A moderation examination of the effects of a mindfulness-based intervention on primary school students’ symptoms of inattention, depression, and anxiety

A moderation examination of the effects of a mindfulness-based intervention on primary school students’ symptoms of inattention, depression, and anxiety | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report A moderation examination of the effects of a mindfulness-based intervention on primary school students’ symptoms of inattention, depression, and anxiety Catherine Malboeuf-Hurtubise, Geneviève Taylor, Terra Léger-Goodes, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8502428/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract The number of mindfulness-based interventions (MBIs) has proliferated in the last decade, as accessible evidence-based practices, to improve children’s mental health in school settings. However, some studies suggest that MBIs do not offer distinct advantages over other mental health promotion interventions. These inconsistent findings may be explained, at least in part, by the lack of a clear definition of what constitutes a MBI, as well as inconsistencies in intervention length and facilitator training. The present study was interested in the potential benefits associated with a case of this type of intervention and aimed to explore whether dispositional (i.e., trait) mindfulness and mental health indicators evolved over time in primary school children. A secondary objective meant to evaluate whether receiving a MBI could moderate the relationship between changes in mindfulness and changes in mental health indicators. Results showed that mindfulness levels were linked with indicators of mental health. Specifically, changes in mindfulness were associated with increases in inattention, anxiety and depression throughout time using structural equation modelling. Taking part in a MBI resulted in worsened outcomes for depression. 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. ClinicalTrials.gov trial registration number NCT06346002; trial registration date: April 3rd 2024. Figures Figure 1 Background The number of mindfulness-based interventions (MBIs) 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-judgment, are key elements to practicing mindfulness. Mindfulness encourages engagement with emotions and sensations (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 are 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 interventions 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 MBI, 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 be moderated by the mindfulness intervention in relationship with 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 moderating variables between change in mindfulness and mental health. This is what we aimed to do in this study. Study aims The present study aimed to explore whether levels of dispositional (i.e., trait) mindfulness and mental health indicators evolved over time among primary school children. A secondary objective was to evaluate whether receiving a MBI could moderate the relationship between changes in levels of mindfulness and mental health indicators. We hypothesized that dispositional mindfulness would have a positive impact on mental health over time, particularly for children who take part in a MBI. 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 primary 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 primary 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 moderation analyses of the data and optimizing the model approach considering a multivariate structure. This manuscript follows the CONSORT reporting guidelines. Mindfulness-based intervention The MBI implemented in this RCT was specifically adapted for elementary school children. Activities comprised in this intervention encompassed formal (e.g., body scan, sitting, and breathing meditation) and informal meditations (e.g., mindful eating, listening, and touching, mindful walking), as well as positive psychology exercises (e.g., taking care of oneself, gratitude). The weekly sessions lasted between 45 and 60 minutes and were delivered during class-time, in a group. Teachers led the sessions. Teachers were all previously trained (total 3 days/24 hours of training) by the first and second authors (CMH and GT). 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. 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 three steps. Spearman’s correlation coefficients 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. Subsequently, linear mixed models were conducted to examine differences in the longitudinal evolution of mindfulness and symptoms of inattention, anxiety, and depression between the control and intervention groups. Results were presented as mean differences with their 95% confidence intervals and model assumptions were validated. We finally examined whether the associations between changes in mindfulness and changes in symptoms of inattention, anxiety and depression differed by group, using a multi-group latent change score framework. This approach allowed us to model outcomes jointly, accounting for their correlations and avoiding inflation of Type I error. For each variable, change scores were computed by subtracting baseline values (T1) from follow-up values (T2). Structural equation modeling (SEM) was conducted in R (version 4.4.2) using the lavaan package. The hypothesized model specified that symptom changes (Δ Anxiety, Δ Inattention, Δ Depression) were regressed on change in mindfulness (Δ Mindfulness), while adjusting for baseline values. To test moderation, the model was estimated allowing the strength of the associations to vary between groups. Direct paths from baseline mindfulness to Δ Mindfulness were also included, as well as covariances among baseline symptoms and among residuals of change scores. The model was further adjusted for age, while sex was excluded due to substantial missing data. Model fit was evaluated using standard fit indices (Goodness of Fit Index [GFI], Comparative Fit Index [CFI], Tucker–Lewis Index [TLI], Root Mean Square Error of Approximation [RMSEA], and Standardized Root Mean Square Residual [SRMR]) following recommended thresholds (GFI/CFI/TLI ≥ 0.90, RMSEA ≤ 0.08, SRMR ≤ 0.08). Group-specific parameter estimates were reported using standardized coefficients with 95% confidence intervals, facilitating direct comparison of effect sizes across outcomes and groups. Results As mentioned, the Spearman’s 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. These interrelationships among mental health indicators support the use of a multivariate model to jointly examine the outcomes. 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 0.41** - 3. Anxiety 0.46** 0.37** - 4. Depression 0.41** 0.39** 0.50** - Notes . N = 220. Linear mixed models allowed us to compare independently changes in trajectory for 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). No statistically significant effects of time, group, or their interaction were observed for mindfulness, anxiety, or depression. Mindfulness improved slightly in the intervention group, anxiety followed comparable trajectories across groups, and depression increased more in the intervention group. Significant effects of time ( β = 0.60 [0.12 – 1.07 ; p = 0.014]) and interaction ( β = -0.73 [-1.38 - -0.08 ; p = 0.027]) were found for inattention, showing an increase over time in the control group and a small decrease in the intervention group (Figure 1). Table 2 Group, time and interaction differences on mindfulness and symptoms of inattention, anxiety and depression Variable Mean (SD) Mean differences [95% C.I.] 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 (0.94) 2.73 (1.00) 2.50 (0.92) 2.63 (0.93) -0.03 [-0.3 -0.2] 0.11 [-0.1 –0.3] 0.14 [-0.1 – 0.4] Inattention 3.35 (2.47) 3.56 (2.53) 3.43 (2.46) 3.35 (2.47) 3.25 (2.49) 3.81 (2.58) 0.2 [-0.5 – 0.8] 0.6* [0.1 – 1.1] -0.7* [-1.4 - -0.1] Anxiety 3.21 (1.95) 3.52 (2.08) 3.23 (1.87) 3.60 (2.06) 3.20 (2.05) 3.43 (2.10) 0.01 [-0.5 – 0.5] 0.2 [-0.2 – 0.6] 0.1 [-0.4 – 0.6] Depression 3.62 (3.31) 3.86 (3.59) 3.69 (3.40) 4.18 (3.61) 3.52 (3.21) 3.48 (3.56) 0.2 [-0.7 – 1.1] -0.01 [-0.7 – 0.6] 0.4 [-0.5 – 1.3] Notes . N = 220. t p < 0.10. * p < 0.05. ** p < 0.01. *** p < 0.001. Structural equation modelling allowed us to examine the direct effects of changes in mindfulness on changes in symptoms of anxiety, inattention and depression in the same model. Moreover, it allowed us to add directly intervention as a moderation effect while adjusting for each score baseline values and age. (Table 3). The model showed partial fit to the data (GFI = 0.90; CFI = 0.72; TLI = 0.47; SRMR = 0.16; RMSEA = 0.21), indicating that results should be interpreted with caution. The results revealed significant direct effect of changes in mindfulness on all the symptoms studied. However, when examining the intervention as a moderator, the conclusions were largely consistent with previous findings. Inattention remained the only outcome with differing trajectories between groups, with a non-significant change in the intervention group (β = 0.13 [-0.04 – 0.30]; p = 0.122) and a significant increase in the control group ( β = 0.46 [0.31 – 0.61]; p < .0001). For other outcomes, symptoms of anxiety increased similarly across groups ( β = 0.37 [0.22 – 0.53]; p < .0001 vs β = 0.39 [0.24 – 0.54] ; p < .0001), while depression symptoms increased more in the intervention group ( β = 0.43 [0.29 – 0.57]; p < .0001 vs β = 0.30 [0.13 – 0.47] ; p < .0001); nonetheless, all these changes remained significant in both groups. Table 3 Group-Specific Standardized Effects from Structural Equation Modeling Intervention Control Variable* Standardized estimate [95% C.I.] P-value Standardized estimate [95% C.I.] P-value Inattention 0.13 [-0.04 – 0.30] 0.122 0.46 [0.31 – 0.61] < .0001 Anxiety 0.37 [0.22 – 0.53] < .0001 0.39 [0.24 – 0.54] < .0001 Depression 0.43 [0.29 – 0.57] < .0001 0.30 [0.13 – 0.47] < .0001 *Adjusted for baseline values and age Discussion The overarching goal of this study was to determine whether changes in dispositional mindfulness in primary school children throughout time were associated with changes in their inattention, anxiety and depression symptoms. A secondary objective was to determine whether participation in a MBI moderated the effect on the relationship between mindfulness and mental health. Results show that changes in dispositional mindfulness were indeed related to changes in inattention, anxiety and depression symptoms. Furthermore, taking part in a MBI resulted in worsened outcomes for depression. When looking at the full sample, regardless of being randomly assigned to the MBI experimental or the wait-list control group, results suggest that mindfulness may indeed play a role in children’s mental health, albeit a detrimental one. Specifically, results show that being more mindful may be associated with worsening inattention, anxiety, and depression symptoms through time. Effects for anxiety and depression were large, whereas they were moderate for inattention. Taking part in a MBI may also exacerbate the worsening of depressive symptoms. In other words, if children become more aware of their emotional state, they may be able to identify and more accurately rate their symptoms. 