(PS9-D92) Online Mindfulness-based Interventions Show Distinct Effects on Well-being for Adults with and Without Heightened Baseline Suicide Risk

Background:  Mindfulness-based interventions (MBIs) have been shown to improve well-being across diagnostic groups. A recent meta-analysis pooling 13 studies further indicates that MBIs can lead to significant, though small, reductions in suicidal ideation, and that more hours spent in MBIs produce slightly stronger reductions in suicidal ideation (Schmelefske et al., 2022). In this study, we examined whether a brief (i.e., three session) MBI improved perceived well-being, stress, and ability to participate in social activities compared to a standard (i.e., eight session) MBI for individuals with and without heightened suicide risk. 

Methods:  Participants (N = 4,411; ages 18+) were recruited from 17 U.S. patient-powered research networks and randomly assigned to either the three-session or eight-session web-based MBI. Additionally, participants completed bi-weekly assessments throughout the intervention period (weeks 0-8) and four monthly follow-up assessments (weeks 12-20). Participants were considered to have heightened baseline suicide risk (n = 372; 8% of participants) if they reported moderate or severe depression (a score of >23 on the Patient-Reported Outcomes Measurement Information System [PROMIS] - Depression Scale) and high levels of hopelessness (selected “often” or “always” for the PROMIS item assessing hopelessness) at the first assessment. Generalized estimating equations with natural cubic splines were used to examine: (a) whether baseline suicide risk moderated the comparative effect of the two MBIs on perceived well-being, stress, and ability to participate in social activities; and (b) whether the trajectories of outcomes differed for those with and without heightened baseline suicide risk. 

Results:  We found that heightened suicide risk at the start of treatment did not moderate the effects of the MBIs, such that those with heightened baseline risk reported comparable well-being, stress, and ability to participate in social activities across the two MBIs, as did those with lower baseline risk (ps = 0.12, 0.06, and 0.48, respectively). However, participants with and without heightened baseline suicide risk showed significantly different trajectories in well-being (p = 0.003). On average, individuals with heightened baseline risk not only reported lower well-being at baseline and across the assessment period, but also reported decreasing well-being in the follow-up period, whereas those with lower baseline risk reported steady or increasing well-being during follow-up. Participants with heightened baseline risk also reported higher mean stress and lower mean abilities to participate in social activities across the assessment period, relative to those with lower risk (ps < 0.001).

Conclusions:  These data suggest that participants with heightened suicide risk experience less sustained benefits of web-based MBIs for well-being, and tend to report relatively elevated stress and lower well-being and abilities to participate in social activities before, throughout, and after treatment. Accordingly, web-based MBIs that are treating individuals with heightened suicide risk may warrant tailoring to address suicide-specific concerns.