title: Coping with stress in medical students: results of a randomized controlled trial using a mindfulness-based stress prevention training (MediMind) in Germany.
abstract: BACKGROUND
  High prevalence rates of psychological distress in medical training and later professional life indicate a need for prevention. Different types of intervention were shown to have good effects, but little is known about the relative efficacy of different types of stress management interventions, and methodological limitations have been reported. In order to overcome some of these limitations, the present study aimed at evaluating the effect of a specifically developed mindfulness-based stress prevention training for medical students (MediMind) on measures of distress, coping and psychological morbidity.
  
  
  METHODS
  We report on a prospective randomized controlled trial with three study conditions: experimental treatment (MediMind), standard treatment (Autogenic Training) and a control group without treatment. The sample consisted of medical or dental students in the second or eighth semester. They completed self-report questionnaires at baseline, after the training and at one year follow-up. Distress (Trier Inventory for the Assessment of Chronic Stress, TICS) was assessed as the primary outcome and coping (Brief COPE) as a co-primary outcome. Effects on the psychological morbidity (Brief Symptom Inventory, BSI) as a secondary outcome were expected one year after the trainings.
  
  
  RESULTS
  Initially, N = 183 students were randomly allocated to the study groups. At one year follow-up N = 80 could be included into the per-protocol analysis: MediMind (n =31), Autogenic Training (n = 32) and control group (n = 17). A selective drop-out for students who suffered more often from psychological symptoms was detected (p = .020). MANCOVA's on TICS and Brief COPE revealed no significant interaction effects. On the BSI, a significant overall interaction effect became apparent (p = .002, η2partial = .382), but post hoc analyses were not significant. Means of the Global Severity Index (BSI) indicated that MediMind may contribute to a decrease in psychological morbidity.
  
  
  CONCLUSIONS
  Due to the high and selective dropout rates, the results cannot be generalized and further research is necessary. Since the participation rate of the trainings was high, a need for further prevention programs is indicated. The study gives important suggestions on further implementation and evaluation of stress prevention in medical schools.
  
  
  BACKGROUND
  This trial is recorded at German Clinical Trials Register under the number DRKS00005354 (08.11.2013).
authors.affiliation: Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. sophie.kuhlmann@unimedizin-mainz.de.
authors.forename: S M
authors.initials: SM
authors.lastname: Kuhlmann
authors.affiliation: Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Huss
authors.affiliation: Department University Hospital of Wuerzburg, Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Fuechsleinstraße 15, 97080, Wuerzburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Bürger
authors.affiliation: Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Hammerle
mesh_terms: D000223:Adaptation, Psychological; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D064866:Mindfulness; D009784:Occupational Diseases / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D010352:Patient Dropouts; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D013337:Students, Medical / Q000523:psychology*; D055815:Young Adult
keywords: Distress; Medical students; Mindfulness; Stress; Stress prevention