et al., \u003cspan class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSystematic review characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe characteristics of the 6 included reviews are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The reviews were published between 2018 and 2024. All included a meta-analysis. Four of the six reviews involved only RCTs, while two included non-RCTs in their analysis. The reviews evaluated 170 primary studies. When duplicates were removed, there were a total of 110 primary studies, with a total of 28,910 participants. Review characteristics are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, and summary details in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of participants (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;28,910) was 12.17 years (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.94, range\u0026thinsp;=\u0026thinsp;5-18y). In all 6 reviews the majority of participants of the included primary studies were in good health. On average, 10.8% of primary studies contained children with physical or mental health problems. The mean number of participants in the reviewed primary studies was 263 participants (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;911, range\u0026thinsp;=\u0026thinsp;14\u0026ndash;8,376), with the primary studies ranging from MBIs delivered to small groups of children to major multi-school projects. The smallest sample involved an MBI delivered to a clinical group of children with generalised anxiety in Iran (\u003cem\u003eN\u0026thinsp;=\u003c/em\u003e\u0026thinsp;14) (Dehghani et al., \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e) and the largest the My Resilience in Adolescence (MYRIAD) Trial, a major project which involved 85 schools in the United Kingdom (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8,376) (Kuyken et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). Primary studies were carried out throughout the world, with the majority carried out in Western, high-income countries such as the US, Canada, Europe and Australia, with other locations including countries in Asia and Africa.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInterventions\u003c/em\u003e: The majority of interventions which were evaluated in the systematic reviews\u0026rsquo; primary studies were structured MBIs (n\u0026thinsp;=\u0026thinsp;74), classified here as Type 1; with the remainder falling into a broader category of mindfulness activities/programmes with additional components (n\u0026thinsp;=\u0026thinsp;36), classified here as Type 2. Interventions are listed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, where the review had provided an intervention name. Type 1 interventions included Mindfulness Based Stress Reduction (MBSR) (Cohen et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e; Sibinga et al., \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e; Sibinga et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e), Mindfulness-based Cognitive Therapy (MBCT) (Atkinson \u0026amp; Wade, \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e; Semple et al., \u003cspan class=\"CitationRef\"\u003e2010\u003c/span\u003e), Learning to Breathe (Lam \u0026amp; Seiden, \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e), dot.be (Lassander et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e), MindKinder (Moreno-G\u0026oacute;mez \u0026amp; Cejudo, \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e), and Taming the adolescent mind (Tan \u0026amp; Martin, \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e). Type 2 interventions included Guided mindfulness (Solar, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e), Mindfulness meditation (Wimmer et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e), Mindfulness oriented meditation (Crescentini et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e), MindUP (Schonert-Reichl et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e), Integrative Contemplate Pedagogy (Britton et al., \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e) and the Gaia Project (Ghiroldi et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). Primary studies were consulted where there was a lack of clarity as to the categorisation for this paper, and categorisation then made. Carsley (2018) had grouped interventions into: Established mindfulness programmes (which were categorised in this paper as Type 1); and Various mindful activities, Mindfulness-based yoga and Other (which were categorised in this paper as Type 2).\u003c/p\u003e\n\u003cp\u003eThe mean duration of all interventions was 10.4 hours (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.43, range 0.3\u0026ndash;40.5). On average 67% of primary studies in meta-analyses involved structured MBI interventions. The mean duration of this type of intervention was 10.8 hours (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.04, range\u0026thinsp;=\u0026thinsp;2\u0026ndash;41).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison conditions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe number of comparisons between MBI treatment and Active Intervention (IA) comparison groups was 66. Active interventions included educational activities such as study skills, emotional literacy, life skills, curriculum as usual; relaxation activities such as progressive muscle relaxation or relaxation; or mind-body activities such as hatha yoga. There were 91 comparisons between MBI treatments and wait list control groups. On average 54.41% (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18.6) of primary studies had inactive control groups. The percentage of primary studies which had an inactive control group ranged from 25% (Carsley et al, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e) to 75% (Odgers et al, 2020).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOutcomes\u003c/em\u003e: Post-intervention data were available in 83% of meta-analyses for anxiety; in 66% of meta-analyses for wellbeing and depression; and in 50% of meta-analyses for mindfulness. Follow-up data from more than 3 studies were not available for any of the 4 outcome variables, and so were not analysed. Kander et al (2024) outcomes were grouped as Therapeutic processes and Therapeutic outcomes. Their variables were mapped to the current variables as: Positive Emotion and self appraisal variable taken as Wellbeing; Negative emotion and subjective distress as Depression; Internalizing problems as Anxiety; and Mindfulness as Mindfulness.