The effects of a mindfulness-based intervention on primary school students’ symptoms of inattention, depression, and anxiety: A moderated mediation examination

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However, some studies also suggest that mindfulness programs do not have added values compared to other mental health promotion interventions. These differences in effectiveness can partly be due to the lack of definition of what constitutes a mindfulness-based intervention, inconsistency in intervention length and in the training of facilitators. Hence, there is a lack of research and knowledge on the mechanisms that underlie these potential changes. The present study aimed to explore whether dispositional (i.e., trait) mindfulness mediated mental health indicators through time, in elementary school children. A secondary objective meant to evaluate whether receiving a mindfulness-based intervention could moderate such a relationship. Results showed that mindfulness scores mediated indicators of mental health. Specifically, mindfulness mediated increases in inattention, anxiety and depression throughout time. Taking part in a mindfulness-based intervention did not have a significant impact on this relationship. Results thus lend support to exercising caution when aiming to only foster mindfulness abilities, without ensuring that children also learn the emotion regulation skills that are required to deal with the increased awareness of their difficulties. Biological sciences/Psychology Biological sciences/Psychology/Human behaviour Background The number of mindfulness-based interventions has proliferated in the last decade as accessible evidence-based practices to improve children’s mental health in schools 1 . While mindfulness meditation has been practiced for centuries, only at the turn of the 21st century have Western societies secularized the concept and developed a stronger clinical interest in these approaches to improving mental health and well-being 2 , 3 . In this latter context, mindfulness has been defined as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of the experience moment by moment.” 4 Introspective awareness of thoughts, sensations and emotions in the present moment, coupled with non-judgement, are key elements to practicing mindfulness. Mindfulness encourages engagement with emotions and sensations, which are seen as transient, rather than avoidance. Enhancing this awareness and engagement through mindfulness practice has been found to improve mental health by promoting non-reactivity, reducing negative affect and increasing positive affect; decreasing symptoms of depression, anxiety, and rumination; and increasing emotional awareness in adults 5 . Mindfulness can be both understood as a transient state that may change within one person 6 , 7 , and as a disposition that is rather stable across time 8 . These two types of mindfulness appear to be conceptually unique and reflect the possibility that some people may have a basic tendency towards being mindful, while others may not 9 . Dispositional – or trait - mindfulness is related to more adaptive emotional regulation, lower levels of rumination and catastrophizing, as well as lower levels of psychopathological symptoms like depression, anxiety, and traumatic stress 10 – 13 . Some have posited that introducing children early on to mindfulness practices and with sustained practice, dispositional mindfulness could become an enduring mental state 14 , 15 . Thus, understanding the relationship between dispositional mindfulness and mental health in children is crucial for developing effective interventions to support their well-being, but very few studies have explored this in children. Children can be introduced to mindfulness in schools using structured activities that encourage the focus of attention on physical sensations, thoughts, and emotions 16 . These types of activities are gaining popularity in schools as they are often seen as easy to integrate into daily routines and cost effective 17 . They are also supported by research evidence. It appears that mindfulness training with children in schools can promote self-regulation skills 18 , 19 , facilitate the satisfaction of basic psychological needs 20 , and reduce anxiety and depression symptoms 21 . While there are promising results regarding children and adolescents mental health and well-being, effect sizes of such interventions are rather small 22 . Furthermore, some studies also suggest that mindfulness programs do not have added values compared to other mental health promotion interventions 23 , 24 . These differences in effectiveness can partly be due to the lack of definition of what constitutes a mindfulness-based intervention, inconsistency in intervention length and in the training of facilitators 22 , 24 , 25 . Hence, there is a lack of research and knowledge on the mechanisms that underlie these potential changes. One model that has been brought forward to explain mechanisms by which mindfulness interventions may have benefits in school-aged children is called the Integrative Model of the Outcomes and Mechanisms of Change of the MBIs in the Classroom 26 . This framework identifies different mechanisms of action such as dispositional mindfulness, diverse cognitive and emotional processes like emotional regulation, and social competence. In this model, the relationship between the mindfulness intervention and its impact on well-being and mental health is believed to be mediated by these various aspects, notably dispositional mindfulness and emotional regulation skills 27 . In this sense, positive changes in dispositional mindfulness and emotional regulation are thought to mediate the relationships between the mindfulness intervention and positive changes in children’s mental health (anxiety, life satisfaction) 27 . Greater empirical support is nonetheless warranted to further evaluate this model and examine the potential mediating variables between mindfulness interventions and mental health. This is what we aimed to do in this study. Study aims The present study aimed to explore whether dispositional (i.e., trait) mindfulness mediated mental health indicators through time, in elementary school children. A secondary objective meant to evaluate whether receiving a mindfulness-based intervention could moderate such a relationship. We hypothesized that dispositional mindfulness would have a positive impact on mental health over time, and more so for children who take part in a mindfulness-based intervention. Methods Design To test our hypotheses, a randomized cluster trial with a wait-list control was implemented. The trial was registered on 21/03/2024 on the ClinicalTrials.gov platform (Identifier: NCT06346002). Participants were recruited from one elementary school in a suburb of a large city in the province of Quebec, Canada. 