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 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 MBIs to children, as these are not necessarily appropriate for their level of cognitive development 40 . Some research does not support a causal relationship between taking part in a MBI 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. There is indeed an increasing number of studies that show that MBIs for youth (children and adolescents alike) may be counter-indicated 23 , 37 , 38 . This study lends further support to the potential risks of implementing MBIs 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, MBIs 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. 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. Several limitations related to the statistical model should be noted. The model fit indices indicated only partial adequacy, with a GFI of 0.91 suggesting acceptable fit, but CFI (0.70), TLI (0.41), SRMR (0.15), and RMSEA (0.23) falling outside commonly recommended thresholds. These values suggest that the model may not fully capture the observed data structure, and results should therefore be interpreted with caution. Future studies may benefit from alternative model specifications or the inclusion of additional variables to improve model fit. More precisely, a new study would benefit from considering individual-level characteristics (e.g., gender, specific difficulties or special needs, socioeconomic background, prior exposure to MBIs or other mental health promotion interventions), as well as intervention-specific characteristics (e.g., number of sessions, duration of the intervention, and supporting contextual factors), all of which may influence outcomes. Such a study would provide an opportunity to examine whether similar interventions implemented in different settings, and therefore with different student populations, yield comparable benefits. Declarations Author contributions CMH, TLG and JS wrote the initial draft of the manuscript. GT and CF extensively reviewed the manuscript. 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, as well as to Samuel Lemaire-Paquette for his invaluable help with statistical analyses. 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). Ethical approval 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. Consent to participate Informed consent was obtained from all parents of children taking part in this study and their teachers. Consent to publish Not applicable. References Emerson L-M, de Diaz NN, Sherwood A, Waters A, Farrell L. Mindfulness interventions in schools: Integrity and feasibility of implementation. Int J Behav Dev. 2020;44:62–75. Lee SF, Young JL. Mind the Gap: The History and Philosophy of Health Psychology and Mindfulness. 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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. 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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-8502428","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":586563460,"identity":"f5b46ecd-a7d0-4a87-94d0-d7b42764f4a2","order_by":0,"name":"Catherine Malboeuf-Hurtubise","email":"data:image/png;base64,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","orcid":"","institution":"Université Laval","correspondingAuthor":true,"prefix":"","firstName":"Catherine","middleName":"","lastName":"Malboeuf-Hurtubise","suffix":""},{"id":586563463,"identity":"34c9f4cc-f00f-4af0-aacb-dcd5b4777ab7","order_by":1,"name":"Geneviève Taylor","email":"","orcid":"","institution":"University of Quebec in Montreal","correspondingAuthor":false,"prefix":"","firstName":"Geneviève","middleName":"","lastName":"Taylor","suffix":""},{"id":586563464,"identity":"2a1ac073-b5ef-41c3-aa02-03a407f781d5","order_by":2,"name":"Terra Léger-Goodes","email":"","orcid":"","institution":"University of Quebec in Montreal","correspondingAuthor":false,"prefix":"","firstName":"Terra","middleName":"","lastName":"Léger-Goodes","suffix":""},{"id":586563465,"identity":"66f0325c-aa60-4e17-b86c-b33b823dddf5","order_by":3,"name":"Caroline Fitzpatrick","email":"","orcid":"","institution":"Université de Sherbrooke","correspondingAuthor":false,"prefix":"","firstName":"Caroline","middleName":"","lastName":"Fitzpatrick","suffix":""},{"id":586563466,"identity":"fa142f1e-5ca2-4999-9233-b9989de30c08","order_by":4,"name":"Jonathan Smith","email":"","orcid":"","institution":"Université de Sherbrooke","correspondingAuthor":false,"prefix":"","firstName":"Jonathan","middleName":"","lastName":"Smith","suffix":""}],"badges":[],"createdAt":"2026-01-02 17:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8502428/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8502428/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102209911,"identity":"1f99894c-a79f-4262-8f62-ba5152f98b24","added_by":"auto","created_at":"2026-02-09 12:15:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59728,"visible":true,"origin":"","legend":"\u003cp\u003eStructural equation model of associations between changes in mindfulness