Efetividade de programas de treinamento baseados em atenção plena na redução do sofrimento psicológico e promoção de bem-estar em estudantes de Medicina: revisão sistemática e metanálise

Abstract

Background: Mindfulness meditation has been used by medical schools as a strategy to assist students in stress management. Objective: The aim of this study was to search evidence on the effectiveness of training programs based on Mindfulness in reducing psychological distress and promoting the well-being of medical students. Method: Systematic review and Meta-analysis guided by the Cochrane methodology and reported according to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analysis). Electronic databases consulted: Cochrane Library; Embase; PubMed / MEDLINE; PsycINFO / PsycNet; LILACS / BVS; ERIC (ProQuest); Web of Science; OpenGrey; Google Scholar; with a systematic search of articles published until August 2020, without time or languages restrictions. Randomized clinical trials (RCTs), evaluating psychological distress and well-being of medical students, before and after training based on Mindfulness, were selected. Two reviewers independently selected, extracted data, assessed the methodological quality of the included studies (ROB 2) and the quality of the evidence (GRADE). Results: Of the 633 articles found, 8 met the inclusion criteria. The total number of participants was 694, 440 females and 254 males, aged between 18 and 25 years. Mindfulness-based training improved outcomes: mindfulness (at the end of the intervention small effect: SMD = 0.29; 95% CI: 0.03 to 0.54; p = 0.03; I2 = 46% and in the follow-up small effect: SMD = 0.37; 95% CI: 0.04 to 0.70; p = 0.03; I2 = 53%); psychological well-being / health (at the end of the intervention small effect: SMD = -0.27; 95% CI: - 0.67 to 0.13; p = 0.18; I2 = 76% and in follow-up big effect: SMD = - 0.73; 95% CI: - 1.23 a - 0.23; p = 0.004; I2 = 61%) and stress (at the end of the intervention small effect: SMD = - 0.29; 95% CI: - 0.56 to - 0.02; p = 0.04; I2 = 57% and in the follow-up moderate effect: SMD = - 0.45; 95% CI: - 0.67 to - 0.22; p = 0.0001; I2 = 0%). The narrative synthesis points out: reduction of symptoms of anxiety and depression after training, with maintenance of this result during follow-up; perception of increased overall levels of empathy at the end of training, but there was no difference between the intervention and control groups at follow-up; for the outcome resilience there was no significant difference, both at the end of the intervention and in the follow-up. The quality of evidence for the mindfulness outcome is high, for the stress and well-being/psychological health outcomes it is moderate, for the anxiety, depression, empathy and resilience outcomes it is very low. Conclusions: Trained students noticed a decrease in symptoms of stress/psychic distress; anxiety and depression; and also reported the perception of improvement in the attributes: well-being/psychological health; resilience and empathy. Systematic review registration: Protocol registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42020153169). Keywords: medical students; undergraduate medical students; medical education; mindfulness; meditation; psychological distress; well-being; mental health; depression; anxiety; resilience; empathy; mindfulness-based stress reduction; MBSR; systematic review; meta-analysis.