13 groups were randomly allocated to either a MBI experimental group (7 classrooms, n = 127 students) or a wait-list control group (6 classrooms, n = 104 students). The total sample consisted in 231 elementary school children from 3rd to 6th grade, aged 8 to 12 years old ( M age = 9,87 years old; 51% boys and 49% girls). All participants filled out pre-and-post-test measures. The study unfolded between the months of September to December, during which groups assigned to the experimental condition received a 10-week MBI. Informed consent was obtained from all parents of children taking part in this study and their teachers. IRB approval was obtained from Université du Québec à Montréal (file # 2026_e_2017 ) and all methods were performed in accordance with the Declaration of Helsinki. A detailed description of the larger study methods, procedure and results have been published elsewhere 23 ; we focus here on additional mediation and moderation analyses of the data. Measures Mindful Attention and Awareness Scale for Children (MAAS-C) 28 : Children completed the MAAS-C to evaluate pre-to-post changes in dispositional mindfulness. As all items from this scale are reverse-coded, lower scores indicated higher levels of mindfulness. Internal consistency was acceptable in this sample (α pre/post = 0.69/.67). Behavior Assessment Scale for Chidlren – II (BASC-II) 29 : Children completed selected items from the inattention (4 items), anxiety (3 items) and depression (5 items) subscales of the BASC-II self-report form to evaluate pre-to-post changes in mental health. The BASC-II is a widely used and valid clinical scale to evaluate symptoms of mental health disorders in children. Once again, internal consistency was acceptable for all subscales at pre-intervention and post-intervention (α depression = 0.81/0.85; α anxiety = 0.70/0.77; α inattention = 0.76/0.77). Data analysis Statistical analyses were carried out in four steps. Correlations were first computed to identify significant relationships between the levels of symptoms of inattention, anxiety, and depression prior to the intervention (at T1). These correlations also allowed to identify significant relationships between the level of mindfulness and the level of these different symptoms. Then, repeated-measure ANOVAs were performed to compare the evolution of mindfulness and of symptoms of inattention, anxiety and depression in students who benefited from the intervention compared with those who did not. After which, simple mediation analyses were used to examine whether changes in students’ mindfulness significantly accounted for changes in their symptoms of inattention, anxiety and depression. Ultimately, mediated moderation analyses were conducted to determine if the tested intervention induced changes in mindfulness and if applicable, if these changes were also associated with changes in symptoms of inattention, anxiety, and depression. All analyses were conducted with IBM SPSS version 29. That said, the simple mediation and mediated moderation analyses required the use of two macros, respectively the PROCESS macro developed by Hayes 30 and the MEMORE macro developed by Montoya & Hayes 31 . Results As mentioned, the Pearson correlations allowed the identification of several significant relationships between the studied dimensions (Table 1). Strong positive relationships were noted between symptoms of anxiety and depression. Moderate positive relationships were also observed between symptoms of inattention and symptoms of anxiety and depression. More importantly, these correlations revealed strong positive relationships between mindfulness and symptoms of depression, as well as moderate positive relationships between mindfulness and symptoms of inattention and anxiety. Table 1 Correlations for mindfulness at T1 and symptoms of inattention, anxiety and depression at T1 Variable 1 2 3 4 1. Mindfulness - 2. Inattention 0.48** - 3. Anxiety 0.49** 0.37** - 4. Depression 0.54** 0.45** 0.57** - Notes . N = 220. The repeated-measure ANOVAs allowed to compare the changes in mindfulness and symptoms of inattention, anxiety and depression of students who took part in the intervention with those of the students who didn’t have this same opportunity (Table 2). The results first revealed that time had a significant effect on mindfulness ( F (1,218) = 9.84, p = 0.002, R 2 = 0.04) and a tendentially significant effect on anxiety ( F (1,212) = 3.77, p = 0.054, R 2 = 0.02). More specifically, mindfulness increased from Time 1 ( M = 2.49, SD = 0.91) to Time 2 ( M = 2.68, SD = 0.97). Anxiety showed a similar tendential increase (T1 M = 3.23, SD = 1.93; T2 M = 3.50, SD = 2.07). According to Cohen's thresholds, these two effects would be small. This analysis also distinguishes a distinct evolution of inattention symptoms in students who benefited from the intervention compared to those who did not ( F (1,200) = 5.46, p = 0.020, R 2 = 0.03). More specifically, these symptoms decreased non-statistically significantly in students who benefited from the intervention (T1 M = 3.51, SD = 2.51; T2 M = 3.33, SD = 2.50), while they increased significantly in those who did not (T1 M = 3.24, SD = 2.51; T2 M = 3.85, SD = 2.59). Once again, the size of this effect is small. Table 2 Group, time and time*group differences on mindfulness and symptoms of inattention, anxiety and depression Variable M (SD) F (effect size) Total ( n = 220) Intervention ( n = 120) Control ( n = 100) Group Time Group * Time 1 2 1 2 1 2 Mindfulness 2.49 (0.91) 2.68 (0.97) 2.48 (0.89) 2.73 (1.00) 2.52 (0.93) 2.63 (0.93) 0.06 (0.00) 9,84** (0.04) 1.40 (0.01) Inattention 2.51 (0.18) 2.55 (0.18) 3.51 (2.51) 3.33 (2.50) 3.24 (2.51) 3.85 (2.59) 0.16 (0.00) 1.65 (0.01) 5.46* (0.03) Anxiety 3.23 (1.93) 3.50 (2.07) 3.31 (1.87) 3.61 (2.09) 3.13 (2.00) 3.36 (2.05) 0.82 (0.00) 3.77 t (0.02) 0.08 (0.00) Depression 3.65 (3.34) 3.83 (3.60) 3.80 (3.44) 4.13 (3.60) 3.46 (3.23) 3.47 (3.59) 1.39 (0.01) 0.56 (0.00) 0.50 (0.00) Notes . N = 220. t p < 0.10. * p < 0.05. ** p < 0.01. *** p < 0.001. The simple mediation (Table 3) analyses allowed to examine the direct effects of time on changes in symptoms of inattention, anxiety and depression as well as the indirect effects when mediated by changes in mindfulness (Table 3). The results revealed no significant direct effect of time on the studied symptoms. However, when considering mindfulness as a mediator, significant indirect effects were found for symptoms of inattention ( b = 0.19, 95% CI [0.047, 0.396]), anxiety ( b = 0.15, 95% CI [0.039, 0.273]) and depression ( b = 0.27, 95% CI [0.084, 0.472]). Table 3 Changes in inattention, anxiety and depression, mediated by changes in mindfulness Variable Total effect Direct effect Indirect effect B (SE) t LLCI ULCI B (SE) t LLCI ULCI B (SE) LLCI ULCI Inattention 0.19 (0.17) 1.11 -0.145 0.521 -0.01 (0.16) -0.03 -0.327 0.317 .19 (0.09) 0.047 0.396 Anxiety 0.26 (0.13) 1.98* 0.001 0.532 0.13 (0.13) 0.95 -0.131 0.372 .15 (0.06) 0.039 0.273 Depression 0.18 (0.22) 0.82 -0.259 0.625 -0.08 (0.21) -0.39 -0.500 0.335 .27 (0.10) 0.084 0.472 Notes . N = 214. LLCI and ULCI Lower and Upper levels of the 95% confidence interval. R 2 for Inattention = 0.12; Anxiety = 0.15, Depression = 0.15. * p < 0.05. As a final step, moderated mediations were used to compare students who benefited from the intervention with those who did not. The intention was to test whether the first group experienced distinct changes in mindfulness, and if these different changes were associated with distinct changes in the symptoms under investigation. The results showed no significant indirect effects, whether in relation to inattention (b = -0.16, 95% CI [-0.599, 0.151]), anxiety (b = 0.08, 95% CI [-0.175, 0.329]) or depression (b = 0.21, 95% CI [-0.222, 0.612]). Discussion The overarching goal of this study was to determine whether dispositional mindfulness in elementary school children mediated changes in their inattention, anxiety and depression symptoms over time. A secondary objective was to determine whether participation in a mindfulness-based intervention moderated the effect on the relationship between mindfulness and mental health. While results show that dispositional mindfulness indeed mediated inattention, anxiety and depression symptoms, taking part in a mindfulness-based intervention, however, did not significantly moderate this relation. When looking at the full sample, regardless of being randomly assigned to the mindfulness-based intervention experimental or the wait-list control group, results suggest that mindfulness may indeed play a role in children’s mental health. Specifically, results show that being more mindful may be associated with inattention, anxiety, and depression symptoms through time. In other words, if children can recognize what is going on within themselves, they may be able to rate their symptoms with some accuracy. These findings are counterintuitive and do not confirm our initial hypotheses. In fact, past research on dispositional mindfulness has shown that being more mindful promotes better mental health 10 . Nonetheless, our results may show that being mindful involves noticing the good and the bad. Hence, being mindful can lead to becoming more attuned to all of one’s internal experiences (i.e., being able to identify, label and acknowledge the unfolding of varying emotions, thoughts and physical sensations), which includes inattention, anxiety and depression 30 , 31 . It is possible that as study participants developed mindfulness skills throughout time, they also became more sensitive to noticing all of these symptoms that may have gone unnoticed before. This, in turn, could explain, at least in part, the mediating relationship between mindfulness and the variables at play in this study. It is further possible that children who showed higher dispositional mindfulness through time were more aware of inattentive, anxious and depressive symptoms, but were not able to detach from these thoughts, which would be normally observed in adults 32 . Hence, it is possible that children tend to gain mindfulness skills that pertain to acknowledging and noticing, but not those related to non-judgment. This would lend further support to recent calls for caution in applying mindfulness-based interventions to children, as these are not necessarily appropriate for their level of cognitive development 40 . Finally, given the absence of a moderated mediation between groups, the relationship between dispositional mindfulness and the worsening of mental health scores cannot be attributed to taking part in a mindfulness-based intervention, but rather to the simple passage of time. Why would this be? It is possible that dispositional mindfulness – as opposed to state-contingent mindfulness – is at play in this mediation relationship. Indeed, previous research has distinguished two types of mindfulness, much similar to anxiety: people can either be naturally more or less mindful, regardless of the context they are in (i.e., trait mindfulness), and people can be placed in contexts which favor being in a mindful posture (i.e., state mindfulness) 9 . While research on mindfulness as an individual disposition has shown that it favors better mental health, decreasing negative cognitive patterns such as rumination and catastrophizing 10 , some interventional research has also suggested that taking part in a mindfulness-based intervention could foster the development of mindfulness as a trait 33 . However, there is a lack of sufficient and robust research to support the latter claim in youth. For example, studies reporting the impact of mindfulness-based interventions sometime omit to measure mindfulness altogether in their sample; issues pertaining to the operationalization and the measure of dispositional mindfulness, especially in children, may have contributed to this gap in the literature 34 , 35 . Recent research on one of the most widely used mindfulness questionnaires, the Five Facet Mindfulness Questionnaire , has highlighted how, although this questionnaire was designed for measuring trait mindfulness, it had been widely used by researchers to evaluate state mindfulness 36 . These findings may explain why researchers have been reporting difficulties in measuring self-reported mindfulness. There is thus a need for developers of mindfulness scales to explicitly address which aspect of mindfulness they aim to measure. Furthermore, some research does not support a causal relationship between taking part in a mindfulness-based intervention and increasing one’s mindful disposition 36 . With this in mind and in light of the present study’s findings, caution is strongly warranted in implementing future studies with the aims of fostering the development of dispositional mindfulness in children, as this could, potentially, disserve them and contribute to potentially worsening their mental health. Given that mindfulness alone could bring greater awareness to difficult emotions, future research in the field could explore whether this could have an added benefit to emotion regulation and coping skill development interventions. Finally, the modest intervention effects may stem from testing normative populations, as children from regular classrooms in elementary schools without severe psychological disorders may have limited capacity for improvement of their mental health indicators. Ceiling effects in non-clinical samples have indeed been shown to constrain observable changes, notably in mindfulness-based intervention studies 23 . There is indeed an increasing number of studies that show that mindfulness-based interventions for youth (children and adolescents alike) may be counter-indicated 23 , 37 , 38 . This study lends further support to the potential risks of implementing mindfulness-based interventions to sustain children’s mental health. Indeed, fostering mindfulness abilities in children may bring them to become more aware of their psychological difficulties, which could, in some cases, lead them with a feeling of hopelessness to change or to improve their situation. At the same time, noticing these difficulties could indicate to them the areas in their lives that are problematic and need to change. However, this awareness is not enough. To help children when they notice their difficulties, mindfulness-based interventions would need to be supplemented with other interventions, such as those based on social-emotional learning, in order to give them the emotion regulation skills they need to deal with the difficult situation 39 . If being more mindful in and of itself has potential negative impacts on youth’s mental health, school and mental health professionals should also reconsider whether fostering the ability to connect with one’s emotions and thoughts in the present moment without building other emotion regulation skills is indicated altogether, especially in non-clinical settings where mental health professionals are not available to provide subsequent psychological support. Limitations The present study counts notable strengths, among which its large sample size and rigorous experimental design, reinforcing its conclusions. Nonetheless, important limitations must be acknowledged: first, the clusters in this randomized design were determined at the classroom level, instead of the school level. Indeed, all classrooms taking part in this study were recruited in the same school. It is thus possible that a contamination effect took place in which teachers spoke among themselves of their respective group condition, which, in the end, influenced mindfulness scores of students across both groups. It may have led teachers from the control group to adopt a more mindful posture in their classrooms, although they were assigned to the wait-list. Further limitations include the psychometric properties of the scales included in this study. Although all scales’ internal consistency values were deemed acceptable, these were in the lower range, which may have impacted the robustness of our results. Indeed, the lower reliability of some of the scales may indicate that children did not fully understand all items that were used in our questionnaire package. As mentioned above, using mindfulness scales in research – especially research involving children – has been an ongoing issue in this field and developing valid, reliable and