and changes in anxiety, inattention, and depression symptoms\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8502428/v1/5144b327c907dd33af77c307.png"},{"id":102296781,"identity":"34909e0a-5376-4be9-a532-a91c1b7815ec","added_by":"auto","created_at":"2026-02-10 10:21:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":627896,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8502428/v1/56d4eb50-36d6-41c2-aa76-03ce88280337.pdf"}],"financialInterests":"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.","formattedTitle":"A moderation examination of the effects of a mindfulness-based intervention on primary school students’ symptoms of inattention, depression, and anxiety","fulltext":[{"header":"Background","content":"\u003cp\u003eThe number of mindfulness-based interventions (MBIs) 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\u003e4\u003c/sup\u003e Introspective awareness of thoughts, sensations and emotions in the present moment, coupled with non-judgment, are key elements to practicing mindfulness. Mindfulness encourages engagement with emotions and sensations (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 are 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 interventions 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 MBI, 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 be moderated by the mindfulness intervention in relationship with 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 moderating variables between change in mindfulness 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 levels of dispositional (i.e., trait) mindfulness and mental health indicators evolved over time among primary school children. A secondary objective was to evaluate whether receiving a MBI could moderate the relationship between changes in levels of mindfulness and mental health indicators. We hypothesized that dispositional mindfulness would have a positive impact on mental health over time, particularly for children who take part in a MBI.\u003c/p\u003e "},{"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 primary 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 primary 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 moderation analyses of the data and optimizing the model approach considering a multivariate structure. This manuscript follows the CONSORT reporting guidelines.\u003c/p\u003e\u003ch3\u003eMindfulness-based intervention\u003c/h3\u003e\u003cp\u003eThe MBI implemented in this RCT was specifically adapted for elementary school children. Activities comprised in this intervention encompassed formal (e.g., body scan, sitting, and breathing meditation) and informal meditations (e.g., mindful eating, listening, and touching, mindful walking), as well as positive psychology exercises (e.g., taking care of oneself, gratitude). The weekly sessions lasted between 45 and 60 minutes and were delivered during class-time, in a group. Teachers led the sessions. Teachers were all previously trained (total 3 days/24 hours of training) by the first and second authors (CMH and GT).\u003c/p\u003e\u003ch3\u003eMeasures\u003c/h3\u003e\u003cp\u003e \u003cem\u003eMindful Attention and Awareness Scale for Children (MAAS-C)\u003c/em\u003e \u003csup\u003e28\u003c/sup\u003e: Children completed the MAAS-C to evaluate pre-to-post changes in dispositional 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 three steps. Spearman’s correlation coefficients 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. Subsequently, linear mixed models were conducted to examine differences in the longitudinal evolution of mindfulness and symptoms of inattention, anxiety, and depression between the control and intervention groups. Results were presented as mean differences with their 95% confidence intervals and model assumptions were validated.\u003c/p\u003e\u003cp\u003eWe finally examined whether the associations between changes in mindfulness and changes in symptoms of inattention, anxiety and depression differed by group, using a multi-group latent change score framework. This approach allowed us to model outcomes jointly, accounting for their correlations and avoiding inflation of Type I error. For each variable, change scores were computed by subtracting baseline values (T1) from follow-up values (T2). Structural equation modeling (SEM) was conducted in R (version 4.4.2) using the \u003cem\u003elavaan\u003c/em\u003e package. The hypothesized model specified that symptom changes (Δ Anxiety, Δ Inattention, Δ Depression) were regressed on change in mindfulness (Δ Mindfulness), while adjusting for baseline values. To test moderation, the model was estimated allowing the strength of the associations to vary between groups. Direct paths from baseline mindfulness to Δ Mindfulness were also included, as well as covariances among baseline symptoms and among residuals of change scores. The model was further adjusted for age, while sex was excluded due to substantial missing data.\u003c/p\u003e\u003cp\u003eModel fit was evaluated using standard fit indices (Goodness of Fit Index [GFI], Comparative Fit Index [CFI], Tucker–Lewis Index [TLI], Root Mean Square Error of Approximation [RMSEA], and Standardized Root Mean Square Residual [SRMR]) following recommended thresholds (GFI/CFI/TLI ≥ 0.90, RMSEA ≤ 0.08, SRMR ≤ 0.08). Group-specific parameter estimates were reported using standardized coefficients with 95% confidence intervals, facilitating direct comparison of effect sizes across outcomes and groups.