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Effects of mindfulness-based interventions on depressive symptoms in patients with substance use disorders: a systematic review and meta-analysis

Chuntana Reangsing
Chuntana Reangsing
, 
Sasinun Pusuwun
Sasinun Pusuwun
, 
Suneerat Boonsin
Suneerat Boonsin
 et 
Sarah Oerther
Sarah Oerther
   | 22 juin 2023
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Article Category: Review
Publié en ligne: 22 juin 2023
Pages: 145 - 162
Reçu: 27 sept. 2022
Accepté: 28 nov. 2022
DOI: https://doi.org/10.2478/fon-2023-0016
Mots clés
© 2023 Chuntana Reangsing et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1.

PRISMA flow of included primary studies in systematic review and meta-analysis. PRISMA, Preferred Reporting Items of Systematic Reviews and Meta-Analyses; SUD, substance use disorder.
PRISMA flow of included primary studies in systematic review and meta-analysis. PRISMA, Preferred Reporting Items of Systematic Reviews and Meta-Analyses; SUD, substance use disorder.

Figure 2.

Effect of MBI on depressive symptoms in patients with SUD. Note: ES, effect size; SUD, substance use disorder; CI, confidence interval; MBI, mindfulness-based intervention.
Effect of MBI on depressive symptoms in patients with SUD. Note: ES, effect size; SUD, substance use disorder; CI, confidence interval; MBI, mindfulness-based intervention.

Figure 3.

Funnel plot.
Funnel plot.

Categorical moderator results for depression comparing MBI versus control groups.

Moderator k ES SE Var. 95% CI Z p(Z) Qbet P (Qbet)
Source characteristics
Funding 0.033 0.856
  Unfunded 8 0.725 0.294 0.087 0.148, 1.301 2.463 0.014
  Funded 11 0.654 0.254 0.065 0.156, 1.153 2.573 0.010
Type of publication 0.036 0.982
  Journal article 16 0.683 0.221 0.049 0.025, 1.116 3.096 0.002
  Dissertation 2 0.787 0.608 0.369 -0.404, 1.977 1.295 0.195
  Thesis 1 0.600 0.895 0.802 -1.155, 2.354 0.670 0.503
Method characteristics
Blinded data collection 0.349 0.554
  No 17 0.634 0.210 0.044 0.222, 1.045 3.021 0.003
  Yes 2 1.004 0.590 0.348 -0.153, 2.160 1.701 0.089
Intention-to-treat 1.066 0.302
  No 8 0.437 0.311 0.097 -0.173, 1.046 1.403 0.161
  Yes 11 0.863 0.271 0.073 0.332, 1.393 3.185 0.001
Concealed allocation 2.946 0.086
  No 14 0.478 0.220 0.048 0.047, 0.909 2.174 0.030
  Yes 5 1.221 0.373 0.139 0.490, 1.952 3.275 0.001
Baseline characteristics equal across groups 0.444 0.505
  No 3 0.629 0.468 0.219 -0.288, 1.545 1.344 0.179
  Yes 12 0.980 0.245 0.060 0.500, 1.460 4.000 <0.001
Fidelity 0.460 0.498
  No 12 0.577 0.251 0.063 0.085, 1.069 2.296 0.022
  Yes 7 0.865 0.342 0.117 0.195, 1.535 2.53 0.011
Intervention characteristics
MBI type 0.100 0.992
  MBSR 1 0.567 0.911 0.831 -1.219, 2.353 0.622 0.534
  MBCT 1 0.833 0.936 0.876 -1.001,2.668 0.891 0.373
  Adapted MBI 9 0.732 0.308 0.095 0.128, 1.337 2.375 0.018
  MBRP 8 0.624 0.329 0.108 -0.021, 1.269 1.896 0.058
Group discussion 0.027 0.869
  No 6 0.688 0.343 0.117 0.017, 1.360 2.008 0.045
  Yes 12 0.619 0.239 0.057 0.150, 1.089 2.587 0.010
Counseling 0.211 0.646
  No 12 0.578 0.239 0.057 0.110, 1.046 2.421 0.015
  Yes 6 0.768 0.338 0.114 0.106, 1.430 2.274 0.023
Home assignment 0.427 0.514
  No 8 0.763 0.270 0.073 0.234, 1.293 2.826 0.005
  Yes 10 0.525 0.246 0.061 0.042, 1.008 2.128 0.033
Structure MBI format 6.790 0.034
  Individual 8 0.330 0.288 0.083 -0.235, 0.895 1.145 0.252
  Group 8 0.639 0.293 0.086 0.066, 1.213 2.185 0.029
  Mixed (individual + group) 2 2.130 0.628 0.394 0.899, 3.361 3.392 0.001
Outcome measure
Days after intervention measured 0.001 0.974
  Immediate post-MBI 7 0.671 0.335 0.112 0.014, 1.328 2.001 0.045
  Delayed follow-up 12 0.685 0.260 0.067 0.175, 1.194 2.635 0.008

ES of MBI vs control groups.