age-appropriate scales has proven difficult. While some scales evaluate various facets of dispositional mindfulness 40 , others – such as the scale used in this project – evaluate a sole facet of mindfulness, actually an absence of mindfulness, namely mindlessness 28 ,41 . Future research may aim to use more extensive mental health and mindfulness scales to ensure adequate operationalization of the concept, thus reinforcing its reliability and validity. Conclusion The purpose of this study was to explore whether dispositional mindfulness mediated the relation between time and mental health, namely symptoms of inattention, anxiety and depression, in elementary school children. A secondary objective meant to evaluate whether taking part in a mindfulness-based intervention moderated this mediated relationship between time and mental health. Results showed that mindfulness scores mediated indicators of mental health. Specifically, mindfulness mediated increases in inattention, anxiety and depression throughout time. Taking part in a mindfulness-based intervention did not have a significant impact on this relationship. Results thus lend support to exercising caution when aiming to only foster mindfulness abilities, without ensuring that children also learn the emotion regulation skills that are required to deal with the increased awareness of their difficulties. Declarations Author contributions CMH, TLG and JS wrote the initial draft of the manuscript. GT and CF extensively reviewed the manuscript. EHT helped with statistical analyses. Competing interests CM-H has released a manual on the mindfulness-based intervention described and used in this study (Midi Trente Publishers). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Data availability statement The data that support the findings of this study are available from the corresponding author upon reasonable request. Acknowledgements The authors wish to express gratitude and thanks to teachers and students who took part in this study, Funding Funding for this project was provided by the Fonds de Recherche du Québec - Société et Culture through a research grant (#204588) to the first author (CMH). References Emerson, L.-M., de Diaz, N. 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Journal of Personality Assessment 1–12 (2019) doi:10.1080/00223891.2019.1616206. Grossman, P. Defining mindfulness by how poorly I think I pay attention during everyday awareness and other intractable problems for psychology’s (re)invention of mindfulness: Comment on Brown et al. (2011). Psychological Assessment 23 , 1034–1040 (2011). Additional Declarations Competing interest reported. CM-H has released a manual on the mindfulness-based intervention described and used in this study (Midi Trente Publishers). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Cite Share Download PDF Status: Posted 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. 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CM-H has released a manual on the mindfulness-based intervention described and used in this study (Midi Trente Publishers). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.","formattedTitle":"The effects of a mindfulness-based intervention on primary school students’ symptoms of inattention, depression, and anxiety: A moderated mediation examination","fulltext":[{"header":"Background","content":"\u003cp\u003eThe number of mindfulness-based interventions has proliferated in the last decade as accessible evidence-based practices to improve children’s mental health in schools\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. While mindfulness meditation has been practiced for centuries, only at the turn of the 21st century have Western societies secularized the concept and developed a stronger clinical interest in these approaches to improving mental health and well-being\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. In this latter context, mindfulness has been defined as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of the experience moment by moment.”\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Introspective awareness of thoughts, sensations and emotions in the present moment, coupled with non-judgement, are key elements to practicing mindfulness. Mindfulness encourages engagement with emotions and sensations, which are seen as transient, rather than avoidance. Enhancing this awareness and engagement through mindfulness practice has been found to improve mental health by promoting non-reactivity, reducing negative affect and increasing positive affect; decreasing symptoms of depression, anxiety, and rumination; and increasing emotional awareness in adults\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMindfulness can be both understood as a transient state that may change within one person\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, and as a disposition that is rather stable across time\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. These two types of mindfulness appear to be conceptually unique and reflect the possibility that some people may have a basic tendency towards being mindful, while others may not\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Dispositional – or trait - mindfulness is related to more adaptive emotional regulation, lower levels of rumination and catastrophizing, as well as lower levels of psychopathological symptoms like depression, anxiety, and traumatic stress\u003csup\u003e\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e–\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Some have posited that introducing children early on to mindfulness practices and with sustained practice, dispositional mindfulness could become an enduring mental state\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Thus, understanding the relationship between dispositional mindfulness and mental health in children is crucial for developing effective interventions to support their well-being, but very few studies have explored this in children.\u003c/p\u003e \u003cp\u003eChildren can be introduced to mindfulness in schools using structured activities that encourage the focus of attention on physical sensations, thoughts, and emotions\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. These types of activities are gaining popularity in schools as they are often seen as easy to integrate into daily routines and cost effective\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. They are also supported by research evidence. It appears that mindfulness training with children in schools can promote self-regulation skills\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, facilitate the satisfaction of basic psychological needs\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, and reduce anxiety and depression symptoms\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. While there are promising results regarding children and adolescents mental health and well-being, effect sizes of such interventions are rather small\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Furthermore, some studies also suggest that mindfulness programs do not have added values compared to other mental health promotion interventions\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. These differences in effectiveness can partly be due to the lack of definition of what constitutes a mindfulness-based intervention, inconsistency in intervention length and in the training of facilitators\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Hence, there is a lack of research and knowledge on the mechanisms that underlie these potential changes.