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cem\u003eReview characteristics\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAuthor \u0026amp; Date\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eK-Total\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDesign\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNo. studies follow-up data\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal N in primary studies\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e%Female\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean Age\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eInterventions\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOutcome measures\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAMSTAR-2 rating\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eType 1\u003c/p\u003e\n\u003cp\u003eStructured MBI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eType 2\u003c/p\u003e\n\u003cp\u003eMulti-component MBI/Mindfulness Activities\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCarsley, 2018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRCT \u0026amp; non-RCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3,977\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13yrs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e*Included MBSR, MBCT, Dot.be\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e*Included Mindfulness oriented meditation, MindUP, Attention Academy, Mindfulness yoga, ICP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMental health \u0026amp; wellbeing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCritically low\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDunning, 2022\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRCT only\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20,138\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNK\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12yrs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMBSR (x6), MBCT (x6), Learning to Breathe (x7), Dot.be (x8), Mindful Awareness Practice, Meditacion Fluir, Pause Breathe Smile, Mindfulness Kindness Curriculum, Breathing Awareness Meditation, Mymind, Mindfulness Prescription for ADHD, Mindfulness matters, Mindfulness skills training, Mission Meditation, MindKinder, Mindfulness Emotional Intelligence, Pawsb, Mindfulness Eating Awareness, Mindfulness based substance abuse treatment.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKamalayan Curriculum, ICP, Mindfulness CBT, MindUP, Unlearning, Gaia, Guided mindfulness, Power source, Mindful schools, Attention academy, Story-based mindfulness, Gaia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWellbeing, Mindfulness, Depression, Anxiety/stress, Attention, Executive functions, Negative behaviour, Social behaviour\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eModerate\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFulambarkar, 2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRCT only\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5,046\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14yrs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMBSR (x4), MBCT, Learning to breathe (x3), Dot.be\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eNone\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAnxiety, Depression, Stress\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLow\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGalla, 2024\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRCT only\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16,558\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNK\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14yrs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMBSR (x3), MBCT, Learning to Breathe, Meditacion Fluir, Dot.be (x8), Mindfulness Eating Awareness, Breathing Awareness Meditation,\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eICP, Unlearning\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWellbeing, Mindfulness, Depression, Anxiety/stress, Attention, Executive functions, Negative behaviour, Social behaviour\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLow\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKander, 2024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRCT \u0026amp; non-RCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3,640\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNK\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9yrs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMBSR, MBCT, Mindful Awareness Practice, Mindfulness Kindness Curriculum, Pause breathe smile, Mindkeys, Mindful moments, Mindfulness enhancement programme\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMindfulness-based social and emotional learning, Living mindfully primary programme, MindUP, ICP, Mindfulness oriented meditation, Mindfulness meditation, Gaia, Mindfulness based activities, Mindful schools, Call to care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTherapeutic processes \u0026amp; Therapeutic outcomes. (A range of variables. under each heading)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLow\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOdgers, 2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRCT only\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,582\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNK\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11yrs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMBSR (x5), MBCT (x6), Learning to breathe, Meditacion Fluir, Mindkinder, Mindfulness emotional intelligence, Audio-guided MBI, Dot.be\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMindful breathing, Mindfulness in schools, Neuro-feedback MBI, Mindfulness yoga\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAnxiety\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eModerate\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"11\"\u003eNote: Where an intervention was featured in the review more than twice, the number of times is indicated. Not all interventions are listed as some interventions were only named MBI.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"11\"\u003e*Carsley did not give the names of interventions\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eDunning stated 66 studies in their review, but only provided details of 65.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eGalla stated 22 studies in their review, with one piece of primary research broken into three studies. For this paper, it was treated as one study.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eICP\u0026thinsp;=\u0026thinsp;Integrative Contemplative Pedagogy, NK\u0026thinsp;=\u0026thinsp;Not Known.