Mindfulness is associated with improved psychological well-being but no change in stress biomarkers in breast cancer survivors with depression: a single group clinical pilot study.

BACKGROUND: The aim of this clinical single group pilot study was to assess mental well-being, psychological symptoms, and a set of stress biomarkers among breast cancer survivors with high depressive symptoms undergoing the Mindfulness-Based Stress Reduction (MBSR) program. METHODS: Participants included 23 curatively treated breast cancer survivors from the Helsinki University Central Hospital with clinically significant symptoms of depression (Beck Depression Inventory > 13, and assessed by a psychiatrist), at 1-year post-operative follow-up. Mental wellbeing and psychological symptoms were assessed with self-reported questionnaires (Resilience Scale, Self-Compassion Scale, Five Facet Mindfulness Questionnaire, World Health Organization Quality of Life-questionnaire, Perceived Stress Scale, Beck Depression Inventory, Beck Anxiety Inventory, Insomnia Severity Index); in addition, stress response was assessed with biomarkers (cortisol, adrenocorticotropine, and high-sensitivity-CRP from blood; 24 h-cortisol from urine). All measures were addressed at baseline, mid-program (4 weeks after baseline) and at the completion of the 8-week MBSR program. Engagement to the independent mindfulness home practice was collected with a diary. RESULTS: From baseline to the completion of the 8-week MBSR program, we observed significant increases in resilience (d = 0.60, p = 0.005), and quality of life (d = 0.92, p = 0.002), and significant reductions in symptoms of depression (d = - 1.17, p < 0.0001), anxiety (d = - 0.87, p < 0.0001), insomnia (d = - 0.58, p = 0.006), and marginally significant reduction in perceived stress (d = - 0.40, p = 0.09). We found no changes in self-compassion or mindfulness skills, nor in the stress biomarkers during or at the completion of the program. There was no association between the engagement time to the independent mindfulness practice and any of the outcomes. CONCLUSIONS: Attending the MBSR program was associated with increased wellbeing and reduced psychological symptoms in breast cancer survivors with clinically significant symptoms of depression. However, these favorably experienced changes did not transfer to the level of stress biomarkers during the 8-week program. Lack of association between the engagement in the mindfulness home practice and change in outcomes suggests that in the studied range of practice time, other qualities of MBSR despite the amount of independent practice may have a more important role for the improved wellbeing. Trial registration ISRCTN12326308 at 16/02/2021, retrospectively registered.

The genetic background of the associations between sense of coherence and mental health, self-esteem and personality.

PURPOSE: Sense of coherence (SOC) represents coping and can be considered an essential component of mental health. SOC correlates with mental health and personality, but the background of these associations is poorly understood. We analyzed the role of genetic factors behind the associations of SOC with mental health, self-esteem and personality using genetic twin modeling and polygenic scores (PGS). METHODS: Information on SOC (13-item Orientation of Life Questionnaire), four mental health indicators, self-esteem and personality (NEO Five Factor Inventory Questionnaire) was collected from 1295 Finnish twins at 20-27 years of age. RESULTS: In men and women, SOC correlated negatively with depression, alexithymia, schizotypal personality and overall mental health problems and positively with self-esteem. For personality factors, neuroticism was associated with weaker SOC and extraversion, agreeableness and conscientiousness with stronger SOC. All these psychological traits were influenced by genetic factors with heritability estimates ranging from 19 to 66%. Genetic and environmental factors explained these associations, but the genetic correlations were generally stronger. The PGS of major depressive disorder was associated with weaker, and the PGS of general risk tolerance with stronger SOC in men, whereas in women the PGS of subjective well-being was associated with stronger SOC and the PGSs of depression and neuroticism with weaker SOC. CONCLUSION: Our results indicate that a substantial proportion of genetic variation in SOC is shared with mental health, self-esteem and personality indicators. This suggests that the correlations between these traits reflect a common neurobiological background rather than merely the influence of external stressors.

School-based mindfulness intervention for depressive symptoms in adolescence: For whom is it most effective?

