Evidence map›Paper›PMID 42584489›Full record

ArticleEuropean child & adolescent psychiatry2026

Implementation dosage and depressive symptoms following school-based mindfulness and relaxation: Complier Average Causal Effect estimation in the INSPIRE cluster randomised trial.

Emma Thornton, Christopher Knowles, Margarita Panayiotou, Joao Santos, Emma Ashworth, Carla Mason, Daniel Hayes, Abigail Thompson, Jessica Deighton, Rosie Mansfield and 3 more

Abstract read
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In one paragraph

Article in European child & adolescent psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Emma ThorntonManchester Institute of Education, University of Manchester, Manchester, UK. emma.thornton@manchester.ac.uk.ORCID https://orcid.org/0000-0003-4623-9538
Christopher KnowlesManchester Institute of Education, University of Manchester, Manchester, UK.
Margarita PanayiotouManchester Institute of Education, University of Manchester, Manchester, UK.
Joao SantosManchester Institute of Education, University of Manchester, Manchester, UK.
Emma AshworthSchool of Psychology, Liverpool John Moores University, Liverpool, UK.
Carla MasonManchester Institute of Education, University of Manchester, Manchester, UK.
Daniel HayesEvidence Based Practice Unit, University College London and Anna Freud, London, UK.
Abigail ThompsonEvidence Based Practice Unit, University College London and Anna Freud, London, UK.
Jessica DeightonEvidence Based Practice Unit, University College London and Anna Freud, London, UK.
Rosie MansfieldCentre for Longitudinal Studies, University College London, London, UK.
Anna MarchEvidence Based Practice Unit, University College London and Anna Freud, London, UK.
Paul StallardDepartment of Health, University of Bath, Bath, UK.
Neil HumphreyManchester Institute of Education, University of Manchester, Manchester, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Implementation variability is hypothesized to be a key treatment effect modifier of universal, school-based mental health interventions, but the evidence base remains meagre. We used Complier Average Causal Effect (CACE) estimation to determine if dosage variability modified treatment effects of relaxation techniques and mindfulness-based exercises in the INSPIRE cluster randomised trial. Analyses were split by phase of education (mindfulness primary: k = 65 primary schools, N = 3,630 pupils; mindfulness secondary: k = 29 secondary schools, N = 3,708 pupils; relaxation primary: k = 66 primary schools, N = 3,800 pupils; relaxation secondary: k = 26 secondary schools, N = 3,252 pupils) and considered compliance effects at the 50th (moderate) and 75th (high) percentiles in the distribution of intervention dosage (total minutes delivered). Despite null intent to treat findings, we observed compliance effects for both interventions. In primary schools, moderate (320 min) and high (376 min) compliance to relaxation techniques significantly reduced depressive symptoms (d=-1.52 and d=-1.48, respectively). In secondary schools, moderate (207 min) and high (285 min) compliance to mindfulness-based exercises also significantly reduced depressive symptoms (d=-1.15 and d=-1.40, respectively). Contrastingly, in primary schools, moderate (325 min) and high (393 min) compliance to mindfulness-based exercises significantly increased depressive symptoms (d = 0.32 and d = 0.48, respectively). In secondary schools, moderate (180 min) and high (275 min) compliance to relaxation techniques also significantly increased depressive symptoms (d = 0.67 and d = 0.83, respectively). The effects of universal, school-based mental health interventions promoting relaxation and mindfulness are contingent on the delivery of a minimally effective dose. However, these interventions may not be appropriate in all educational contexts and could result in iatrogenic effects.Trial registration: Trial registration number: ISRCTN16386254. Trial registration date:04/09/2018.

Indexed as

Cluster randomised controlled trialComplier average causal effect analysisIntervention dosageMindfulnessRelaxationUniversal school-based interventions

Identifiers

PMID42584489

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.