title: Life Balance - a mindfulness-based mental health promotion program: conceptualization, implementation, compliance and user satisfaction in a field setting.
abstract: BACKGROUND
  Mental health disorders account for a large percentage of the total burden of illness and constitute a major economic challenge in industrialized countries. Several prevention programs targeted at high-risk or sub-clinical populations have been shown to decrease risk, to increase quality of life, and to be cost-efficient. However, there is a paucity of primary preventive programs aimed at the general adult population. "Life Balance" is a program that employs strategies borrowed from well-established psychotherapeutic approaches, and has been made available to the public in one federal German state by a large health care insurance company. The data presented here are the preliminary findings of an ongoing field trial examining the outcomes of the Life Balance program with regard to emotional distress, life satisfaction, resilience, and public health costs, using a matched control group design.
  
  
  METHODS
  Life Balance courses are held at local health-care centers, in groups of 12 to 15 which are led by laypeople who have been trained on the course materials. Participants receive instruction on mindfulness and metacognitive awareness, and are assigned exercises to practice at home. Over an 8-month period in 2013-2014, all individuals who signed up for the program were invited at the time of enrollment to take part in a study involving the provision of psychometric data and of feedback on the course. A control group of subjects was invited to complete the questionnaires on psychometric data but did not receive any intervention.
  
  
  RESULTS
  Of 4,898 adults who attended Life Balance courses over the specified period, 1,813 (37.0 %) provided evaluable study data. The average age of study participants was 49.5 years, and 83 % were female. At baseline, participants' self-reported symptoms of depression and anxiety, life satisfaction, and resilience were significantly higher than those seen in the general German population. Overall, evaluations of the course were positive, and 83 % of participants attended at least at 6 of the 7 sessions. Some sociodemographic correlations were noted: men carried out the assigned exercises less often than did women, and younger participants practiced mindfulness less frequently than did older ones. However, satisfaction and compliance with the program were similar across all sociodemographic categories.
  
  
  CONCLUSIONS
  While the Life Balance program is publicized as a primary prevention course that is not directed at a patient population, the data indicate that it was utilized by people with a significant mental health burden, and that the concept can be generalized to a broad population. As data from the control group are not yet available, conclusions about effectiveness cannot yet be drawn.
  
  
  BACKGROUND
  German Clinical Trials Registration ID: DRKS00006216.
authors.affiliation: Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany. lisa.lyssenko@zi-mannheim.de.
authors.forename: Lisa
authors.initials: L
authors.lastname: Lyssenko
authors.affiliation: AOK Baden-Württemberg, Villingen-Schwenningen, Germany. gerhard.mueller@bw.aok.de.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Müller
authors.affiliation: Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany. nikolaus.kleindienst@zi-mannheim.de.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Kleindienst
authors.affiliation: Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany. christian.schmahl@zi-mannheim.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Schmahl
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg im Breisgau, Germany. mathias.berger@uniklinik-freiburg.de.
authors.forename: Mathias
authors.initials: M
authors.lastname: Berger
authors.affiliation: College of Health & Behavioral Sciences, Chapman University, Orange, USA. geifert@chapman.edu.
authors.forename: Georg
authors.initials: G
authors.lastname: Eifert
authors.affiliation: AOK Baden-Württemberg, Villingen-Schwenningen, Germany. alexander.koelle@bw.aok.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kölle
authors.affiliation: AOK Baden-Württemberg, Villingen-Schwenningen, Germany. siegmar.nesch@bw.aok.de.
authors.forename: Siegmar
authors.initials: S
authors.lastname: Nesch
authors.affiliation: AOK Baden-Württemberg, Villingen-Schwenningen, Germany. jutta.ommer-hohl@bw.aok.de.
authors.forename: Jutta
authors.initials: J
authors.lastname: Ommer-Hohl
authors.affiliation: Wenner Burnout Prävention, Freiburg, Germany. mw@wenner-burnout-praevention.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Wenner
authors.affiliation: Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany. martin.bohus@zi-mannheim.de.|Faculty of Health, University of Antwerp, Antwerp, Belgium. martin.bohus@zi-mannheim.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Bohus
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000517:prevention & control*; D001521:Behavior Therapy / Q000379:methods*; D003863:Depression / Q000517:prevention & control*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006293:Health Promotion; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D064866:Mindfulness / Q000379:methods*; D010349:Patient Compliance; D010549:Personal Satisfaction; D011594:Psychometrics; D011788:Quality of Life; D013315:Stress, Psychological / Q000517:prevention & control*; D011795:Surveys and Questionnaires