INTRODUCTION: There is accumulating evidence for the effectiveness of mindfulness-based interventions in alleviating depressive symptoms. A crucial question is, however, whether mindfulness interventions are more effective for some individuals than others, depending on individual characteristics before a mindfulness intervention. We exploratorily investigated whether the effectiveness of school-based mindfulness intervention against depressive symptoms is modified by executive functions, rumination, and emotion regulation among adolescents. METHODS: The longitudinal data included adolescents with at least mild depressive symptoms at the baseline (n = 369, at the 6th-8th grade, 68.4% female) who were randomized into a 9-week school-based mindfulness intervention group, into an active control group receiving relaxation program, or into an inactive control group. Adolescents' executive functions, rumination, and emotion regulation (i.e., acceptance, catastrophizing, and positive reappraisal) were assessed at the baseline; and depressive symptoms at three time points (at the baseline and at 9-week and 6-month follow-ups). RESULTS AND CONCLUSIONS: In adolescents with at least mild depressive symptoms at the baseline, high catastrophizing, high acceptance, and low executive functions were found to increase the effectiveness of mindfulness-based intervention against depressive symptoms. There seemed to be some sex differences. Thus, when aiming to alleviate depressive symptoms, mindfulness-based intervention may possibly be more effective for adolescents with high catastrophizing, high acceptance, and low executive functioning (than for adolescents with the opposite dispositions). However, as this study was exploratory by nature and corrections for multiple testing were not used, the findings must be regarded as preliminary and need confirmation in further studies.

Effects of school-based mindfulness intervention on health-related quality of life: moderating effect of gender, grade, and independent practice in cluster randomized controlled trial.

OBJECT: We investigated the impact of a school-based 9-week mindfulness program vs. active control program (relaxation) and inactive control group on children's self-reported Health-Related Quality of Life (HRQoL) moderated by gender, grade, and independent practice. METHOD: In total 3519 (50/50% boys/girls) Finnish students aged 12-15 years from 56 schools were randomized into mindfulness intervention, active, and inactive control groups. HRQoL was measured at baseline, at 9 weeks, and at 26 weeks and analyzed with multilevel linear modeling. RESULTS: Significant improvement on HRQoL was found (ß = mean difference) (ß = 1.587, 95% CI 0.672-2.502, p < 0.001) after 9 weeks and at 26 weeks of follow-up among students in the mindfulness group as compared to the active control group. Moderating effects on HRQoL were found for gender, grade, and independent practice: girls, 7th and 8th grade students, and students with regular independent mindfulness practice benefited most. CONCLUSIONS: Gender and developmental stage may moderate the effects of mindfulness interventions on HRQoL and offer guidance in designing effective promotive interventions for children and adolescents. TRIAL REGISTRATION INFORMATION: Healthy Learning Mind-a school-based mindfulness and relaxation program: a study protocol for a cluster randomized controlled trial (RCT) ISRCTN18642659 retrospectively registered on 13 October 2015. The full trial protocol can be accessed at http://rdcu.be/t57S .

A supportive family environment in childhood enhances the level and heritability of sense of coherence in early adulthood.

PURPOSE: To analyze the effects of genetic and environmental factors on sense of coherence (SOC) in young adulthood and whether family environment measured in childhood modifies these effects. METHODS: SOC was measured at 20-27 years of age in 3,193 Finnish twins using the Antonovsky's 13-item short scale. The twins and their parents had rated their emotional family environment independently when the twins were 12 years of age. The data were analyzed using applications of structural linear equation modeling to twin data. RESULTS: Females rated SOC 2.42 points lower than males. Additive genetic factors explained 39% of the variation of SOC in males and 49% in females, whereas the rest of the variation was explained by environmental factors unique to each twin individual. For the dimensions of SOC, the highest genetic correlation was found between comprehensibility and manageability (0.90 in males and 0.97 in females). SOC was strongest in the participants who had reported supportive family atmosphere and low relational tensions to parents in childhood. These participants also had higher genetic variance and lower unique environmental variance of SOC when compared to those who reported emotionally more stressful family environment. The results were similar when we used parental rating of family environment. CONCLUSION: Genetic factors are important for SOC, but genetic influences are much greater in supportive family environments. This emphasizes the importance of childhood home for the development of strong SOC.

Latent profile analysis as a method for process evaluations: Discovering response subgroups in a mindfulness intervention.