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" style=\"width: 766px;\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cem\u003eSummary review characteristics\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth style=\"width: 485px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 87px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003cp\u003eMean\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 38.1829px;\" align=\"left\"\u003e\n\u003cp\u003eRange\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth style=\"width: 485px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMeta-analysis characteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 87px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth style=\"width: 106px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth style=\"width: 38.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal number of meta-analyses\u003c/strong\u003e (\u003cem\u003ek\u003c/em\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal number of primary studies\u003c/strong\u003e (N\u003csub\u003eps\u003c/sub\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003eRange\u0026thinsp;=\u0026thinsp;9\u0026ndash;65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal no of participants in primary studies reviewed\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eN\u0026thinsp;=\u003c/em\u003e\u0026thinsp;28,910\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of participants in individual primary studies\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eM\u0026thinsp;=\u003c/em\u003e\u0026thinsp;263\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e = 911\u003c/p\u003e\n\u003cp\u003eRange\u0026thinsp;=\u0026thinsp;14\u0026ndash;8,376\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 485px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 38.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12.17y\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.94\u003c/p\u003e\n\u003cp\u003eRange\u0026thinsp;=\u0026thinsp;5\u0026ndash;18y\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% Female\u0026sup1; (\u003c/strong\u003e\u003cstrong\u003ek\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;2)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;52.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.61\u003c/p\u003e\n\u003cp\u003eRange\u0026thinsp;=\u0026thinsp;45\u0026ndash;60%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHealth status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 359px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMainly healthy participants\u003c/strong\u003e \u003cstrong\u003e(k\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;6)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 154.183px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 359px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% primary studies of children with health problems (\u003c/strong\u003e\u003cstrong\u003ek\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;5)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003eRange\u0026thinsp;=\u0026thinsp;0\u0026ndash;33%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 154.183px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 572px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eInterventions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 38.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eType 1: Structured MBI in primary studies\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003e67%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eType 2: Other MBIs in primary studies\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eN\u0026thinsp;=\u003c/em\u003e\u0026thinsp;36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003e33\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDuration (\u003c/strong\u003e\u003cstrong\u003ek\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;6)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\n\u003cp\u003eMean duration (hours)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.43\u003c/p\u003e\n\u003cp\u003eRange\u0026thinsp;=\u0026thinsp;0.3\u0026ndash;40.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 572px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eComparison groups\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 38.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% inactive control group\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;54.41%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18.60\u003c/p\u003e\n\u003cp\u003eRange\u0026thinsp;=\u0026thinsp;25\u0026ndash;75%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 572px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 38.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of meta-analyses with post-treatment data (\u003c/strong\u003e\u003cstrong\u003ek\u0026thinsp;=\u0026thinsp;6)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003e(% based on \u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 314px;\" align=\"left\"\u003e\n\u003cp\u003eWellbeing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 45px;\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\n\u003cp\u003e66%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 241.183px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 314px;\" align=\"left\"\u003e\n\u003cp\u003eMindfulness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 45px;\" align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\n\u003cp\u003e50%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 241.183px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 314px;\" align=\"left\"\u003e\n\u003cp\u003eDepression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 45px;\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\n\u003cp\u003e66%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 241.183px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 314px;\" align=\"left\"\u003e\n\u003cp\u003eAnxiety\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 45px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\n\u003cp\u003e83%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 241.183px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 572px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 38.