Mobile Mindfulness for Psychological Distress and Burnout Among Frontline COVID-19 Nurses: A Pilot Randomized Trial

The COVID-19 pandemic exacerbated psychological distress and burnout in frontline healthcare workers. Interventions addressing psychological distress and burnout among these workers are lacking. Determine feasibility and explore impact of mobile mindfulness to treat psychological distress and burnout among nurses in frontline COVID-19 units. Pilot randomized trial of 102 nurses working in COVID-19 units at a single hospital between May 2021 and January 2022. Participants were randomized to mobile mindfulness (intervention) or waitlist (control). The primary outcome was feasibility, assessed by comparing rates of randomization, retention, and intervention completion to predefined targets. Secondary outcomes were changes in psychological distress (Patient Health Questionnaire-9 [PHQ-9], General Anxiety Disorder-7 [GAD-7], Perceived Stress Scale-4 [PSS-4]) and burnout symptoms (Maslach Burnout Inventory [MBI]) after one month. We randomized 102 of 113 consented individuals (90%, target 80%), and 88 completed follow-up (86%, target 80%). Among 69 intervention participants, 19 completed ≥1 mindfulness session per week (28%, target 60%) and 13 completed ≥75% of mindfulness sessions (19%, target 50%). Intervention participants had greater decreases in PHQ-9 scores than controls (Difference in differences [DID] = -2.21; 95% CI, -3.99, -0.42; p = 0.016), but the MBI-depersonalization scores decreased more in controls arm compared to intervention (DID = 1.60; 95% CI, 0.18, 3.02; p = 0.027). There were no other changes in emotional distress or burnout symptoms. This trial of mobile mindfulness in frontline nurses met feasibility targets for randomization and retention, but participants had modest intervention usage. Intervention participants had a reduction in depression symptoms, but not burnout. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/). Clinical trial registration available at www. gov, ID: NCT04816708.