RATIONALE: Clustering techniques have been used within intervention studies to locate any distinct subgroups among intervention participants. One way in which they have not yet been utilized, but for which there is potential benefit, is in finding different motivational and behavioral response types to a newly introduced behavior. OBJECTIVE: This study aimed to use latent profile analyses (the same as latent class analyses except with continuous indicator variables) to identify 1) types, or classes, in terms of social cognitive responses to a mindfulness intervention, using The Reasoned Action Approach constructs, and 2) longitudinal/change trajectory classes of the target behavior (i.e., mindfulness practice). METHODS: The data derived from a school-based mindfulness intervention (N = 1646) among 12-15 year-olds, conducted in southern Finland from 2014 to 2016. We explored associations between the identified classes and with gender, linguocultural group, and mental health and practice outcomes. RESULTS: Analyses indicated a solution of five latent classes for both social cognition post-intervention-Uncertain but Positive (40.2%), Acceptable but No (18.8%), Indifferent (16.8), Inclined (15.5%), Disinclined (8.6%)-and practice trajectories-Stable Low (52.1%), Decreased from Seldom (25.8%), Decreased from Sometimes (10.7%), Increased from Zero (6.8%), Increased from Seldom (4.6%). The strongest differentiating theoretical construct among the social cognitive classes was a descriptive norm. The classes were characterized by some associations between each other (e.g., "Acceptable but No" and "Stable Low") and with linguocultural groups (e.g., "Inclined" and small language minorities) and mental health (e.g., "Disinclined" and externalization and depressive symptoms), but no specific associations were found by gender. CONCLUSIONS: This study shows how more person-centered analyses can be utilized in process evaluations, which predominantly only make use of variable-centered analyses. This knowledge could suggest ways to tailor universal interventions for subgroups with different receipt profiles and thereby improve intervention acceptability and engagement.

Uptake of and Motivational Responses to Mental Health-Promoting Practices: Comparing Relaxation and Mindfulness Interventions.

Background: Comparative analyses of alternative interventions within the same trial enable acceptability and fidelity of each to be investigated more critically. In addition, whereas so far studies have focused on efficacy evaluations, more understanding is needed on motivational factors influencing the uptake of mental health-promoting practices rather than solely their effects. Purpose: This study investigates whether the motivational responses to a mindfulness intervention are different from a relaxation intervention. We compare social cognitions outlined by the reasoned action approach and their roles in practice uptake, self-reported reasons for non-practice, and experienced benefits. Methods: In a cluster-randomized trial (ISRCTN18642659; N = 3134), 12-15-year-old participants were given a 9-week intervention and followed up to 52 weeks. Main statistical analyses included t-tests, mixed ANOVAs, path models, and chi-square tests. Results: Social cognitions in the mindfulness arm were slightly more positive immediately post-intervention, but recipients mostly responded similarly to the two interventions in the longer term. While attitudes, norms, intention, and self-efficacy were relatively high post-intervention, most of them slightly decreased by 26 weeks. Main reasons for non-practice in both arms included not finding the exercises helpful, no felt need, boringness of exercises and forgetting. The most common benefits experienced by practicing respondents were stress management and concentration ability. Better sleep was a more frequently reported benefit in the relaxation arm, but no other major differences emerged. Conclusion: This study offers an example of comparing motivational responses to experimental and active control arm interventions, a potentially helpful approach in improving intervention adherence.

Sense of coherence and intentions to retire early among Finnish women and men.