Comparison MM group
k ES P (ES) 95% CI SE I2 Q p (Q)
MBI vs. control groups 19 0.67 0.001 0.29, 1.05 0.19 89.59 172.87 <0.001
Single group MBI
Pre- vs. post- (r = 0.0) 14 0.90 <0.001 0.51, 1.29 0.20 75.44 52.94 <0.001
Pre- vs. post- (r = 0.8) 14 0.95 <0.001 0.59, 1.30 0.18 94.42 232.98 <0.001
Control group
Pre- vs. post- (r = 0.0) 14 0.29 0.036 0.02, 0.56 0.14 61.47 33.74 0.001
Pre- vs. post- (r = 0.8) 14 0.28 0.025 0.04, 0.52 0.12 90.81 141.41 <0.001

Continuous moderators of the effects of mindfulness-based intervention on depression.

Moderator k Slope SE Tau2 Qmodel P-value
Study characteristic
Publication year 19 -0.007 0.062 0.70 0.01 0.917
Sample characteristic
Age (mean) 15 -0.004 0.038 0.83 0.01 0.918
Women 7 0.014 0.022 1.36 0.41 0.520
Method characteristic
Attrition 18 -0.004 0.010 0.76 0.15 0.703
Reliability of depressive instruments 8 0.337 2.69 0.32 0.02 0.900
Intervention characteristics
Intervention length (total week) 19 0.001 0.021 0.70 0.00 0.962
Online MBI sessions/week 6 0.036 0.132 0.44 0.08 0.783
Duration of online MBI min./session 16 0.001 0.008 0.86 0.01 0.922
Dose (length × duration) 16 0.000 0.000 0.86 0.01 0.933
Days after intervention measured 19 -0.001 0.002 0.69 0.14 0.706

Quality indicators of included primary studies (n = 19).

Author(s)/years Assignment into groups Concealed allocation Masked data collector Intention-to-treat A priori of power Compared groups at baseline Baseline characteristics equal Fidelity check Interventionist trained
Alexander (2018)31 5 0 0 0 0 1 0 0 1
Bevan (2012)32 1 1 0 0 0 1 0 0 0
Cooperman et al. (2021)33 1 1 0 0 0 1 0 1 1
de Souza et al. (2020)44 1 0 0 0 0 1 1 1 1
Glasner-Edwards et al. (2017)34 1 1 0 1 0 1 1 1 1
Hosseinzadeh and Barahmand (2014)46 1 0 0 1 0 1 1 1 1
Machado et al. (2020)45 2 0 0 1 0 1 1 1 1
Nakamura et al. (2015)35 1 0 0 1 0 1 1 1 NR
Price et al. (2012)37 1 0 0 1 0 1 1 1 1
Price et al. (2019)36 1 1 1 1 1 1 1 0 1
Rogojanski et al. (2011)47 1 0 0 1 1 1 1 1 NR
Ross et al. (2019)38 1 0 0 1 0 0 NR 1 NR
Sarvandani et al. (2021)41 5 0 0 1 1 0 NR 0 NR
Shareh et al. (2018)42 1 0 0 0 0 1 1 1 NR
Spears et al. (2017)39 1 0 0 0 0 0 NR 0 NR
Wongtongkam et al. (2018)49 1 0 0 0 0 1 0 0 1
Yadav (2016)48 1 0 0 0 0 1 1 0 NR
Zemestani and Ottaviani (2016)43 5 1 1 1 0 1 1 0 1
Zullig et al. (2021)40 3 0 0 0 0 1 1 0 1

Summary demographic of included primary studies (n = 19).