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAs mentioned, the Spearman\u0026rsquo;s 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. These interrelationships among mental health indicators support the use of a multivariate model to jointly examine the outcomes.\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\u003e0.41**\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\u003e0.46**\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\u003e0.41**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.39**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.50**\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;Linear mixed models allowed us to compare independently changes in trajectory for 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). No statistically significant effects of time, group, or their interaction were observed for mindfulness, anxiety, or depression. Mindfulness improved slightly in the intervention group, anxiety followed comparable trajectories across groups, and depression increased more in the intervention group. Significant effects of time (\u003cem\u003e\u0026beta;\u0026nbsp;\u003c/em\u003e= 0.60 [0.12 \u0026ndash; 1.07 ; \u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.014]) and interaction (\u003cem\u003e\u0026beta;\u0026nbsp;\u003c/em\u003e= -0.73 [-1.38 - -0.08 ; \u003cem\u003ep\u003c/em\u003e = 0.027]) were found for inattention, showing an increase over time in the control group and a small decrease in the intervention group (Figure 1).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\" valign=\"top\" style=\"width: 630px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eGroup, time and interaction 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=\"7\" style=\"width: 302px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 233px;\"\u003e\n \u003cp\u003eMean differences [95% C.I.]\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 colspan=\"2\" valign=\"top\" style=\"width: 96px;\"\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 rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 82px;\"\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: 49px;\"\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 \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 (0.94)\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: 49px;\"\u003e\n \u003cp\u003e2.50 (0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2.63 (0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.03\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;[-0.3 -0.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003cp\u003e[-0.1 \u0026ndash;0.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.14\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[-0.1 \u0026ndash; 0.4]\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\u003e3.35 (2.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3.56 (2.53)\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\u003e3.43 (2.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.35 (2.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e3.25 (2.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3.81 (2.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[-0.5 \u0026ndash; 0.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.6*\u003c/p\u003e\n \u003cp\u003e[0.1 \u0026ndash; 1.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.7*\u003c/p\u003e\n \u003cp\u003e[-1.4 - -0.1]\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\u003e3.21 (1.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3.52 (2.08)\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\u003e3.23 (1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.60 (2.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e3.20 (2.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3.43 (2.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003cp\u003e[-0.5 \u0026ndash; 0.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e[-0.2 \u0026ndash; 0.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003cp\u003e[-0.4 \u0026ndash; 0.6]\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\u003e3.62 (3.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3.86 (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: 48px;\"\u003e\n \u003cp\u003e3.69 (3.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e4.18 (3.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e3.52 (3.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3.48 (3.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e[-0.7 \u0026ndash; 1.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003cp\u003e[-0.7 \u0026ndash; 0.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e[-0.5 \u0026ndash; 1.