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTrial design (\u003c/strong\u003e\u003cstrong\u003ek\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;6)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\n\u003cp\u003eRCT only\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003e66%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\n\u003cp\u003eRCT \u0026amp; non-RCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003e33%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 362px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e%non-RCT (\u003c/strong\u003e\u003cstrong\u003ek\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;6)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 123px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.84%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 106px;\" align=\"left\"\u003e\n\u003cp\u003eRange\u0026thinsp;=\u0026thinsp;0\u0026ndash;31%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48.1829px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e1. Data on gender were missing in four meta-analyses\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e Review quality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe AMSTAR-2 scores for the 6 meta-analyses ranged from critically low to moderate quality, using a system of scoring based on the AMSTAR-2 tool guidelines (Shea et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). See Table \u003cspan class=\"InternalRef\"\u003eS1\u003c/span\u003e in Appendix C of Supplementary Information for AMSTAR-2 scores and rating system applied. All reviews demonstrated rigor in their quantitative synthesis of results of primary studies, including their use of meta-analytic techniques, measuring risk of bias in primary studies, addressing risk of bias in the interpretation of results, and likewise for publication bias. Areas of weakness were the lack by Carsley et al. (\u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e), Galla et al. (2024) and Fulambarkar et al. (2023) of pre-registration of their systematic reviews, and the fact that none of the reviews provided the list of excluded studies with reasons for exclusion. A non-critical item which no review met was the reporting of funding for the studies included in their meta-analysis, although all reported any funding or potential conflicts of interest for their own papers.\u003c/p\u003e\n\u003cp\u003eIn reviewing the evidence, it is important that a meta-analysis gives careful consideration to the quality of the primary studies (Sperling et al., \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e). Galla et al (2024) did not carry out their own quality assessment, instead accepting Dunning et al\u0026rsquo;s (\u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e) when using their data. The other reviews all used a quality assessment tool, and reported the results for included studies. Dunning et al (\u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e), Odgers et al (2020) and Fulambarkar et al (2023) used Cochrane Collaboration\u0026rsquo;s Risk-of-Bias Tool V.2 (Sterne et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e), each developing a scoring system to rate the quality of primary studies, while Carsley et al (\u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e) used JADAD\u0026rsquo;s criteria (Jadad et al., \u003cspan class=\"CitationRef\"\u003e1996\u003c/span\u003e), and Kander et al (2024) the What Works Clearinghouse (WWC) tool. All reviews commented on significant variations in study quality, and called for an increased number of well-designed RCTs. Four reviews assessed if study quality moderated effects, with differing findings. Dunning et al (\u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e) and Kander et al (2024) found a correlation between higher quality studies and lower effect sizes for some outcome variables, and also Carsley et al (\u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e) to a lesser extent, while Odgers et al (2020) found no moderating effect.\u003c/p\u003e\n\u003cp\u003eAssessment of the credibility of the evidence, using the GRADE (Guyatt et al., \u003cspan class=\"CitationRef\"\u003e2008\u003c/span\u003e) approach, which involved a four level rating of Very low, Low, Moderate to High, found that credibility was in the Very low range across all four variables. See Table S2 in Appendix D of Supplementary Information. GRADE ratings for individual meta-analyses fell between Very low and Moderate ranges, although many fell within the Low or Very low range, with low scores primarily due to difficulties with imprecision, given that an umbrella review measures each domain at a meta-analytic level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePooled effect sizes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA series of random-effects meta-analyses were conducted to assess the impact of MBIs on four outcome domains at post-test: wellbeing, mindfulness, depression, and anxiety. See Figs.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e to \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e for forest plot depictions of the individual and pooled effect sizes for each of the four variables of wellbeing, mindfulness, depression and anxiety. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e sets out the pooled effect sizes and related statistics. At post-treatment, MBIs showed small, statistically significant effects for wellbeing, mindfulness and anxiety, but no statistically significant effects for depression. For the three variables with statistical significance, in order of decreasing values, the effects were as follows: wellbeing \u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.128 [0.01, 0.25]; anxiety \u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.112 [0.06, 0.17]; mindfulness \u003cem\u003eg\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.11 [0.01, 0.21]. There was no statistically significant effect for depression, with a very small effect size (\u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cem\u003ePooled effect sizes and heterogeneity tests at post-treatment\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth style=\"height: 35px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eEffect size statistics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHeterogeneity tests\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 83px;\"\u003e\n\u003ctd style=\"height: 83px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measures\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 83px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ek\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 83px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eg\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 83px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e95%\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLL\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 83px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e95%\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUL\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 83px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ez\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 83px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eQ\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 83px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAll comparisons at