(PS14-45) Baseline Symptom Severity and Well-being Improvement in Low-intensity Mindfulness Interventions

Introduction: Higher baseline symptom severity is often associated with greater improvements from cognitive behavioral therapy and mindfulness-based interventions (MBIs). However, it remains unclear how baseline symptom severity affects treatment outcomes in low-intensity psychosocial interventions (i.e., brief, self-guided, low-cost treatments). Since low-intensity treatments can increase access to care, it is crucial to understand who benefits from these treatments and whether these treatments have sustained effects. Here, we examine if individuals with heightened baseline symptom severity who are enrolled in low-intensity MBIs experience distinct well-being trajectories during and after treatment, relative to those with lower baseline symptom severity. Specifically, we assess if baseline depression, anxiety, and social functioning predict well-being trajectories over 20-weeks among adults with a broad range of physical and mental conditions, and their caretakers.

Methods: This secondary analysis is based on a randomized trial comparing two asynchronous, self-guided online interventions: an 8-session mindfulness-based cognitive therapy and a 3-session mindfulness intervention. Participants (N = 4,111; age >18+) were recruited from 17 patient powered research networks focused on specific conditions (e.g., mood disorders, arthritis) and randomized to either treatment. During the intervention period (weeks 0-8), participants completed bi-weekly assessments measuring well-being (WHO-5 Well-Being Index), depression (PROMIS-Depression scale), anxiety (PROMIS-Anxiety scale), and perceived ability to engage in social roles (PROMIS-Social Roles scale). Participants completed these assessments monthly during follow-up (weeks 12-20). We stratified participants into four categories based on each baseline PROMIS measure: “Within Normal Limits”, “Mild”, “Moderate” or “Severe”.  To assess if well-being trajectories differed by baseline anxiety, depression, and social roles, three linear mixed effect models were conducted with well-being as the outcome. Descriptive mean trajectory models with crude and model-based estimates and 95% confidence intervals were generated to assess how mean well-being trajectories differed between symptom levels.

Results: At baseline, 60% of participants experienced anxiety beyond normal limits, 48% experienced some level of depression, and 43% experienced some social impairment. Different levels of baseline symptoms had varying well-being trajectories. On average, all participants experienced improved well-being during weeks 0-8. However, participants with more severe baseline depression, anxiety, and social impairment did not maintain improvements, returning to baseline well-being levels during follow-up.

 


Discussion: Regardless of baseline symptom severity, individuals can experience improvement from low-intensity psychosocial interventions. However, the effects of low-intensity interventions might be less sustained for individuals with more severe baseline symptoms. Thus, patients with higher baseline symptom severity might benefit from more intensive treatment options, or low-intensity treatments for a longer period.