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\" 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\u003e\u0026nbsp;Structural equation modelling allowed us to examine the direct effects of changes in mindfulness on changes in symptoms of anxiety, inattention and depression in the same model. Moreover, it allowed us to add directly intervention as a moderation effect while adjusting for each score baseline values and age. (Table 3). The model showed partial fit to the data (GFI = 0.90; CFI = 0.72; TLI = 0.47; SRMR = 0.16; RMSEA = 0.21), indicating that results should be interpreted with caution. The results revealed significant direct effect of changes in mindfulness on all the symptoms studied. However, when examining the intervention as a moderator, the conclusions were largely consistent with previous findings. Inattention remained the only outcome with differing trajectories between groups, with a non-significant change in the intervention group (\u0026beta; = 0.13 [-0.04 \u0026ndash; 0.30]; \u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.122) and a significant increase in the control group (\u003cem\u003e\u0026beta;\u0026nbsp;\u003c/em\u003e= 0.46 [0.31 \u0026ndash; 0.61]; \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; .0001). For other outcomes, symptoms of anxiety increased similarly across groups (\u003cem\u003e\u0026beta;\u003c/em\u003e = 0.37 [0.22 \u0026ndash; 0.53]; \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; .0001 vs \u003cem\u003e\u0026beta;\u0026nbsp;\u003c/em\u003e= 0.39 [0.24 \u0026ndash; 0.54] ; \u003cem\u003ep\u003c/em\u003e \u0026lt; .0001), while depression symptoms increased more in the intervention group (\u003cem\u003e\u0026beta;\u003c/em\u003e = 0.43 [0.29 \u0026ndash; 0.57]; \u003cem\u003ep\u003c/em\u003e \u0026lt; .0001 vs \u003cem\u003e\u0026beta;\u003c/em\u003e = 0.30 [0.13 \u0026ndash; 0.47] ; \u003cem\u003ep\u003c/em\u003e \u0026lt; .0001); nonetheless, all these changes remained significant in both groups.\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 576px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eGroup-Specific Standardized Effects from Structural Equation Modeling\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eVariable*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eStandardized estimate\u003c/p\u003e\n \u003cp\u003e[95% C.I.]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eStandardized estimate\u003c/p\u003e\n \u003cp\u003e[95% C.I.]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eInattention\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.13 [-0.04 \u0026ndash; 0.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.46 [0.31 \u0026ndash; 0.61]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; .0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.37 [0.22 \u0026ndash; 0.53]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; .0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.39 [0.24 \u0026ndash; 0.54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; .0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.43 [0.29 \u0026ndash; 0.57]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; .0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.30 [0.13 \u0026ndash; 0.47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; .0001\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*Adjusted for baseline values and age\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe overarching goal of this study was to determine whether changes in dispositional mindfulness in primary school children throughout time were associated with changes in their inattention, anxiety and depression symptoms. A secondary objective was to determine whether participation in a MBI moderated the effect on the relationship between mindfulness and mental health. Results show that changes in dispositional mindfulness were indeed related to changes in inattention, anxiety and depression symptoms. Furthermore, taking part in a MBI resulted in worsened outcomes for depression.\u003c/p\u003e \u003cp\u003eWhen looking at the full sample, regardless of being randomly assigned to the MBI experimental or the wait-list control group, results suggest that mindfulness may indeed play a role in children\u0026rsquo;s mental health, albeit a detrimental one. Specifically, results show that being more mindful may be associated with worsening inattention, anxiety, and depression symptoms through time. Effects for anxiety and depression were large, whereas they were moderate for inattention. Taking part in a MBI may also exacerbate the worsening of depressive symptoms. In other words, if children become more aware of their emotional state, they may be able to identify and more accurately rate their symptoms.\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 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 MBIs 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.\u003c/p\u003e \u003cp\u003eSome research does not support a causal relationship between taking part in a MBI 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.\u003c/p\u003e \u003cp\u003eThere is indeed an increasing number of studies that show that MBIs for youth (children and adolescents alike) may be counter-indicated\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. This study lends further support to the potential risks of implementing MBIs 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, MBIs 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. 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 \u003cp\u003eSeveral limitations related to the statistical model should be noted. The model fit indices indicated only partial adequacy, with a GFI of 0.91 suggesting acceptable fit, but CFI (0.70), TLI (0.41), SRMR (0.15), and RMSEA (0.23) falling outside commonly recommended thresholds. These values suggest that the model may not fully capture the observed data structure, and results should therefore be interpreted with caution. Future studies may benefit from alternative model specifications or the inclusion of additional variables to improve model fit. More precisely, a new study would benefit from considering individual-level characteristics (e.g., gender, specific difficulties or special needs, socioeconomic background, prior exposure to MBIs or other mental health promotion interventions), as well as intervention-specific characteristics (e.g., number of sessions, duration of the intervention, and supporting contextual factors), all of which may influence outcomes. Such a study would provide an opportunity to examine whether similar interventions implemented in different settings, and therefore with different student populations, yield comparable benefits.