\u003c/p\u003e \u003cp\u003eOne model that has been brought forward to explain mechanisms by which mindfulness interventions may have benefits in school-aged children is called the \u003cem\u003eIntegrative Model of the Outcomes and Mechanisms of Change of the MBIs in the Classroom\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. This framework identifies different mechanisms of action such as dispositional mindfulness, diverse cognitive and emotional processes like emotional regulation, and social competence. In this model, the relationship between the mindfulness intervention and its impact on well-being and mental health is believed to be mediated by these various aspects, notably dispositional mindfulness and emotional regulation skills\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. In this sense, positive changes in dispositional mindfulness and emotional regulation are thought to mediate the relationships between the mindfulness intervention and positive changes in children’s mental health (anxiety, life satisfaction)\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Greater empirical support is nonetheless warranted to further evaluate this model and examine the potential mediating variables between mindfulness interventions and mental health. This is what we aimed to do in this study.\u003c/p\u003e\n\u003ch3\u003eStudy aims\u003c/h3\u003e\n\u003cp\u003eThe present study aimed to explore whether dispositional (i.e., trait) mindfulness mediated mental health indicators through time, in elementary school children. A secondary objective meant to evaluate whether receiving a mindfulness-based intervention could moderate such a relationship. We hypothesized that dispositional mindfulness would have a positive impact on mental health over time, and more so for children who take part in a mindfulness-based intervention.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e\n\n "},{"header":"Methods","content":"\u003ch2\u003eDesign\u003c/h2\u003e\u003cp\u003eTo test our hypotheses, a randomized cluster trial with a wait-list control was implemented. The trial was registered on 21/03/2024 on the ClinicalTrials.gov platform (Identifier: NCT06346002). Participants were recruited from one elementary school in a suburb of a large city in the province of Quebec, Canada. 13 groups were randomly allocated to either a MBI experimental group (7 classrooms, \u003cem\u003en\u003c/em\u003e = 127 students) or a wait-list control group (6 classrooms, \u003cem\u003en\u003c/em\u003e = 104 students). The total sample consisted in 231 elementary school children from 3rd to 6th grade, aged 8 to 12 years old (\u003cem\u003eM\u003c/em\u003e\u003csub\u003eage\u003c/sub\u003e = 9,87 years old; 51% boys and 49% girls). All participants filled out pre-and-post-test measures. The study unfolded between the months of September to December, during which groups assigned to the experimental condition received a 10-week MBI. Informed consent was obtained from all parents of children taking part in this study and their teachers. IRB approval was obtained from Université du Québec à Montréal (file # 2026_e_2017\u003cb\u003e)\u003c/b\u003e and all methods were performed in accordance with the Declaration of Helsinki. A detailed description of the larger study methods, procedure and results have been published elsewhere\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e; we focus here on additional mediation and moderation analyses of the data.\u003c/p\u003e\u003ch3\u003eMeasures\u003c/h3\u003e\u003cp\u003e \u003cem\u003eMindful Attention and Awareness Scale for Children (MAAS-C)\u003c/em\u003e \u003csup\u003e \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e \u003c/sup\u003e: Children completed the MAAS-C to evaluate pre-to-post changes in dispositional mindfulness. As all items from this scale are reverse-coded, lower scores indicated higher levels of mindfulness. Internal consistency was acceptable in this sample (α\u003csub\u003epre/post\u003c/sub\u003e = 0.69/.67).\u003c/p\u003e\u003cp\u003e \u003cem\u003eBehavior Assessment Scale for Chidlren – II (BASC-II)\u003c/em\u003e \u003csup\u003e \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e \u003c/sup\u003e: Children completed selected items from the inattention (4 items), anxiety (3 items) and depression (5 items) subscales of the BASC-II self-report form to evaluate pre-to-post changes in mental health. The BASC-II is a widely used and valid clinical scale to evaluate symptoms of mental health disorders in children. Once again, internal consistency was acceptable for all subscales at pre-intervention and post-intervention (α\u003csub\u003edepression\u003c/sub\u003e = 0.81/0.85; α\u003csub\u003eanxiety\u003c/sub\u003e = 0.70/0.77; α\u003csub\u003einattention\u003c/sub\u003e = 0.76/0.77).\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were carried out in four steps. Correlations were first computed to identify significant relationships between the levels of symptoms of inattention, anxiety, and depression prior to the intervention (at T1). These correlations also allowed to identify significant relationships between the level of mindfulness and the level of these different symptoms. Then, repeated-measure ANOVAs were performed to compare the evolution of mindfulness and of symptoms of inattention, anxiety and depression in students who benefited from the intervention compared with those who did not. After which, simple mediation analyses were used to examine whether changes in students’ mindfulness significantly accounted for changes in their symptoms of inattention, anxiety and depression. Ultimately, mediated moderation analyses were conducted to determine if the tested intervention induced changes in mindfulness and if applicable, if these changes were also associated with changes in symptoms of inattention, anxiety, and depression. All analyses were conducted with IBM SPSS version 29. That said, the simple mediation and mediated moderation analyses required the use of two macros, respectively the PROCESS macro developed by Hayes\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e and the MEMORE macro developed by Montoya \u0026amp; Hayes\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAs mentioned, the Pearson correlations allowed the identification of several significant relationships between the studied dimensions (Table 1). Strong positive relationships were noted between symptoms of anxiety and depression. Moderate positive relationships were also observed between symptoms of inattention and symptoms of anxiety and depression. More importantly, these correlations revealed strong positive relationships between mindfulness and symptoms of depression, as well as moderate positive relationships between mindfulness and symptoms of inattention and anxiety.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eCorrelations for mindfulness at T1 and symptoms of inattention, anxiety and depression at T1\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"397\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1. Mindfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2. Inattention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.48**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3. Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.49**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.37**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4. Depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.54**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.45**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.57**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003e\u003cem\u003eNotes\u003c/em\u003e. N = 220.