post-test\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eWellbeing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.128\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.246\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2.120*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e21.526***\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e86.063\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eMindfulness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.214\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2.080*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2.737\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e26.924\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eDepression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.049\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e1.550\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4.968\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e39.613\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eAnxiety\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.112\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.056\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.167\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3.924***\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4.279\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e6.510\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr style=\"height: 55.0768px;\"\u003e\n\u003ctd style=\"height: 55.0768px;\" colspan=\"8\"\u003e\u003cem\u003eNote\u003c/em\u003e: \u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;number of meta-analyses. \u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;Standardized mean difference effect size based on comparison of MBI and inactive or active intervention control groups. CI confidence interval. LL\u0026thinsp;=\u0026thinsp;Lower limit of confidence interval. UL\u0026thinsp;=\u0026thinsp;Upper limit of confidence interval. \u003cem\u003ez\u0026thinsp;=\u003c/em\u003e\u0026thinsp;z test. \u003cem\u003eQ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;test of heterogeneity of effect sizes. \u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;test of heterogeneity of effect sizes indicating percentage variation. *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. ** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01. *** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Studies were considered outliers if their 95% confidence interval did not overlap with the 95% confidence interval of the pooled effect size.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eHeterogeneity tests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, it may be seen that the distribution effect sizes for wellbeing showed significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and high (\u003cstrong\u003eI\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u0026thinsp;\u0026gt;\u0026thinsp;75%) heterogeneity. Heterogeneity was somewhat lower for the other three variables with the \u003cem\u003eI\u003c/em\u003e\u0026sup2; statistic ranging from to moderate (\u003cstrong\u003eI\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e 25\u0026ndash;50%) for mindfulness and depression, to mild (\u003cstrong\u003eI\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u0026thinsp;\u0026lt;\u0026thinsp;25%) for anxiety However, results must be interpreted with caution given the small sample size.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cem\u003eMeta regression moderator analysis\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOutcome measure\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eModerator\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ek\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBeta\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLL\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUL\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eQ\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eR\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWellbeing\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0331\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.1005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0342\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.335\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% female\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% health problems\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention duration\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0690\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.051\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.1432\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0679\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.57\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% inactive control group\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0045\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0065\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0025\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.54***\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% non-RCT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0075\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0150\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.95*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0470\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.61\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0047\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0471\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0376\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.8267\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% female\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% health problems\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0049\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0682\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention duration\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0083\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.1341\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.1174\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.8970\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% inactive control group\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0079\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0030\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.3833\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% non-RCT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0075\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0063\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.8642\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0232\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0610\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0145\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.2282\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% female\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% health