Effectiveness of virtual mindfulness-based interventions on perceived anxiety and depression of physicians during the COVID-19 pandemic: A pre-post experimental study

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Abstract

Background: The outbreak of coronavirus disease 2019 (COVID-19) created unprecedented stress on physicians. Mindfulness is a type of meditation that focuses on being fully present, aware of senses, and emotions in the present moment without analyzing or judging them, and it may help reduce psychological distress in physicians. This study aimed to examine the effectiveness of virtual mindfulness-based intervention (MBI) on physicians' perceived anxiety and depression and different facets of mindfulness.

Methods: During the COVID-19 pandemic, an online survey was administered to physicians to assess depression, anxiety, and awareness using the 9-item Patient Health Questionnaire (PHQ-9), 7-item General Anxiety Disorder (GAD-7), and Five-Facets Mindfulness Questionnaire (FFMQ), respectively. Physicians that received the virtual MBI sessions also completed post-questionnaires at a 3-week follow-up time point.

Results: A total of 125 physicians responded to the online survey, with 56 completing the MBI. The prevalence of moderate to severe anxiety and depression was 45.0 and 46.7%, respectively. Mindfulness scores were negatively associated with depression (r = -0.38, P < 0.001) and anxiety (r = -0.36, p < 0.001). Mindfulness scores for the 56 physicians who received virtual MBI sessions were significantly improved (mean difference ± SD, 17.7 ± 16.1, p = 0.001). Significant reductions were also evidenced in anxiety (4.4 ± 4.2) and depression (4.5 ± 5.1) scores (p's < 0.001). There was also an improvement in mindfulness facets of observing (5.1 ± 4.7), describing (2.3 ± 4.3), acting with awareness (2.7 ± 5.3), non-judging of inner experience (3.6 ± 6.1), and non-reactivity to inner experience (3.9 ± 4.0) (p's < 0.001). A facet of mindfulness, acting with awareness was most efficiently associated with improved anxiety (B = -0.3, p = 0.02) and depression (B = -0.4, p = 0.01).

Conclusion: This study has demonstrated that virtual MBI improved physicians' psychological wellbeing and mindfulness during the crisis. Regular mindfulness practice may help physicians to tolerate and handle unpleasant circumstances, such as future epidemics or pandemics.

Keywords: anxiety; depression; healthcare profession; mindfulness-based interventions (MBIs); physicians.

Conflict of interest statement

The 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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KMEL References