BACKGROUND: Previous studies have shown that age, physical and mental health status and working circumstances, along with different socio-economic and psychosocial factors affect the retirement process. However, the role of psychological resources, such as sense of coherence (SOC), on the retirement process is still poorly understood. This study investigated the associations between SOC and intentions to retire early and whether these associations were explained by socio-economic, psychosocial and work and health related factors. METHODS: The data were derived from the Finnish Health and Social Support (HeSSup) Study. The information was gathered from postal surveys in 1998 (baseline) and in 2003 (follow-up). The analyzed data consisted of 7409 women and 4866 men aged 30-54 at baseline. SOC and background factors including childhood circumstances, language, education, working circumstances, social support, health behaviour and somatic and mental health status were assessed at baseline. The intentions to retire early were assessed at follow-up using logistic regression analysis. RESULTS: SOC was associated with intentions to retire early among both genders. Socio-economic, psychosocial and work and health behaviour related factors did not influence the association between SOC and intentions to retire early among women and men reporting somatic or mental illness. Further, the association between SOC and intentions to retire early remained among (somatically and mentally) healthy men. Among healthy women the association was weaker and statistically non-significant. Among unhealthy women, the odds ratios of SOC was 0.97 (CI 95% 0.96-0.98) and 0.97 among ill men (CI 95% 0.96-0.98), i.e., each additional SOC score reduced the risk of intentions by 3% among both genders. CONCLUSION: Unhealthy employees with low SOC and low education were in the greatest risk to have reported intentions to retire early. SOC had an independent effect on intentions to retire early, and a strong SOC may have a potential to prevent early retirement in groups otherwise at risk. An important challenge would be to target the resources of SOC to the most vulnerable and design appropriate interventions in order to strengthen the level of SOC and hence prolong working years of the aging employees.

The Effects of School-based Mindfulness Intervention on Executive Functioning in a Cluster Randomized Controlled Trial.

Executive functions (EFs) are essential for student's learning and classroom functioning. The current cluster randomized controlled trial examines the effects of mindfulness intervention vs. active control program (i.e., relaxation) focusing on the main EFs (i.e., working memory, response inhibition, cognitive processing, cognitive flexibility and verbal fluency). A total of 131 students from 6th grade and 8th grade (median age 12 and 15) from four comprehensive schools participated. The schools were to equal shares randomized to intervention and active control groups, i.e., groups who underwent a 9-week mindfulness practice or relaxation program, respectively. Participants completed a cognitive test-package at baseline/pre-intervention, post-intervention at 9 weeks and follow-up at 6 months. Both intervention and active relaxation-based control groups improved on a majority of EF measures at both 9 weeks and 6 months. There was no significant difference between the mindfulness intervention group and the active control program in EFs. The current study suggests that mindfulness intervention and active control program do not differ in their effects to EFs, although both may have positive outcomes. Further research with both active and inactive control groups is needed to map the potential benefits of similar programs for cognitive functioning.

Parent-child-relationship quality predicts offspring dispositional compassion in adulthood: A prospective follow-up study over three decades.

Compassion is known to predict prosocial behavior and moral judgments related to harm. Despite the centrality of compassion to social life, factors predicting adulthood compassion are largely unknown. We examined whether qualities of parent-child-relationship, namely, emotional warmth and acceptance, predict offspring compassion decades later in adulthood. We used data from the prospective population-based Young Finns Study. Our sample included 2,761 participants (55.5% women). Parent-child-relationship qualities were reported by each participant's parents at baseline in 1980 (T0) when participants were between 3 and 18 years old. Compassion was self-reported 3 times: in 1997 (T1), 2001 (T2), and 2012 (T3) with the Temperament and Character Inventory (Cloninger, Przybeck, Svrakic, & Wetzel, 1994). By using age at the assessment as a time-variant variable, we applied multilevel modeling for repeated measurements to examine developmental trajectories of compassion from the ages of 20 (the age of the youngest cohort at T1) to 50 (the age of the oldest cohort at T3). On average, compassion increased in a curvilinear pattern with age. Higher acceptance (p = .013) and higher emotional warmth (p < .001) were related to higher compassion in adulthood. After adjusting for childhood confounds (i.e., participant gender, birth cohort, externalizing behavior, parental socioeconomic status, and parental mental health problems), only emotional warmth (p < .001) remained a significant predictor of compassion. Quality of the parent-child-relationship has long-term effects on offspring compassion. An emotionally warm and close relationship, in particular, may contribute to higher offspring compassion in adulthood. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Healthy Learning Mind - a school-based mindfulness and relaxation program: a study protocol for a cluster randomized controlled trial.