problems\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0052\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.2050\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention duration\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0562\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0091\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.1216\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0915\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% inactive control group\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0076\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0064\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.8663\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e% non-RCT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.0093\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0067\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.7484\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eNote: k\u003c/em\u003e\u0026thinsp;=\u0026thinsp;Number of meta-analyses. \u003cem\u003eBeta\u003c/em\u003e\u0026thinsp;=\u0026thinsp;regression coefficient from meta-regression. 95%CI\u0026thinsp;=\u0026thinsp;95% confidence interval for meta-regression coefficient. LL\u0026thinsp;=\u0026thinsp;lower limit of confidence interval. UL\u0026thinsp;=\u0026thinsp;Upper limit of confidence interval. \u003cem\u003eQ\u0026thinsp;=\u0026thinsp;Q\u003c/em\u003e test for meta-regression. \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;probability level for Q test. R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;proportion of variance accounted for by moderator. *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05.**\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01. ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001. Where k\u0026thinsp;\u0026lt;\u0026thinsp;4, it was not possible to carry out a moderator analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModerator analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eModerator analyses were conducted on post-treatment data, where there was sufficient data, for continuous variables of: age, %female, %health problems, intervention duration, %inactive control group and %non-RCT. Where k\u0026thinsp;\u0026lt;\u0026thinsp;4, it was not possible to conduct moderator analyses. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e sets out the results of moderator analyses. Wellbeing was the only variable which showed evidence of moderator effects, with greater effect sizes seen where there was a relatively higher proportion of non-RCTs, and lower effects sizes where there was a higher percentage of inactive control groups, with the moderating effect strongest for the latter.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReview overlap\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 6 meta-analytic reviews included in this paper covered a total of 110 primary studies. The meta-analysis by Galla (2024) involved the extraction of data from 32 of the 66 studies covered by Dunning\u0026rsquo;s (Dunning et al, \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e) meta-analysis. Galla\u0026rsquo;s meta-analysis was included because it ran a separate series of tests focused only on adolescents, which was deemed useful. The CCA Index was calculated to establish the potential risk of overlap bias, with the result of 0.30, indicating a slight risk of overlap bias, using Pieper\u0026rsquo;s method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication bias\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEgger\u0026rsquo;s test results were not significant for wellbeing (intercept\u0026thinsp;=\u0026thinsp;3.64, \u003cem\u003et\u003c/em\u003e(2)\u0026thinsp;=\u0026thinsp;1.69, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.1), mindfulness (intercept\u0026thinsp;=\u0026thinsp;0.62, \u003cem\u003et\u003c/em\u003e(1)\u0026thinsp;=\u0026thinsp;0.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.1), depression (intercept\u0026thinsp;=\u0026thinsp;1.46, \u003cem\u003et\u003c/em\u003e(2)\u0026thinsp;=\u0026thinsp;1.63, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.1), or anxiety (intercept\u0026thinsp;=\u0026thinsp;0.84, \u003cem\u003et\u003c/em\u003e(3)\u0026thinsp;=\u0026thinsp;0.88, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.1). This indicated that there was no funnel plot asymmetry, and that results of the current meta-analysis were not affected by publication bias. However, because there was a small number of reviews in this meta-analysis (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3\u0026ndash;5), publication bias test results must be interpreted with caution.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe primary aim of this umbrella systematic review was to review the evidence base for school-based MBIs, exploring the scale, quality and findings of controlled trials in this area. The outcomes of interest to this paper were positive outcomes (wellbeing and mindfulness) and negative outcomes (anxiety and depression). Data were extracted from 6 systematic reviews with meta-analyses, which encompassed 110 primary studies and more than 28,000 children and adolescents. Children ranged in age from 5 years to 18 years, with a mean age of 12.17 years. While there was an overlap of primary studies in included reviews, the CCA Index (Pieper et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) indicated a low risk of overlap bias. There was a wide range of interventions represented in the primary studies, from frequently featured structured interventions such as MBSR, MBCT and Learning to Breathe, to more loosely structured MBIs such as Mindfulness meditation or MBIs with additional components, such as MindUP or ICP. The sample sizes of primary studies also varied very significantly, from single classes to major, multi-school projects. Almost all reviews had used a recognised methodological assessment tool to assess methodological quality of primary studies, and all noted a significant variation in quality and recommended an increase in the number of large well-designed RCTs. Several, although not all, reviews found an association between higher study quality and lower effect size for some outcomes.