A pragmatic randomized wait-list controlled trial of a smartphone-based well-being training in public school system employees during the COVID-19 pandemic
While the extraordinary pressures of the COVID-19 pandemic on student mental health have received considerable attention, less attention has been placed on the well-being of school system employees despite their vital role in society and the education of young people. The need for innovative mental health promotion strategies that are acceptable, accessible, and scalable has never been more evident. In a remote pragmatic randomized wait-list controlled trial of Wisconsin public school system employees (N=662) during the COVID-19 pandemic, we investigate a candidate program: a freely available four-week smartphone-based meditation app designed to train key constituents of well-being (Healthy Minds Program; HMP). Following our preregistered analysis plan and consistent with hypotheses, assignment to the HMP predicted significantly larger reductions in psychological distress, our primary outcome, at post-intervention (standardized mean difference (SMD)=-0.52 95% CI [-0.68 to -0.37], P<0.0001) and at the three-month follow-up (SMD=-0.33 [-0.48 to -0.18], P<0.001). Also consistent with hypotheses, similar indications of immediate and sustained benefit following the HMP were observed on all six preregistered secondary outcomes selected to tap skills targeted in the app (absolute value SMDs=0.19 to 0.42, all Ps<0.031 corrected). Secondary outcomes included an antecedent to anxiety and depression (perseverative thinking) and a measure of loneliness. We found no evidence for elevated adverse effects in the HMP group and the HMP was at least as effective in subsample analyses involving participants with elevated anxiety and depressive symptoms at baseline. These data suggest that the HMP has promise as an acceptable, accessible, and scalable mental health intervention.