Impact of App-Delivered Mindfulness Meditation on Functional Connectivity, Mental Health, and Sleep Disturbances Among Physician Assistant Students: Randomized, Wait-list Controlled Pilot Study

Abstract

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Healthcare provider and trainee burnout results in substantial national and institutional costs and profound social effects, and identifying effective solutions and interventions to cultivate resilience among healthcare trainees is critical. While less is known about the mental health needs of physician assistants or physician assistant (PA) students, accumulating research indicates that they experience similarly alarming rates of burnout, depression, and emotional exhaustion. Mobile app-delivered mindfulness meditation may be an effective part of salubrious programming to bolster long-term resilience and health among PA students. Objective: The purpose of this study was to examine the impact of app-delivered mindfulness meditation on self-reported mental health symptoms among physician assistant students. A secondary aim was to interrogate changes in brain connectivity to identify neurobiological changes related to changes in mental health symptoms. Methods: We recruited PA students enrolled in their third semester of PA school, and used a longitudinal and randomized, wait-list controlled design. Participants randomized to the mindfulness group were provided 1-year subscriptions to the 10% Happier app, a consumer-based meditation app, and asked to practice every day for 8 weeks. Prior to randomization and again after completion of the 8-week program, all participants completed resting state fMRI as well as self-report assessments of burnout, depression, anxiety, and sleep impairment. App usage was acquired as a measure of mindfulness practice time. Results: PA students randomized to the mindfulness group reported improvements in sleep impairment compared to those randomized to the wait-list control group (P = 0.012, partial eta-squared = 0.42). Sleep impairment decreased significantly in the mindfulness group (19% reduction, P = .006), but not in the control group (1% reduction, P = .710). There were no other significant changes in mental health for those randomized to app-delivered mindfulness. Across all students, changes in sleep impairment were associated with increased resting state functional connectivity between the medial prefrontal cortex (a component of the default mode network) and the superior temporal gyrus, as well as between areas important for working memory. Changes in connectivity predicted categorical conversion from sleep impaired to non-impaired in the mindfulness group. Conclusions: This pilot study is the first to examine app-based mindfulness for PA student mental health and the first to examine the impact of mindfulness on PA student brain function. These findings suggest that app-delivered mindfulness may be an effective tool to improve sleep dysfunction and that it may be an important part of the programming necessary to reduce the epidemic of suffering among health profession trainees. Clinical Trial: NCT03452670