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A systematic review and meta-analysis of psychological interventions to improve mental wellbeing

Abstract

Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.

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Fig. 1: Simplified relationship between outcomes of mental health and indicators of illness and wellbeing.
Fig. 2: Study PRISMA flow diagram.
Fig. 3: Forest plot visualizing the impact of each intervention type on overall wellbeing compared with control conditions split by population type.

Data availability

The datasets that were used in this review are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank colleagues at the South Australian Health and Medical Research Institute, Wellbeing and Resilience Centre, for their support during the creation of this review, S. Brown and N. May, for their help in crafting the search strategy. This work was supported by a grant by the James and Diana Ramsay Foundation. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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J.v.A.: review methodology, screening of literature, data extraction, risk of bias, meta-analysis and writing. M.I.: review methodology, screening of literature, data extraction, risk of bias and writing. L.L.: screening of literature, data extraction, risk of bias and writing. J.B.: data extraction, risk of bias and writing. Z.K.: risk of bias and writing. M.C.: data extraction and writing. M.K.: input into methodology, focus of review and writing.

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Correspondence to Joep van Agteren.

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van Agteren, J., Iasiello, M., Lo, L. et al. A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Hum Behav 5, 631–652 (2021). https://doi.org/10.1038/s41562-021-01093-w

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