Mindfulness app lowers depression symptoms among COVID-19 nurses
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Key takeaways:
- Using a mindfulness app improved symptoms of depression in frontline COVID-19 nurses.
- Rates of app use and engagement fell below set targets.
Symptoms of depression among frontline COVID-19 nurses decreased after using a mindfulness app for 1 month, according to results published in Annals of the American Thoracic Society.
“Despite lower than expected app use and engagement, a self-directed mobile mindfulness program was feasibly delivered to frontline COVID-19 nurses and reduced depression symptoms, though not burnout, when compared with a control group,” Elias H. Pratt, MD, medical instructor in the department of medicine at Duke University School of Medicine, and colleagues wrote.
In a pilot randomized trial, Pratt and colleagues assessed 102 frontline COVID-19 nurses (median age, 26.5 years; 94.1% women; 85.3% white) between May 2021 and January 2022 to see how feasible mobile mindfulness was in this population and if it helped combat psychological distress/depression and burnout after 1 month of use.
To evaluate feasibility, researchers used predefined targets for randomization, retention and completion of mobile mindfulness and looked at how they stacked up against the rates in this cohort.
At the start of the trial, the target for randomization (80%) was met as 102 of 113 nurses (90%) completed the necessary requirements to be assigned to either mobile mindfulness/the Lift intervention (n = 69) or a waiting list (n = 33).
One month after this assignment, researchers gave out a follow-up survey, and 86% of the total cohort completed it, surpassing the retention target of 80%.
Researchers hoped that 60% of those assigned to mobile mindfulness would complete at least one mindfulness session each week, but only 28% (n = 19) achieved this level of completion.
The target rate for completion of more than 75% of daily mindfulness sessions was 50%, and once again the cohort fell short, with only 19% (n = 13) meeting this criterion.
Within the total cohort, researchers commonly found elevated levels of burnout and mild to moderate symptoms of depression, anxiety and perceived stress at baseline.
Researchers used the Patient Health Questionnaire-9 to assess changes in psychological distress between those in the mobile mindfulness group and those in the waiting list group after 1 month and found more significant improvement among those in the mobile mindfulness group (difference in differences, –2.21; 95% CI, –3.99 to –0.42).
In contrast, nurses in the waiting list group vs. the mobile mindfulness group had more significant improvement in burnout, as seen through Maslach Burnout Inventory Depersonalization scores (difference in differences, –1.6; 95% CI, 0.18-3.02).
Notably, changes in some measures of psychological distress (General Anxiety Disorder-7 and Perceived Stress Scale-4), as well as burnout (Maslach Burnout Inventory Emotional Exhaustion scores and Personal Accomplishment scores) after 1 month did not differ between the two groups.
“Further efforts to improve app engagement, including incorporating feedback from nurses who participated in this trial, are needed,” Pratt and colleagues wrote. “An efficacy-focused trial to confirm our findings of decreased emotional distress is also warranted. Burnout remains a challenging clinical entity that demands additional attention and innovation in individual- and systems-based interventions.”
This study by Pratt and colleagues adds to growing literature that addresses burnout and depression in nurses, Komal Patel Murali, PhD, RN, ACNP-BC, assistant professor at NYU Rory Meyers College of Nursing, and colleagues wrote in an accompanying editorial.
They note that although mobile interventions can help nurses who are struggling, combatting burnout also comes in forms outside of technology.
“Bold system-wide structural changes are needed to address the underlying contributors to burnout — an occupational phenomenon — such as poor work environments that include hazardous schedules and shift work, short staffing, exposure to patient-inflicted violence and abuse, bullying, and bias, racism and discrimination,” Murali and colleagues wrote.