BACKGROUND: Mindfulness has shown positive effects on mental health, mental capacity and well-being among adult population. Among children and adolescents, previous research on the effectiveness of mindfulness interventions on health and well-being has shown promising results, but studies with methodologically sound designs have been called for. Few intervention studies in this population have compared the effectiveness of mindfulness programs to alternative intervention programs with adequate sample sizes. METHODS/DESIGN: Our primary aim is to explore the effectiveness of a school-based mindfulness intervention program compared to a standard relaxation program among a non-clinical children and adolescent sample, and a non-treatment control group in school context. In this study, we systematically examine the effects of mindfulness intervention on mental well-being (primary outcomes being resilience; existence/absence of depressive symptoms; experienced psychological strengths and difficulties), cognitive functions, psychophysiological responses, academic achievements, and motivational determinants of practicing mindfulness. The design is a cluster randomized controlled trial with three arms (mindfulness intervention group, active control group, non-treatment group) and the sample includes 59 Finnish schools and approx. 3 000 students aged 12-15 years. Intervention consists of nine mindfulness based lessons, 45 mins per week, for 9 weeks, the dose being identical in active control group receiving standard relaxation program called Relax. The programs are delivered by 14 educated facilitators. Students, their teachers and parents will fill-in the research questionnaires before and after the intervention, and they will all be followed up 6 months after baseline. Additionally, students will be followed 12 months after baseline. For longer follow-up, consent to linking the data to the main health registers has been asked from students and their parents. DISCUSSION: The present study examines systematically the effectiveness of a school-based mindfulness program compared to a standard relaxation program, and a non-treatment control group. A strength of the current study lies in its methodologically rigorous, randomized controlled study design, which allows novel evidence on the effectiveness of mindfulness over and above a standard relaxation program. TRIAL REGISTRATION: ISRCTN18642659 . Retrospectively registered 13 October 2015.

Sense of coherence and its determinants: a comparative study of the Finnish-speaking majority and the Swedish-speaking minority in Finland.

BACKGROUND: Despite similar living conditions among the Finnish-speaking majority and the Swedish-speaking minority in Finland, the latter is a more advantaged group e.g. in terms of socioeconomic status and health. This study investigated (1) the level of sense of coherence (SOC), (2) the structure of generalized resistance resources (GRRs), and (3) associations of GRRs with SOC among Finnish- and Swedish-speaking Finns. METHODS: The data derived from the Health and Social Support (HeSSup) Study. The sample comprised 22,937 Finnish men and women aged 20-54, including an additional sample from the Swedish-speaking population (n = 2,967). The response rate was 40%. Ordinary regression analysis was used. RESULTS: Swedish-speaking women scored 0.9 (p = 0.005) and men 0.6 (p = 0.05) points higher on SOC scale compared with Finnish-speaking respondents. The minor difference in the SOC level between the language groups was explained by Finnish speakers' worse psychosocial living conditions in childhood and working conditions in adulthood. Only one interaction was found: parents' divorce during childhood was associated with a significant decrease of SOC scores only for Finnish speakers. Otherwise the same GRRs had similar effects on both Finnish- and Swedish-speaking men's and women's SOC. CONCLUSION: The only key difference between Finnish- and Swedish-speaking Finns concerned the unequal distribution of GRRs. An increase in GRRs among Finnish speakers would probably strengthen their SOC. However, the slightly stronger level of SOC among Swedish-speaking compared with Finnish-speaking Finns is unlikely to explain the possible differences in well-being between the two language groups.

Factors contributing to sense of coherence among men and women.

BACKGROUND: The purpose of this study was to examine the associations of four key areas of resistance resources (GRR), i.e. childhood living conditions, work and family life, and social relationships, with sense of coherence (SOC) among Finnish men and women. A particular interest was devoted to interactions between sex and GRR. METHODS: The data derived from a representative personal interview survey collected by Statistics Finland in 1994 (N=8650, response rate 73%). This study included ages 25-64 (N=6506, 49% women). The associations of age, educational attainment, childhood living conditions, work and family, and social relationships with SOC were analysed using ordinary regression analysis. RESULTS: Among both men and women, psycho-emotional resources rather than socio-economic circumstances were associated with SOC. These resources included the quality of the relationship with partner, social support, quality of work, and childhood living conditions. Although sex differences were small, the association of living without a partner with low SOC was stronger among men than women. CONCLUSION: SOC is strongly associated with the psycho-emotional resistance resources. In the Finnish context, the SOC scale was largely sex neutral.