No. Author Study design Samples/setting Age mean ± SD MMI/control Control MMIs characteristics F/U (month) Measures Results Comments
1 Alexander (2018)31, USA Quasi 83 SUD mothers with depression A comprehensive treatment facility 30.5 48% <30 years. 70/13 - MBSR- 2 h/week over 12 weeks.- workbook with guided stretching, yoga, relaxation exercise and meditations (iPod NANO) - BDI At baseline:MMI: 18.51 (11.1) Control: 16.46 (9.03) At posttest: mean difference- MMI: -3.9 (10.1)- Control: 6.8 (13.2)t (71) =-2.44, P < 0.05 - 92% unemployed- 75% white- Attrition rate: 32% MMIs and 29% control
2 Bevan (2012)32, USA RCT 75 inpatients with SUD42 males33 femalesDrug and alcohol treatment center 42 (11) 35/40 - A 5-d MBI training first.- Then 30 min./session over 14 weeks.- 2 weeks. DASS-21 At 2 weeks. F/U Depression: MMI: 22.09 (11.69) to 8.40 (8.95)Waitlist: 28.1 (14.99) to 14.69 (12.34) - 97% white- 37% married- 57% Employed- 40% unemployed- 73% alcoholism- 35% opiates- 45% used antidepressants- 32% used anti-anxiety medicine
3 Cooperman et al. (2021)33, USA RCT 30 people with opioid use disorder and chronic pain 2 clinics in New Jersey, USA 50.4 (8.8) 15/15 Weekly as group format over 8 weeks, with 15 min. daily for home practice 4 CES-D At 4 months F/UDepression: Mean difference: MORE: 7.7 (2.6), P = 0.012TAU: 14.9 (2.7), P < 0.001 - 53% whites- 83% unemployed- 53% had low back pain, 40% arthritis- 67% used Heroin in past 30 d
4 De Souza et al. (2021)44, Brazil RCT Adults with smoking Outpatient public health tobacco treatment service in Brazil 50.0 (10.5) 14/18 MBRP- 120 min/session weekly over 8 weeks, included guided meditation, exercise, discussion and homework review 4 HAD At 4 months F/U.Depression: MBRP = 6.86 (1.17)Control = 6.00 (1.03) - Small sample size- 63% Attrition rate
5 Glasner-Edwards et al. (2017)34, USA RCT Stimulant dependent adults UCLA 45.3 (8.9) 14/12 MBRP- 75 min./session/week. over 8 weeks, with CD guided meditation- practice log with CD guided as home assignment 1 BDI-II At 1 months F/UDepression: MMI: 14.5 (9.6) to 4.7 (6.9)HE: 15.6 (12.9) to 9.0 (8.5) - Small sample size- High attrition rate (41%)- 70% males- 44% African American- 44% unemployed- 63% never married- 55% cocaine- 44% methamphetamine- 43% were diagnosed with mood disorders.- 58% Attrition rate- Small sample size
6 Hosseinzadeh et al. (2014)46, Turkey RCT 35 males with drug-dependent (opium or heroin) who suffered from depression 29.5 18/17 MBCT- 120 min/session over 8 weeks. - BDI-II At posttestDepression: MBCT: 26.75 (12.26) to 16.94 (7.64)Control: 24.52 (8.46) to 23.65 (8.05)F = 71.31, P = 0.000 - Small sample size
7 Machado et al. (2020)45, Brazil RCT 42 patients in SUD treatment from Outpatient clinics in city of Sao Paulo 44 (11.2) 10/6 MBRP- 120 min/session weekly over 8 weeks. 3 months CES-D At 3 months F/UExperiment: 23.0 (13.7) to 12.4 (6.6)Control: 28.0 (14.4) to 27.1 (14.6) sig. - 50%-75% attrition rate
8 Nakamura et al. (2015)35, USA RCT Women with SUD 89% not married/separated/divorced 100% whites At a facility in Salt Lake City, Utah MBB: 30.4 (8.3)TAU: 34.7 (10.2) Range 18-55 14/17 MBB- 20 sessions over 10 weeks. - CES-D At posttest DepressionMBB: 30.85 [27.94, 33.75] to 22.88 [19.59, 26.18]TAU: 31.11 [27.46, 34.76] to 24.19 [20.46, 27.91] - Included only women- No F/U
9 Price et al. (2012)37, USA RCT Women with SUDNonprofit SUD treatment facility in the NW United States 39Range19-58 31/15 MABT8 weekly sessions, 90 min/session 9 BSI At 9 months F/UDepression: MABT 2.4 (0.34) to 0.90 (0.54)TAU: 2.2 (0.43) to 1.8 (0.69) - Small sample size- 100% women- Participants in intervention group were highly SES- 94% whites- 65% unemployed- 71% pt. w/AUD