\u003c/p\u003e \u003cp\u003e The AMSTAR-2 tool was used to assess methodological quality of reviews, with mixed evidence of rigour. Most reviews scored well on critical items such as detailed search strategy, use of PICOS, statistical tests used, reporting conflicts of interest, and pre-registration of the systematic review protocol, but there were methodological weaknesses in some areas, in particular the lack of pre-registration of several reviews, and lack of publication of excluded studies by all reviews. Notably, all reviews failed to include a list of excluded studies and given that this is regarded by the AMSTAR-2 developers as a critical criterion, it had a significant effect on the review quality ratings. Marks were also lost for the critical criterion regarding search strategy (criterion 4) as most reviews had excluded grey literature and/or consultation with an expert in the field. However, there has been some criticism of a lack of clarity by the AMSTAR-2 developers with regard to this item as one of the review authors or co-authors might be regarded as an expert in the field (De Santis et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The GRADE tool was used to assess the certainty of the evidence, with overall ratings falling in the Very low range. The primary reasons for this was heterogeneity among primary studies, small effect sizes, and wide confidence intervals which sometimes crossed the null. This finding resonates with the included review interpretations, all of which highlighted difficulties in these areas, commenting on the need for an increased number of rigorous RCTs in this field.\u003c/p\u003e \u003cp\u003eA meta-analysis of review data found that school-based mindfulness programmes have significant, but very small or negligible effects on trait wellbeing, trait mindfulness and trait anxiety; and non-significant effects on trait depression; in school children who do not have clinical problems. It wasn\u0026rsquo;t possible to statistically evaluate if effects were maintained over time, as there was insufficient follow-up data. Results of moderator analyses on variables of age, gender, proportion inactive control groups, proportion of children with health problems, intervention duration, and proportion non-RCT showed no evidence of impact on effect, with the exception of wellbeing, where greater effect sizes were seen where there was a higher proportion of non-RCTs, and lower effect sizes where there was a higher proportion of inactive control groups. These results must be viewed with caution as, although 110 studies were effectively covered by the umbrella review, the statistical tests were on the six reviews which had reviewed those primary studies, making it a small sample size (Borenstein, 2010).\u003c/p\u003e \u003cp\u003eWhen compared to other major reviews, the current paper\u0026rsquo;s findings regarding wellbeing were consistent with those included reviews which had measured wellbeing, with the exception of Dunning et al (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, the current paper\u0026rsquo;s finding that MBIs have a positive effect on trait anxiety resonate with some of the included reviews (e.g. Dunning et al, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e and Galla et al (2024), but not others (e.g. Fulambarkar et al (2023). Additionally, there were differences in findings even where there was a relatively significant crossover of primary studies, such as Fulambarkar et al (2023) and Galla et al (2024), where six of the nine studies in Fulambarkar et al\u0026rsquo;s (2023) review were among the 22 studies in Galla et al (2024). An interesting finding of Galla et al\u0026rsquo;s (2024), which was not seen in other reviews, was that mindfulness decreased for adolescents following completion of an MBI for the MBI intervention group versus passive control. The authors described this as counter-intuitive and commented that there might be a possibility of a Type 1 error, also commenting on a related issue mentioned by several other researchers in this area, namely that the passive control groups used in research on schools-based MBIs often involve engagement in the school\u0026rsquo;s social and emotional learning curriculum, which in itself might have benefits. Given the amount of discussion in the field about age as a potential moderating variable, it might have been expected that this paper would have found evidence of age as a moderator, but this was not the case. The moderating effect seen with regard to non-RCTs is consistent with evidence that non-RCTs can tend to report greater effect sizes and be more prone to bias than RCTs (Anglemyer et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The moderating effect relating to inactive control groups resonates with the findings of the MYRIAD trial (Kuyken et al, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), the largest primary study among the 110 in this review, with those authors commenting that inactive control was often the social and emotional learning curriculum, which therefore might have a positive impact on wellbeing and merit further research.\u003c/p\u003e \u003cp\u003eThere are a number of limitations to the current paper. Firstly, a relatively small number of meta-analyses met inclusion criteria and so the results of meta-analytic tests must be viewed with caution. While 110 primary studies were encompassed under the umbrella of this review, the effect size data was extracted from 6 reviews. Secondly, the four outcome variables which this paper focused on were not always directly measured by the reviews, a common limitation of umbrella reviews (Fernandez et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). While there was a direct correlation with the majority, there wasn\u0026rsquo;t a neat fit for two reviews (Carsley et al, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, and Kander et al, 2024). Thirdly, state wellbeing was not measured by any of the reviews, and state wellbeing may capture the potential mechanisms of change regarding MBIs for children, namely the way in which mindfulness can support emotional regulation for children, which can have longer term benefits (Maynard et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Fourthly, two of the reviews had not pre-registered the systematic protocol, and the review which used secondary data had not carried out its own quality assessment of primary studies. Fifthly, an umbrella review does not extract data from primary studies, so any human error that might have been made with data extraction by a review would effectively be carried forward to this paper. Limitations which apply to the included reviews would also, by definition, likewise apply to the umbrella review (Fusar-Poli, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Finally, the umbrella review is a relatively new research tool and while this paper used methodological best practices as a guide, further benefits and limitations of this type of research will emerge over time. For example, the GRADE tool is a highly regarded tool for meta-analyses, but it was developed for meta-analyses of primary studies and there are some limitations in its application to umbrella reviews (Sadoyu et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Given these limitations, the results of this paper, in particular the moderator analysis and Egger test publication bias results, should be interpreted with caution.