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe repeated-measure ANOVAs allowed to compare the changes in mindfulness and symptoms of inattention, anxiety and depression of students who took part in the intervention with those of the students who didn\u0026rsquo;t have this same opportunity (Table 2). The results first revealed that time had a significant effect on mindfulness (\u003cem\u003eF\u003c/em\u003e(1,218) = 9.84,\u003cem\u003e\u0026nbsp;p\u0026nbsp;\u003c/em\u003e= 0.002, \u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/em\u003e= 0.04) and a tendentially significant effect on anxiety (\u003cem\u003eF\u003c/em\u003e(1,212) = 3.77, \u003cem\u003ep\u003c/em\u003e = 0.054, \u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/em\u003e= 0.02). More specifically, mindfulness increased from Time 1 (\u003cem\u003eM\u003c/em\u003e = 2.49, \u003cem\u003eSD\u003c/em\u003e = 0.91) to Time 2 (\u003cem\u003eM\u003c/em\u003e = 2.68, \u003cem\u003eSD\u003c/em\u003e = 0.97). Anxiety showed a similar tendential increase (T1 \u003cem\u003eM\u003c/em\u003e = 3.23, \u003cem\u003eSD\u003c/em\u003e = 1.93; T2 \u003cem\u003eM\u003c/em\u003e = 3.50, \u003cem\u003eSD\u0026nbsp;\u003c/em\u003e= 2.07). According to Cohen\u0026apos;s thresholds, these two effects would be small. This analysis also distinguishes a distinct evolution of inattention symptoms in students who benefited from the intervention compared to those who did not (\u003cem\u003eF\u003c/em\u003e(1,200) = 5.46, \u003cem\u003ep\u003c/em\u003e = 0.020, \u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/em\u003e= 0.03). More specifically, these symptoms decreased non-statistically significantly in students who benefited from the intervention (T1 \u003cem\u003eM\u003c/em\u003e = 3.51, \u003cem\u003eSD\u003c/em\u003e = 2.51; T2 \u003cem\u003eM\u003c/em\u003e = 3.33, \u003cem\u003eSD\u003c/em\u003e = 2.50), while they increased significantly in those who did not (T1 \u003cem\u003eM\u003c/em\u003e = 3.24, \u003cem\u003eSD\u003c/em\u003e = 2.51; T2 \u003cem\u003eM\u003c/em\u003e = 3.85, \u003cem\u003eSD\u003c/em\u003e = 2.59). Once again, the size of this effect is small.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" valign=\"top\" style=\"width: 630px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eGroup, time and time*group differences on mindfulness and symptoms of inattention, anxiety and depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eM (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e (effect size)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e = 220)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e = 120)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e = 100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eMindfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2.49 (0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2.68 (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2.48 (0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2.73 (1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e2.52 (0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e2.63 (0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.06 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e9,84** (0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.40 (0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eInattention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2.51 (0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2.55 (0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.51 (2.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.33 (2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3.24 (2.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3.85 (2.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.16 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.65 (0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.46* (0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3.23 (1.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3.50 (2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.31 (1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.61 (2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3.13 (2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3.36 (2.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.82 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.77\u003csup\u003et\u003c/sup\u003e (0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.08 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3.65 (3.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3.83 (3.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.80 (3.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e4.13 (3.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3.46 (3.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3.47 (3.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.39 (0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.56 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.50 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" valign=\"top\" style=\"width: 630px;\"\u003e\n \u003cp\u003e\u003cem\u003eNotes\u003c/em\u003e. N = 220.\u003c/p\u003e\n \u003cp\u003e\u003csup\u003et\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.10. \u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05. \u003csup\u003e**\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01. \u003csup\u003e***\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe simple mediation (Table 3) analyses allowed to examine the direct effects of time on changes in symptoms of inattention, anxiety and depression as well as the indirect effects when mediated by changes in mindfulness (Table 3). The results revealed no significant direct effect of time on the studied symptoms. However, when considering mindfulness as a mediator, significant indirect effects were found for symptoms of inattention (\u003cem\u003eb\u003c/em\u003e = 0.19, 95% CI [0.047, 0.396]), anxiety (\u003cem\u003eb\u003c/em\u003e = 0.15, 95% CI [0.039, 0.273]) and depression (\u003cem\u003eb\u003c/em\u003e = 0.27, 95% CI [0.084, 0.472]).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"708\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"14\" valign=\"top\" style=\"width: 708px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003eChanges in inattention, anxiety and depression, mediated by changes in mindfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003eeffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eDirect\u003c/p\u003e\n \u003cp\u003eeffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eIndirect\u003c/p\u003e\n \u003cp\u003eeffect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003cp\u003e(SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eLLCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eB (SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eLLCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eB (SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eLLCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eInattention\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003cp\u003e(0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003cp\u003e(0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e.19\u003c/p\u003e\n \u003cp\u003e(0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.26 (0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1.98*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003cp\u003e(0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e.15\u003c/p\u003e\n \u003cp\u003e(0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003cp\u003e(0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-0.08\u003c/p\u003e\n \u003cp\u003e(0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e.27\u003c/p\u003e\n \u003cp\u003e(0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"14\" valign=\"top\" style=\"width: 708px;\"\u003e\n \u003cp\u003e\u003cem\u003eNotes\u003c/em\u003e. N = 214. LLCI and ULCI Lower and Upper levels of the 95% confidence interval.