This is another post in celebration of World Meditation Day, and it covers a study near and dear to my heart… because it’s my own study!

In fall 2020, serving as my department’s graduate coordinator, I was observing firsthand the impact that the pandemic was having on our students’ mental health. There are many studies that show meditation has positive impacts on mental health in both students and the general population. However, most of these studies either used time-intensive interventions where participants met regularly or were targeting health-related students (med students, nursing students, etc.). I knew that the last thing our students needed was another meeting on their calendar (and a Zoom meeting at that!), and I wasn’t sure if the effects found for health-focused students would carry over to our own students.

So I set out to find out!

Now you might be asking, “Kelly, what does this have to do with PCOS?” Good question!

We often think of PCOS as a women’s health disorder, effecting menstrual cycles and fertility. If you have a better-informed perspective of it, you might think of it as an endocrine disorder, with impacts on various hormones, both reproductive and metabolic. If you have an even better perspective, you see it as a whole person disorder, with far-reaching impacts on different aspects of well-being. And these aspects include mental health.

Controlling for things like age, BMI, and health status (aside from PCOS), women with PCOS have higher rates of anxiety, depression, and possibly bipolar disorder (Berni et al. 2018). It is unclear what exactly drives these higher rates. It could be the challenges of dealing with the symptoms of PCOS (obesity, acne, hirsutism, infertility), or it could be a manifestation of the underlying differences in reproductive and/or metabolic hormones. Or it could be something else! We just don’t know.

But from the data, we do know that it is especially important for women with PCOS to actively address their mental health. And meditation is one such way to do so!

The use of a meditation app to improve markers of mental health

So back to the study.

89 graduate students were recruited from across 21 different departments at the University of Florida. The group was then split into a treatment group that received free access to the Ten Percent Happier app at the start of the intervention period, and a control group that was promised to receive access to the app at the end of the intervention period.

Before, at the mid point of, and after the 8-week intervention period, both groups were asked to complete surveys. There were three key measures on the survey:

1. The Center for Epidemiologic Studies Depression Scale (CES-D): This scale uses 20  statements such as “I was bothered by things that usually don’t bother me” and “I felt lonely.” In the traditional scale, respondents are asked to respond with: rarely or none of the time (less than 1 day), some or a little of the time (1 – 2 days), occasionally or a moderate amount of the time (3 – 4 days), or most or all of the time (5 – 7 days), and these responses are given scores ranging from 0 to 3, respectively. Respondents scoring 16 or higher are generally diagnosed with depression, but cut-off points vary across studies.

2. The Generalized Anxiety Disorder 7-item (GAD-7) Scale: This scale uses 7 statements such as “Feeling nervous, anxious, or on edge” and “Being so restless that it is hard to sit still.” In the traditional scale, respondents are asked to respond with: not at all, several days, more than half the days, and nearly every day, and these responses are given scores ranging from 0 to 3, respectively. Respondents are then categorized as having mild, moderate, or severe anxiety if they receive scores of 5, 10, or 15 or more, respectively.

3. Physical Symptoms Scale: This scale included a list of ailments that might accompany stress and anxiety. These were taken from question 3 of the Anxiety Disorder Diagnostic Questionnaire (ADDQ). In the original questionnaire, patients would be asked to check all physical symptoms which they experience frequently.

For each measure, respondents were asked to consider their experiences in the preceding calendar week. Given the discrepancies between frequencies used in the CES-D (smooth 2 – 3 day increments) and GAD-7 (increments that include extreme end ranges of not at all and nearly every day), the survey used the following categories across all three measures: not at all (experienced on 0 days), some of the time (experienced on 1 – 2 days), a moderate amount of time (experienced 3 – 4 days), most of the time (experienced on 5 – 6 days), and all of the time (experienced on 7 days), and these responses were given scores of 0 to 4, respectively.

As is traditionally done for CES-D and GAD-7, a numerical value is assigned for each symptom based on the frequency of experiencing the symptom. Given the five time increments used in this survey, the assigned numerical values range from 0 (experienced on 0 days) to 4 (experienced on 7 days). The same process was used for the physical symptoms scale. Note, some of the CES-D statements are framed as positive, e.g., I was happy; for these statements, the numerical assignment is reversed with 0 assigned to experiencing it on 7 days and 4 assigned to experiencing it on 0 days.