\u003c/p\u003e \u003cp\u003eThere are a number of strengths to the current paper. Firstly, this is the first umbrella review to have been carried out on a rapidly expanding area of acknowledged importance for children\u0026rsquo;s health and wellbeing. A benefit of the umbrella review is the capacity to consider the broad evidence base by defining eligibility criteria and drawing on the findings of systematic reviews which meet those criteria, facilitating the inclusion of a significant amount of data. (Sadoyu et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The conclusions drawn by this umbrella review are based on 110 studies involving over 27,000 children. The findings show that school-based MBIs may have very small but statistically significant positive effects on \u0026lsquo;trait\u0026rsquo; wellbeing, mindfulness and anxiety variables, but not on depression. A further strength is the methodological rigour which was shown in this review, including the use of PRISMA guidelines, pre-registration of the protocol, and quality and credibility assessment tools of AMSTAR-2 and GRADE.\u003c/p\u003e \u003cp\u003eIn terms of implications for research policy and practice, this review has highlighted significant gaps in follow-up data for schools-based MBIs and in the reporting of gender by primary studies, areas which would merit addressing in future primary studies. The majority of studies encapsulated in this review were of general school populations, rather than clinical samples. There is a rationale for carrying out more research on the use of MBIs with clinical populations as the results of subgroup analyses of clinical groups within school populations, suggested that there may be different results for general and clinical populations. It would also be useful for researchers who are planning primary studies to consider the use of state wellbeing measures when measuring the potential effectiveness of schools-based MBIs, given the potential mechanisms of change of MBIs for children.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical standards\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript does not contain clinical studies or patient data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary Information\u0026nbsp;\u003c/strong\u003eis available here\u0026nbsp;\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eStudy design (SG, AC). Literature review and database searches (SG). Article screening and data extraction (SG, AOD). Presentation of data (SG). Statistical analyses (SG, AC, CT). Drafting the manuscript (SG). Reviewing draft manuscript and providing feedback (AC). Revising draft manuscript (SG). Reviewing the final manuscript (All authors).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAnglemyer, A., Horvath, H. T., Bero, L., \u0026amp; Bero, L. (2014). Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials. \u003cem\u003eCochrane Database of Systematic Reviews\u003c/em\u003e, \u003cem\u003e2014\u003c/em\u003e(4), MR000034\u0026ndash;MR000034. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/14651858.MR000034.pub2\u003c/span\u003e\u003cspan address=\"10.1002/14651858.MR000034.pub2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAromataris, E., Fernandez, R., Godfrey, C. M., Holly, C., Khalil, H., \u0026amp; Tungpunkom, P. (2015). 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Mindfulness interventions with youth: A meta-analysis. \u003cem\u003eMindfulness\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(2), 290\u0026ndash;302. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12671-013-0260-4\u003c/span\u003e\u003cspan address=\"10.1007/s12671-013-0260-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6932647/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6932647/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This umbrella review synthesised evidence from meta-analyses of school-based mindfulness-based interventions (MBIs) to evaluate effects on wellbeing, mindfulness, depression, and anxiety in children and adolescents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Searches were conducted in PubMed, PsycINFO, CINAHL, ERIC, and Cochrane databases to end 2024. Eligibility criteria included controlled trials of school-based MBIs for children and adolescents aged 5–18 yrs, and peer reviewed publication. Data extraction followed PRISMA Guidelines, with AMSTAR-2 and GRADE used to measure quality. Pooled effect sizes were analysed using random-effects models, and meta-regression analyses for moderator effects. The review protocol was pre-registered with PROSPERO.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Six meta-analyses, covering a total of 110 primary studies and 28,910 participants, met inclusion criteria. MBIs showed small but statistically significant effects for wellbeing (g = 0.13), mindfulness (g = 0.11), and anxiety (g = 0.11), but no effect for depression (g = 0.05). Quality of included reviews ranged from critically low to moderate (AMSTAR-2). GRADE assessments indicated very low certainty of evidence across all outcomes, primarily due to risk of bias, inconsistency, and imprecision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations:\u003c/strong\u003e Results were limited by the small number of meta-analyses included in the umbrella review (\u003cem\u003ek \u003c/em\u003e= 6), variation in methodological quality of primary studies, and lack of follow-up data in some meta-analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e School-based MBIs are associated with very small improvements in wellbeing, mindfulness, and anxiety, but not depression, for children and adolescents in the general school population. However, the evidence is limited and inconsistent, with a need for further high-quality RCTs in this field.\u003cbr\u003e\n \u003cstrong\u003eRegistration:\u003c/strong\u003e PROSPERO CRD42025636892\u003c/p\u003e","manuscriptTitle":"An umbrella review of meta-analyses of school-based Mindfulness Based Interventions (MBIs)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-29 14:32:11","doi":"10.21203/rs.3.rs-6932647/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ef041016-ffe6-476a-a7eb-d6c555c30f57","owner":[],"postedDate":"June 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:08:19+00:00","versionOfRecord":{"articleIdentity":"rs-6932647","link":"https://doi.org/10.1007/s12671-026-02809-7","journal":{"identity":"mindfulness","isVorOnly":false,"title":"Mindfulness"},"publishedOn":"2026-03-18 15:58:42","publishedOnDateReadable":"March 18th, 2026"},"versionCreatedAt":"2025-06-29 14:32:11","video":"","vorDoi":"10.1007/s12671-026-02809-7","vorDoiUrl":"https://doi.org/10.1007/s12671-026-02809-7","workflowStages":[]},"version":"v1","identity":"rs-6932647","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6932647","identity":"rs-6932647","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}