\u003c/p\u003e\n \u003cp\u003eR\u003csup\u003e2\u0026nbsp;\u003c/sup\u003efor Inattention = 0.12; Anxiety = 0.15, Depression = 0.15.\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAs a final step, moderated mediations were used to compare students who benefited from the intervention with those who did not. The intention was to test whether the first group experienced distinct changes in mindfulness, and if these different changes were associated with distinct changes in the symptoms under investigation. The results showed no significant indirect effects, whether in relation to inattention (b = -0.16, 95% CI [-0.599, 0.151]), anxiety (b = 0.08, 95% CI [-0.175, 0.329]) or depression (b = 0.21, 95% CI [-0.222, 0.612]).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe overarching goal of this study was to determine whether dispositional mindfulness in elementary school children mediated changes in their inattention, anxiety and depression symptoms over time. A secondary objective was to determine whether participation in a mindfulness-based intervention moderated the effect on the relationship between mindfulness and mental health. While results show that dispositional mindfulness indeed mediated inattention, anxiety and depression symptoms, taking part in a mindfulness-based intervention, however, did not significantly moderate this relation.\u003c/p\u003e \u003cp\u003eWhen looking at the full sample, regardless of being randomly assigned to the mindfulness-based intervention experimental or the wait-list control group, results suggest that mindfulness may indeed play a role in children\u0026rsquo;s mental health. Specifically, results show that being more mindful may be associated with inattention, anxiety, and depression symptoms through time. In other words, if children can recognize what is going on within themselves, they may be able to rate their symptoms with some accuracy.\u003c/p\u003e \u003cp\u003eThese findings are counterintuitive and do not confirm our initial hypotheses. In fact, past research on dispositional mindfulness has shown that being more mindful promotes better mental health\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Nonetheless, our results may show that being mindful involves noticing the good and the bad. Hence, being mindful can lead to becoming more attuned to all of one\u0026rsquo;s internal experiences (i.e., being able to identify, label and acknowledge the unfolding of varying emotions, thoughts and physical sensations), which includes inattention, anxiety and depression\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. It is possible that as study participants developed mindfulness skills throughout time, they also became more sensitive to noticing all of these symptoms that may have gone unnoticed before. This, in turn, could explain, at least in part, the mediating relationship between mindfulness and the variables at play in this study. It is further possible that children who showed higher dispositional mindfulness through time were more aware of inattentive, anxious and depressive symptoms, but were not able to detach from these thoughts, which would be normally observed in adults\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Hence, it is possible that children tend to gain mindfulness skills that pertain to acknowledging and noticing, but not those related to non-judgment. This would lend further support to recent calls for caution in applying mindfulness-based interventions to children, as these are not necessarily appropriate for their level of cognitive development\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Finally, given the absence of a moderated mediation between groups, the relationship between dispositional mindfulness and the worsening of mental health scores cannot be attributed to taking part in a mindfulness-based intervention, but rather to the simple passage of time.\u003c/p\u003e \u003cp\u003eWhy would this be? It is possible that dispositional mindfulness \u0026ndash; as opposed to state-contingent mindfulness \u0026ndash; is at play in this mediation relationship. Indeed, previous research has distinguished two types of mindfulness, much similar to anxiety: people can either be naturally more or less mindful, regardless of the context they are in (i.e., trait mindfulness), and people can be placed in contexts which favor being in a mindful posture (i.e., state mindfulness)\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. While research on mindfulness as an individual disposition has shown that it favors better mental health, decreasing negative cognitive patterns such as rumination and catastrophizing\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, some interventional research has also suggested that taking part in a mindfulness-based intervention could foster the development of mindfulness as a trait\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. However, there is a lack of sufficient and robust research to support the latter claim in youth. For example, studies reporting the impact of mindfulness-based interventions sometime omit to measure mindfulness altogether in their sample; issues pertaining to the operationalization and the measure of dispositional mindfulness, especially in children, may have contributed to this gap in the literature\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Recent research on one of the most widely used mindfulness questionnaires, the \u003cem\u003eFive Facet Mindfulness Questionnaire\u003c/em\u003e, has highlighted how, although this questionnaire was designed for measuring trait mindfulness, it had been widely used by researchers to evaluate state mindfulness\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. These findings may explain why researchers have been reporting difficulties in measuring self-reported mindfulness. There is thus a need for developers of mindfulness scales to explicitly address which aspect of mindfulness they aim to measure.\u003c/p\u003e \u003cp\u003eFurthermore, some research does not support a causal relationship between taking part in a mindfulness-based intervention and increasing one\u0026rsquo;s mindful disposition\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. With this in mind and in light of the present study\u0026rsquo;s findings, caution is strongly warranted in implementing future studies with the aims of fostering the development of dispositional mindfulness in children, as this could, potentially, disserve them and contribute to potentially worsening their mental health. Given that mindfulness alone could bring greater awareness to difficult emotions, future research in the field could explore whether this could have an added benefit to emotion regulation and coping skill development interventions. Finally, the modest intervention effects may stem from testing normative populations, as children from regular classrooms in elementary schools without severe psychological disorders may have limited capacity for improvement of their mental health indicators. Ceiling effects in non-clinical samples have indeed been shown to constrain observable changes, notably in mindfulness-based intervention studies\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere is indeed an increasing number of studies that show that mindfulness-based interventions for youth (children and adolescents alike) may be counter-indicated\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. This study lends further support to the potential risks of implementing mindfulness-based interventions to sustain children\u0026rsquo;s mental health. Indeed, fostering