\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.\u0026nbsp;\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, as well as to Samuel Lemaire-Paquette for his invaluable help with statistical analyses.\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 Qu\u0026eacute;bec - Soci\u0026eacute;t\u0026eacute; et Culture through a research grant (#204588) to the first author (CMH).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIRB approval was obtained from Universit\u0026eacute; du Qu\u0026eacute;bec \u0026agrave; Montr\u0026eacute;al (file #\u003cstrong\u003e\u0026nbsp;2026_e_2017\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e and all methods were performed in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003cbr\u003e\u003c/strong\u003eInformed consent was obtained from all parents of children taking part in this study and their teachers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEmerson L-M, de Diaz NN, Sherwood A, Waters A, Farrell L. 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Development of a Short Form of the Five Facet Mindfulness Questionnaire\u0026ndash;Adolescents for Children and Adolescents. J Pers Assess. 2019;1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/00223891.2019.1616206\u003c/span\u003e\u003cspan address=\"10.1080/00223891.2019.1616206\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrossman P et al. Defining mindfulness by how poorly I think I pay attention during everyday awareness and other intractable problems for psychology\u0026rsquo;s (re)invention of mindfulness: Comment on Brown. (2011). \u003cem\u003ePsychological Assessment\u003c/em\u003e 23, 1034\u0026ndash;1040 (2011).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8502428/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8502428/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe number of mindfulness-based interventions (MBIs) has proliferated in the last decade, as accessible evidence-based practices, to improve children\u0026rsquo;s mental health in school settings. However, some studies suggest that MBIs do not offer distinct advantages over other mental health promotion interventions. These inconsistent findings may be explained, at least in part, by the lack of a clear definition of what constitutes a MBI, as well as inconsistencies in intervention length and facilitator training. The present study was interested in the potential benefits associated with a case of this type of intervention and aimed to explore whether dispositional (i.e., trait) mindfulness and mental health indicators evolved over time in primary school children. A secondary objective meant to evaluate whether receiving a MBI could moderate the relationship between changes in mindfulness and changes in mental health indicators. Results showed that mindfulness levels were linked with indicators of mental health. Specifically, changes in mindfulness were associated with increases in inattention, anxiety and depression throughout time using structural equation modelling. Taking part in a MBI resulted in worsened outcomes for depression. 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. ClinicalTrials.gov trial registration number NCT06346002; trial registration date: April 3rd 2024.\u003c/p\u003e","manuscriptTitle":"A moderation examination of the effects of a mindfulness-based intervention on primary school students’ symptoms of inattention, depression, and anxiety","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 12:14:54","doi":"10.21203/rs.3.rs-8502428/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-29T07:18:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-01T02:18:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-27T04:24:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73911963471142705488674089389744999300","date":"2026-02-21T01:52:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"40206562257407256904827598287956316804","date":"2026-02-20T17:28:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-20T00:06:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112204988585949239928090615235218503858","date":"2026-02-11T14:38:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-04T07:18:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-10T05:30:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-09T12:41:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Mental Health","date":"2026-01-09T12:30:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c342c902-c3e1-4511-a0f9-e8fbe28852f7","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-04-29T07:18:16+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T07:25:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 12:14:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8502428","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8502428","identity":"rs-8502428","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}