References

  1.  
    1. Zhu H, Wei L, Niu P. The novel coronavirus outbreak in Wuhan, China. Glob Health Res Policy. (2020) 5:6. 10.1186/s41256-020-00135-6 - DOI - PMC - PubMed
  2.  
    1. Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology. (2020) 297:E346. 10.1148/radiol.20202090214 - DOI - PMC - PubMed
  3.  
    1. Allan S, Bealey R, Birch J, Cushing T, Parke S, Sergi G, et al. The prevalence of common and stress-related mental health disorders in healthcare workers based in pandemic-affected hospitals: a rapid systematic review and meta-analysis. Eur J Psychotraumatol. (2020) 11:1810903. 10.1080/20008198.2020.18109039 - DOI - PMC - PubMed
  4.  
    1. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho C. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. (2020) 17:1729. 10.3390/ijerph170517299 - DOI - PMC - PubMed
  5.  
    1. Cabarkapa S, Nadjidai S, Murgier J, Ng C. The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: a rapid systematic review. Brain Behav Immun Health. (2020) 8:100144. 10.1016/j.bbih.2020.1001441 - DOI - PMC - PubMed
  6.  
    1. Lucas D, Brient S, Eveillard B, Gressier A, LeGrand T, Pougnet R, et al. Health impact of work stressors and psychosocial perceptions among French hospital workers during the COVID-19 outbreak: a cross-sectional survey. BMJ Open. (2022) 12:e053638. 10.1136/bmjopen-2021-0536385 - DOI - PMC - PubMed
  7.  
    1. Benfante A, Di Tella M, Romeo A, Castelli L. Traumatic stress in healthcare workers during COVID-19 pandemic: a review of the immediate impact. Front Psychol. (2020) 11:569935. 10.3389/fpsyg.2020.569935 - DOI - PMC - PubMed
  8.  
    1. Jemal K, Deriba B, Geleta T. Psychological distress, early behavioral response, and perception toward the COVID-19 pandemic among health care workers in North Shoa Zone, Oromiya Region. Front Psychiatry. (2021) 12:628898. 10.3389/fpsyt.2021.628898 - DOI - PMC - PubMed
  9.  
    1. Marvaldi M, Mallet J, Dubertret C, Moro M, Guessoum S. Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Neurosci Biobehav Rev. (2021) 126:252–64. 10.1016/j.neubiorev.2021.03.0245 - DOI - PMC - PubMed
  10.  
    1. Saragih I, Tonapa S, Saragih I, Advani S, Batubara S, Suarilah I, et al. Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: a systematic review and meta-analysis. Int J Nurs Stud. (2021) 121:104002. 10.1016/j.ijnurstu.2021.1040020 - DOI - PMC - PubMed
  11.  
    1. Gilboa S, Shirom A, Fried Y, Cooper C. A meta-analysis of work demand stressors and job performance: examining main and moderating effects. Personnel Psychol. (2008) 61:227–71.
  12.  
    1. Salari N, Khazaie H, Hosseinian-Far A, Khaledi-Paveh B, Kazeminia M, Mohammadi M, et al. The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: a systematic review and meta-regression. Hum Resour Health. (2020) 18:100. 10.1186/s12960-020-00544-1 - DOI - PMC - PubMed
  13.  
    1. David E, DePierro J, Marin D, Sharma V, Charney D, Katz C. COVID-19 pandemic support programs for healthcare workers and implications for occupational mental health: a narrative review. Psychiatr Q. (2022) 93:227–47. 10.1007/s11126-021-09952-57 - DOI - PMC - PubMed
  14.  
    1. Callus E, Bassola B, Fiolo V, Bertoldo E, Pagliuca S, Lusignani M. Stress reduction techniques for health care providers dealing with severe coronavirus infections (SARS, MERS, and COVID-19): a rapid review. Front Psychol. (2020) 11:589698. 10.3389/fpsyg.2020.5896984 - DOI - PMC - PubMed
  15.  
    1. Gupta S, Kumar M, Rozatkar A, Basera D, Purwar S, Gautam D, et al. Feasibility and effectiveness of telecounseling on the psychological problems of frontline healthcare workers amidst COVID-19: a randomized controlled trial from Central India. Indian J Psychol Med. (2021) 43:343–50. 10.1177/025371762110245379 - DOI - PMC - PubMed
  16.  
    1. Kim S, Crawford J, Hunter S. Role of an online skill-based mindfulness program for healthcare worker’s resiliency during the COVID-19 pandemic: a mixed-method study. Front Public Health. (2022) 10:907528. 10.3389/fpubh.2022.9075280 - DOI - PMC - PubMed