mindfulness abilities in children may bring them to become more aware of their psychological difficulties, which could, in some cases, lead them with a feeling of hopelessness to change or to improve their situation. At the same time, noticing these difficulties could indicate to them the areas in their lives that are problematic and need to change. However, this awareness is not enough. To help children when they notice their difficulties, mindfulness-based interventions would need to be supplemented with other interventions, such as those based on social-emotional learning, in order to give them the emotion regulation skills they need to deal with the difficult situation\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. If being more mindful in and of itself has potential negative impacts on youth\u0026rsquo;s mental health, school and mental health professionals should also reconsider whether fostering the ability to connect with one\u0026rsquo;s emotions and thoughts in the present moment without building other emotion regulation skills is indicated altogether, especially in non-clinical settings where mental health professionals are not available to provide subsequent psychological support.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThe present study counts notable strengths, among which its large sample size and rigorous experimental design, reinforcing its conclusions. Nonetheless, important limitations must be acknowledged: first, the clusters in this randomized design were determined at the classroom level, instead of the school level. Indeed, all classrooms taking part in this study were recruited in the same school. It is thus possible that a contamination effect took place in which teachers spoke among themselves of their respective group condition, which, in the end, influenced mindfulness scores of students across both groups. It may have led teachers from the control group to adopt a more mindful posture in their classrooms, although they were assigned to the wait-list.\u003c/p\u003e \u003cp\u003eFurther limitations include the psychometric properties of the scales included in this study. Although all scales\u0026rsquo; internal consistency values were deemed acceptable, these were in the lower range, which may have impacted the robustness of our results. Indeed, the lower reliability of some of the scales may indicate that children did not fully understand all items that were used in our questionnaire package. As mentioned above, using mindfulness scales in research \u0026ndash; especially research involving children \u0026ndash; has been an ongoing issue in this field and developing valid, reliable and age-appropriate scales has proven difficult. While some scales evaluate various facets of dispositional mindfulness\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e, others \u0026ndash; such as the scale used in this project \u0026ndash; evaluate a sole facet of mindfulness, actually an absence of mindfulness, namely mindlessness\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,41\u003c/sup\u003e. Future research may aim to use more extensive mental health and mindfulness scales to ensure adequate operationalization of the concept, thus reinforcing its reliability and validity.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe purpose of this study was to explore whether dispositional mindfulness mediated the relation between time and mental health, namely symptoms of inattention, anxiety and depression, in elementary school children. A secondary objective meant to evaluate whether taking part in a mindfulness-based intervention moderated this mediated relationship between time and mental health. Results showed that mindfulness scores mediated indicators of mental health. Specifically, mindfulness mediated increases in inattention, anxiety and depression throughout time. Taking part in a mindfulness-based intervention did not have a significant impact on this relationship. Results thus lend support to exercising caution when aiming to only foster mindfulness abilities, without ensuring that children also learn the emotion regulation skills that are required to deal with the increased awareness of their difficulties.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCMH, TLG and JS wrote the initial draft of the manuscript. GT and CF extensively reviewed the manuscript. EHT helped with statistical analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCM-H has released a manual on the mindfulness-based intervention described and used in this study (Midi Trente Publishers). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to express gratitude and thanks to teachers and students who took part in this study,\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this project was provided by the Fonds de Recherche du Québec - Société et Culture through a research grant (#204588) to the first author (CMH).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEmerson, L.-M., de Diaz, N. 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(2011). \u003cem\u003ePsychological Assessment\u003c/em\u003e\u003cstrong\u003e23\u003c/strong\u003e, 1034\u0026ndash;1040 (2011).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"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-6448641/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6448641/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe number of mindfulness-based interventions has proliferated in the last decade as accessible evidence-based practices to improve children\u0026rsquo;s mental health in schools. However, some studies also suggest that mindfulness programs do not have added values compared to other mental health promotion interventions. These differences in effectiveness can partly be due to the lack of definition of what constitutes a mindfulness-based intervention, inconsistency in intervention length and in the training of facilitators. Hence, there is a lack of research and knowledge on the mechanisms that underlie these potential changes. The present study aimed to explore whether dispositional (i.e., trait) mindfulness mediated mental health indicators through time, in elementary school children. A secondary objective meant to evaluate whether receiving a mindfulness-based intervention could moderate such a relationship. Results showed that mindfulness scores mediated indicators of mental health. Specifically, mindfulness mediated increases in inattention, anxiety and depression throughout time. Taking part in a mindfulness-based intervention did not have a significant impact on this relationship. Results thus lend support to exercising caution when aiming to only foster mindfulness abilities, without ensuring that children also learn the emotion regulation skills that are required to deal with the increased awareness of their difficulties.\u003c/p\u003e","manuscriptTitle":"The effects of a mindfulness-based intervention on primary school students’ symptoms of inattention, depression, and anxiety: A moderated mediation examination","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-12 16:35:32","doi":"10.21203/rs.3.rs-6448641/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":"6a320b35-9aaa-4865-a7be-93147a8f966d","owner":[],"postedDate":"May 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":48269748,"name":"Biological sciences/Psychology"},{"id":48269749,"name":"Biological sciences/Psychology/Human behaviour"}],"tags":[],"updatedAt":"2025-05-26T07:10:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-12 16:35:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6448641","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6448641","identity":"rs-6448641","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}