Mindfulness-Based Stress Reduction in Older Individuals: Who Benefits the Most?

Background: Preexisting patient characteristics may influence the outcome of mindfulness training, and a composite predictive index may be most informative in predicting outcome. Primary Study Objective: To develop a predictive index from baseline patient characteristics to determine which characteristics are associated with improvement following mindfulness-based stress reduction (MBSR) vs health education and to examine whether intreatment variables-reflecting adherence to the mindfulness intervention-predicted clinical outcome. Methods: In a secondary data analysis, a composite moderator statistical approach created a predictive index from baseline participant characteristics that were associated with clinical global impressions improvement following intervention. Setting: Data come from a 2-site, randomized controlled trial which took place in medical centers in St Louis, Missouri, and San Diego, California. Participants: Included 103 older adults with anxiety and/or depressive disorders randomized to either 8 sessions of MBSR or health education classes. Intervention: MBSR was delivered in 8 sessions of 2 hours each by credentialed health care providers. The control condition consisted of health education classes designed to match the length and timing of the MBSR sessions. Primary Outcome Measures: The Clinical Global Impressions-Improvement scale was used to measure symptom improvement and was assigned by a blind rater. Results: The combined moderator approach generated a predictive index with a moderate effect size (0.46; 95% CI: 0.35, 0.57). Individuals who demonstrated improvement on the scale following MBSR were more likely to be younger, female, with lower psychological symptom severity, and less likely to have a diagnosis of depression or to be taking selective serotonin reuptake inhibitors. Discussion: Baseline characteristics predicted clinical response with MBSR in older adults. These predictive factors, if replicated and validated, could determine which patients are most likely to benefit from mindfulness training and lead to personalized strategies to maximize outcomes. The study was registered on ClinicalTrials.gov (identifier: NCT01693874).