  17.  
    1. Yıldırım D, Çiriş Yıldız C. The effect of mindfulness-based breathing and music therapy practice on nurses’ stress, work-related strain, and psychological well-being during the COVID-19 pandemic: a randomized controlled trial. Holist Nurs Pract. (2022) 36:156–65. 10.1097/HNP.00000000000005117 - DOI - PMC - PubMed
  18.  
    1. Keng S, Smoski M, Robins C. Effects of mindfulness on psychological health: a review of empirical studies. Clin Psychol Rev. (2011) 31:1041–56. 10.1016/j.cpr.2011.04.006 - DOI - PMC - PubMed
  19.  
    1. Zeller J, Johnson A, Hoffman A, Hoyem R, Alexander M, Yudkowsky R. Mindfulness training to improve nurse clinical performance: a pilot study. West J Nurs Res. (2021) 43:250–60. 10.1177/01939459209649383 - DOI - PubMed
  20.  
    1. McConville J, McAleer R, Hahne A. Mindfulness training for health profession students-the effect of mindfulness training on psychological well-being, learning and clinical performance of health professional students: a systematic review of randomized and non-randomized controlled trials. Explore. (2017) 13:26–45. 10.1016/j.explore.2016.10.0025 - DOI - PubMed
  21.  
    1. Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol Sci Pract. (2003) 10:144–56. 10.1093/clipsy.bpg016 - DOI
  22.  
    1. Ngan S, Cheng P. Classification of mindfulness meditation and its impact on neural measures in the clinical population. Front Psychol. (2022) 13:891004. 10.3389/fpsyg.2022.8910042 - DOI - PMC - PubMed
  23.  
    1. Hofmann S, Gómez A. Mindfulness-based interventions for anxiety and depression. Psychiatr Clin North Am. (2017) 40:739–49. 10.1016/j.psc.2017.08.0087 - DOI - PMC - PubMed
  24.  
    1. Chien W, Chow K, Chong Y, Bressington D, Choi K, Chan C. The role of five facets of mindfulness in a mindfulness-based psychoeducation intervention for people with recent-onset psychosis on mental and psychosocial health outcomes. Front Psychiatry. (2020) 11:177. 10.3389/fpsyt.2020.001777 - DOI - PMC - PubMed
  25.  
    1. Baer R, Smith G, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. (2006) 13:27–45. 10.1177/10731911052835047 - DOI - PubMed
  26.  
    1. Spitzer R, Kroenke K, Williams J, Group P, Group P. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. (1999) 282:1737–44. - PubMed
  27.  
    1. Al-Ozairi E, Al Ozairi A, Blythe C, Taghadom E, Ismail K. The epidemiology of depression and diabetes distress in type 2 diabetes in Kuwait. J Diabetes Res. (2020) 2020:7414050. 10.1155/2020/7414050 - DOI - PMC - PubMed
  28.  
    1. Spitzer R, Kroenke K, Williams J, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Internal Med. (2006) 166:1092–7. 10.1001/archinte.166.10.10921 - DOI - PubMed
  29.  
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. London: Routledge; (2013).
  30.  
    1. Abdulla E, Velladath S, Varghese A, Anju M. Depression and anxiety associated with COVID- 19 pandemic among healthcare professionals in India- a systematic review and meta-analysis. Clin Epidemiol Glob Health. (2021) 12:100888. 10.1016/j.cegh.2021.100888 - DOI - PMC - PubMed
  31.  
    1. Hasan M, Anjum A, Biswas M, Hossain S, Alin S, Koly K, et al. A survey on depressive symptoms and its correlates amongst physicians in Bangladesh during the COVID-19 pandemic. Front Psychol. (2022) 13:846889. 10.3389/fpsyg.2022.8468891 - DOI - PMC - PubMed
  32.  
    1. Alsharji K. Anxiety and depression during the COVID-19 pandemic in Kuwait: the importance of physical activity. Middle East Curr Psychiatry. (2020) 27:60. 10.1186/s43045-020-00065-6 - DOI
  33.  
    1. Alsairafi Z, Naser A, Alsaleh F, Awad A, Jalal Z. Mental health status of healthcare professionals and students of health sciences faculties in Kuwait during the COVID-19 pandemic. Int J Environ Res Public Health. (2021) 18:2203. 10.3390/ijerph180422032 - DOI - PMC - PubMed
  34.  