10 Price et al. (2019)36, USA RCT Women with SUD-Nonprofit SUD treatment facility in the NW United States 35Range20-61 41/54 MABT8 weekly sessions, 90 min./session 12 BDI-II At 12 months F/UDepressionMABT= 16.80 (11.1) to 12.30 (10.60)Control = 15.30 (10.50) to 11.50 (9.80) - 75% whites- 51% unemployed- 100% any reported traumatic event- 82% intimate partner violence- All females
11 Rogojanski et al. (2011)47, Canada RCT Adults with smokingCanadian city 40.34 (12.42) 31/30 Mindfulness intervention- 2 sessions spaced 7 d apartSuppression intervention (to avoid themselves from experience by actively avoiding the thoughts and feeling that arise) 7d DASS-21 At 7 d F/U.Depression: Mindfulness: 12.70 (11.11) to 8.26 (8.58) Suppression gr.: 10.61 (11.59) to 12.70 (10.63) F(1,44) = 8.09, P = 0.007, Sig. - The intervention was just a brief mindfulness intervention for coping with smoking urges- 41% participants were low nicotine dependence- 72% whites
12 Ross et al. (2020)38, USA RCT Adults with SUD Two clinical sites 38.44 (10.92) 103/95 MBRP- 120 min/session weekly over 8 weeks, included guided meditation, exercise, discussion and homework review - BDI-II At posttest Depression MBRP = mean difference = -0.01 (0.45)Control = mean difference =- 0.27 (0.43) - 78% males- 48% non-whites
13 Sarvandani et al. (2021)41, Iran Quasi Adults with SUD Addition treatment clinics in Kerman NR 25/25 MBSR- 8 sessions over 8 weeks, included raisin meditation and body scan and sitting meditation and mindfulness movement - BDI-II At posttestDepressionMBI = 33.86 (9.82) to 28.68 (7.45)Control = 34.36 (9.86) to 33.84 (10.24) - Small sample size
14 Shareh et al. (2018)42, Iran RCT 40 adolescents with methamphetamine- addictedAddiction treatment center 28.41 20/20 MBRP- 9, 60 min./session. biweekly over 4 weeks. - BDI-II At posttestDepression: MBRP: 29.4 (6.18) to 17.14 (5.59)Control: 31.27 (7.17) to 26.31 (6.64) - No F/U
15 Spears, et al. (2017)39, USA RCT Adults with smoking > 18 years 154/103 MBAT- 120 min/session over8 weeks, with group counseling - CESD - MBAT vs. Usual care Depression -.18[-0.40, 0.03], P = 0.099 - 48% African American- 42% non-Latino- 55% females- Mean 20 cigarettes/d
16 Wongtongkam et al. (2018)49, Thailand RCT Adults with alcohol dependence Rehabilitation center, Thailand 40.22 (8.74) 23/15 Vipassana mindfulness meditation120 min/daily for consecutive day - BDI-21 At posttest: Depression: MMI: 16.04 (6.53) to 13.86 (9.18)Control: 17.27 (7.59) to 16.78 (8.54) - 100% males- Small sample size- Long-term F/U is needed- 90% of participants drank alcohol every day, two bottles of alcohol on weekend recruited by staffs—maybe selection bias
17 Yadav (2016)48, India RCT Patients with AUD All malesCentral Institute of Psychiatry, India 35.67 (7.75) 15/15 Body scan meditation60 min/session - HAM-D HDRS: MMI: 3.0 (1.51) to 2.0 (1.61)Control: 3.66 (1.79) to 2.93 (1.49) - 100% males- 86% employed- 66.6% married- Small sample size- Severity of alcohol dependence (SADQ) of experimental gr. was 33.6 (5.64), while control gr. was 39.6 (5,68)
18 Zemestani and Ottaviani (2016)43, Iran RCT 74 adults with SUD At the treatment community center in Ahvaz, Iran 30.1 (9.7) 37/37 MBRP- 120 min/session/week. over 8 weeks. 2 BDI-II At 2 months F/UDepressionMBRP: 31.2 (5.1) to 18.3 (4.7)Control: 30.8 (4.3) to 28.1 (4.3) Sig. (F = 30.7, P < 0.0001) - 80% males- 36% married- 30% divorced/separated- 64% unemployed- 40% methamphetamine- 18% cocaine- 44% were diagnosed with MDD- 37% comorbid anxiety disorders
19 Zullig et al. (2021)40, USA Qua-si Patients receiving MOUD 36.3 (NR) 45/35 MBRP- 60 min./biweekly over 24 weeks. 4 months ODSIS Depression score was different compared control group. (F = 5.94, P < 0.0001) - 27% attrition rate

