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

Background: Health care provider and trainee burnout results in substantial national and institutional costs and profound socialeffects. Identifying effective solutions and interventions to cultivate resilience among health care trainees is critical. Althoughless is known about the mental health needs of physician assistants (PAs) or PA students, accumulating research indicates thatthey experience similarly alarming rates of burnout, depression, and emotional exhaustion. Mobile app-delivered mindfulnessmeditation may be an effective part of salubrious programming to bolster long-Term resilience and health among PA students.Objective: This study aims to examine the impact of app-delivered mindfulness meditation on self-reported mental healthsymptoms among PA students. A secondary aim is to investigate changes in brain connectivity to identify neurobiological changesrelated to changes in mental health symptoms.Methods: We recruited PA students enrolled in their third semester of PA school and used a longitudinal, 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. Before randomization and againafter completion of the 8-week program, all participants completed resting-state functional magnetic resonance imaging as wellas self-report assessments of burnout, depression, anxiety, and sleep impairment. App use was acquired as a measure of mindfulnesspractice time.Results: PA students randomized to the mindfulness group reported improvements in sleep impairment compared with thoserandomized to the wait-list control group (p2=0.42; P=.01). Sleep impairment decreased significantly in the mindfulness group(19% reduction; P=.006) but not in the control group (1% reduction; P=.71). There were no other significant changes in mentalhealth for those randomized to app-delivered mindfulness. Across all students, changes in sleep impairment were associated withincreased 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 predictedcategorical conversion from impaired to nonimpaired sleep in the mindfulness group.Conclusions: This pilot study is the first to examine app-based mindfulness for PA students' mental health and investigate theimpact of mindfulness on PA students' 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 ofsuffering among health profession trainees.