    1. Yıldırım M, Arslan G, Özaslan A. Perceived risk and mental health problems among healthcare professionals during COVID-19 pandemic: exploring the mediating effects of resilience and coronavirus fear. Int J Ment Health Addict. (2022) 20:1035–45. 10.1007/s11469-020-00424-87 - DOI - PMC - PubMed
  35.  
    1. Ma H, Qiao H, Qu H, Wang H, Huang Y, Cheng H, et al. Role stress, social support and occupational burnout among physicians in China: a path analysis approach. Int Health. (2020) 12:157–63. 10.1093/inthealth/ihz0547 - DOI - PubMed
  36.  
    1. Magallón-Botaya R, Pérula-de Torres L, Verdes-Montenegro Atalaya J, Pérula-Jiménez C, Lietor-Villajos N, Bartolomé-Moreno C, et al. Mindfulness in primary care healthcare and teaching professionals and its relationship with stress at work: a multicentric cross-sectional study. BMC Fam Pract. (2021) 22:29. 10.1186/s12875-021-01375-29 - DOI - PMC - PubMed
  37.  
    1. Haase L, May A, Falahpour M, Isakovic S, Simmons A, Hickman S, et al. A pilot study investigating changes in neural processing after mindfulness training in elite athletes. Front Behav Neurosci. (2015) 9:229. 10.3389/fnbeh.2015.00229 - DOI - PMC - PubMed
  38.  
    1. Bonde E, Mikkelsen E, Fjorback L, Juul L. Impacting employees’ and managers’ mental health skills using a workplace-adapted mindfulness-based intervention. Front Psychol. (2022) 13:1020454. 10.3389/fpsyg.2022.1020454 - DOI - PMC - PubMed
  39.  
    1. Trombka M, Creedon T, Demarzo M, Cuoco L, Smith L, Oxnard A, et al. Mindfulness training for primary care for Portuguese-speaking immigrants: a pilot study. Front Psychiatry. (2021) 12:664381. 10.3389/fpsyt.2021.6643818 - DOI - PMC - PubMed
  40.  
    1. Gaspar I, Martinho A, Lima M. Exploring the benefits of a mindfulness program for Portuguese public healthcare workers. Curr Psychol. (2021) 40:772–81. 10.1007/s12144-018-9987-3 - DOI
  41.  
    1. Rojiani R, Santoyo J, Rahrig H, Roth H, Britton W. Women benefit more than men in response to college-based meditation training. Front Psychol. (2017) 8:551. 10.3389/fpsyg.2017.00551 - DOI - PMC - PubMed
  42.  
    1. Alsubaie M, Abbott R, Dunn B, Dickens C, Keil T, Henley W, et al. Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: a systematic review. Clin Psychol Rev. (2017) 55:74–91. 10.1016/j.cpr.2017.04.0087 - DOI - PubMed
  43.  
    1. Kriakous S, Elliott K, Lamers C, Owen R. The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: a systematic review. Mindfulness. (2020) 12:1–28. 10.1007/s12671-020-01500-96 - DOI - PMC - PubMed
  44.  
    1. Rodriguez-Vega B, Palao Á, Mu noz-Sanjose A, Torrijos M, Aguirre P, Fernández A, et al. Implementation of a mindfulness-based crisis intervention for frontline healthcare workers during the COVID-19 outbreak in a public general hospital in Madrid, Spain. Front Psychiatry. (2020) 11:562578. 10.3389/fpsyt.2020.562578 - DOI - PMC - PubMed
  45.  
    1. Segal Z, Williams M, Teasdale J. Mindfulness-Based Cognitive Therapy for Depression. New York, NY: Guilford Publications; (2018).
  46.  
    1. Kandola A, Stubbs B. Exercise and anxiety. Adv Exp Med Biol. (2020) 1228:345–52. 10.1007/978-981-15-1792-1_239 - DOI - PubMed
  47.  
    1. Ma Y, She Z, Siu A, Zeng X, Liu X. Effectiveness of online mindfulness-based interventions on psychological distress and the mediating role of emotion regulation. Front Psychol. (2018) 9:2090. 10.3389/fpsyg.2018.020906 - DOI - PMC - PubMed
  48.  
    1. Royuela-Colomer E, Calvete E. Mindfulness facets and depression in adolescents: rumination as a mediator. Mindfulness. (2016) 7:1092–102. 10.1007/s12671-016-0547-3 - DOI
  49.  
    1. Nolen-Hoeksema S, Wisco B, Lyubomirsky S. Rethinking rumination. Perspect Psychol Sci. (2008) 3:400–24. - PubMed
  50.  
    1. Desrosiers A, Vine V, Klemanski D, Nolen-Hoeksema S. Mindfulness and emotion regulation in depression and anxiety: common and distinct mechanisms of action. Depress Anxiety. (2013) 30:654–61. 10.1002/da.221246 - DOI - PMC - PubMed