An example of the electronic search strategy.

No. Searches Results
1 Search mindfulness OR mindful* OR meditation OR meditat* 14,861
2 Search (“mindfulness”[Mesh])OR “meditation” [Mesh] 5353
3 Search ((mindfulness OR mindful* OR meditation OR meditat*)) OR ((“mindfulness”[Mesh])OR “meditation” [Mesh]) 14,861
4 Search (substance use disorder*) OR (substance use) OR (drug* addict*) 91,476
5 Search (“substance-related disorders”[Mesh] or (“substance abuse treatment centers” [Mesh] OR “substance abuse, Intervenous” [Mesh] OR “psychoses, substance-induced” [Mesh] OR “substance abuse, oral” [Mesh] OR “substance withdrawal syndrome”[Mesh]) 276,574
6 Search (“substance-related disorders”[Mesh] or (“substance abuse treatment centers” [Mesh] OR “substance abuse, Intervenous” [Mesh] OR “psychoses, substance-induced” [Mesh] OR “substance abuse, oral” [Mesh] OR “substance withdrawal syndrome”[Mesh]) OR ((substance use disorder*) OR (substance use) OR (drug* addict*)) 313,986
7 Search ((mindfulness OR mindful* OR meditation OR meditat*)) OR ((“mindfulness”[Mesh])OR “meditation” [Mesh]) AND ((((“substance-related disorders”[Mesh] or (“substance abuse treatment centers” [Mesh] OR “substance abuse, Intervenous” [Mesh] OR “psychoses, substance-induced” [Mesh] OR “substance abuse, oral” [Mesh] OR “substance withdrawal syndrome”[Mesh]) OR ((substance use disorder*) OR (substance use) OR (drug* addict*)))) 599
8 Search ((mindfulness OR mindful* OR meditation OR meditat*)) OR ((“mindfulness”[Mesh])OR “meditation” [Mesh]) AND ((((“substance-related disorders”[Mesh] or (“substance abuse treatment centers” [Mesh] OR “substance abuse, Intervenous” [Mesh] OR “psychoses, substance-induced” [Mesh] OR “substance abuse, oral” [Mesh] OR “substance withdrawal syndrome”[Mesh]) OR ((substance use disorder*) OR (substance use) OR (drug* addict*)))) Filters: Clinical trial 100
9 Search ((mindfulness OR mindful* OR meditation OR meditat*)) OR ((“mindfulness”[Mesh])OR “meditation” [Mesh]) AND ((((“substance-related disorders”[Mesh] or (“substance abuse treatment centers” [Mesh] OR “substance abuse, Intervenous” [Mesh] OR “psychoses, substance-induced” [Mesh] OR “substance abuse, oral” [Mesh] OR “substance withdrawal syndrome”[Mesh]) OR ((substance use disorder*) OR (substance use) OR (drug* addict*)))) Filters: Clinical trial; Review 215
10 Search ((mindfulness OR mindful* OR meditation OR meditat*)) OR ((“mindfulness”[Mesh])OR “meditation” [Mesh]) AND ((((“substance-related disorders”[Mesh] or (“substance abuse treatment centers” [Mesh] OR “substance abuse, Intervenous” [Mesh] OR “psychoses, substance-induced” [Mesh] OR “substance abuse, oral” [Mesh] OR “substance withdrawal syndrome”[Mesh]) OR ((substance use disorder*) OR (substance use) OR (drug* addict*)))) Filters: Clinical trial; Review; Publication date from 2018/01/01 to 2020/12/31 50

Characteristics of primary studies.

Characteristic n Min Q1 Mdn. Q3 Max Mean SD
Mean age (years) 15 28.4 32.4 38.4 44.0 50.4 38.6 7.0
Total sample size at analysis
MBI group 19 10.0 15.0 23.0 37.0 154.0 36.1 36.4
Control group 19 6.0 15.0 18.0 37.0 103.0 30.4 26.9
  Female 8 0 0 29.9 43.7 50.0 24.6 22.3
  White 6 0 27.5 72.9 97.0 100.0 63.1 38.3
  African American 4 0 0.3 16.1 47.7 53.3 21.4 25.6
  Asian 4 0 0.3 1.2 75.3 100.0 25.6 49.6
  Weeks of structured MBI 19 1.0 5.0 8.0 8.0 48.0 8.8 10.0
  Days across intervention (length) 19 5.0 28.0 49.0 49.0 322.0 55.4 67.7
  Structured MBI session/week 19 1.0 1.0 1.0 2.0 7.0 2.0 2.0
  Structured MBI min./session 16 20.0 63.8 120.0 120.0 120.0 95.0 33.3
  Dose (length × duration) 16 100.0 2178.8 5880.0 5880.0 19,320.0 5306.9 4514.8
Days after intervention measured
  Attrition, MBI group 18 0 0 19.3 54.6 59.1 23.1 24.4
  Attrition, control group 18 0 0 8.1 31.2 70.0 19.6 24.9
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