Given that maximum scores were scaled by 33% to create uniformity across questions, in the analysis that follows the cutoffs were correspondingly scaled up by 33%. This resulted in a cutoff for depression of 21 instead of 16 and the cutoffs for mild, moderate, and severe anxiety set to 7, 13, and 20, respectively. No cutoff existed for the physical symptoms index so this measure is only presented as a raw score.

During the intervention period, the treatment group was asked to meditate once per day, and they were encouraged to use the app’s reminder feature to assist with establishing the daily habit. In addition to single meditation sessions, TPH includes multi-day courses on meditation. Each course is centered around a theme, and each session within the course includes a short video with explanations of concepts and then a longer guided meditation session. Respondents were asked to work through Basics I (7 days, 5 – 10 minutes/day) and Basics II (8 days, 14 – 17 minutes/day) first. These two courses are taught by Joseph Goldstein, a vipassana meditation teacher. The courses train students on focused awareness, primarily using breath awareness techniques.

After completing these two courses, they were allowed to choose from the following courses:

1.     Essential Advice (14 days, 15 – 19 minutes/day)

2.     Common Questions (24 days, 17 – 22 minutes/day)

3.     Relationships (15 days, 15 – 20 minutes/day)

4.     Stress Better (7 days, 12 – 14 minutes/day)

5.     Emotions (15 days, 13 – 16 minutes/day)

6.     Focus (14 days, 16 – 20 minutes/day)

7.     Performance (12 days, 16 – 21 minutes/day).

Course options were chosen based on topics that might be most relevant to them as well as to ensure that participants had a diverse set of instructors from whom to learn. All expand on the original focused awareness techniques presented in the Basics I and II courses.

While the treatment group was asked to meditate, the control group was instructed to continue on with their semester as they normally would.

Results: Meditation Reduces Depression scores and Rates of Mild Anxiety

I’m a big believer that a picture is worth a thousand words, and I think the results are best demonstrated in graphs.

In Figure 1 below, we’ve got the CES-D scores (marker of depression) in the top left, the GAD-7 scores (marker of anxiety) in the top right, and the physical symptoms score in the bottom left. The dashed lines represent the meditation group and the solid lines the control groups. For all three measures, we see declines in the treatment group across the 8 weeks, while there is no clear pattern in the control group. In terms of statistical significance, we see a significant difference in depression scores at the end of the 8 weeks, and we see a statistically significant difference in the trends for the anxiety scores.

Taking the participants’ scores and categorizing them into either meeting the criteria for depression or mild/moderate/severe anxiety or not, we can see impacts of meditation on the rates of having scores that correspond to these mental health challenges. We see this most clearly for rates of mild anxiety. At the start of the intervention period, about two-thirds of the meditation group had GAD-7 scores consistent with mild anxiety (or worse).

By the end of the intervention period, only 15% had scores consistent with at least mild anxiety. This is pretty huge!

Conversely, we don’t see a big impact on rates of moderate anxiety, and meditation was pretty much useless for severe anxiety.

In terms of depression, the rates don’t end up being statistically significantly different themselves, but the trends between the two groups are statistically significantly different. These results suggest that much of the differences in raw CES-D scores found above are coming from well-being improvements occurring for people whose scores are staying within the same category, i.e., people without depression have reductions in their scores and are thus still below the threshold for depression and/or people with depression are having reductions in their scores that are just not big enough to move them out of the depression category. I would argue these two kinds of improvements are still helpful for people.

How much meditation is necessary to see these effects?

So you might be thinking, okay, this is cool, but I’m really busy, and I don’t have time to meditate for an hour a day! And I’m certain I will miss some days.

Well, you’re in luck! Participants meditated on about 80% of days during the intervention period. That’s about 5 or 6 days a week, so they weren’t perfect at meditating every day.

On days they meditated, they meditated for about 12 minutes on average. That’s not a lot! And much of the literature shows that about 10 - 15 minutes per day, done fairly consistently, is enough to see impacts on mental health and focus.

Take home points

PCOS is associated with higher rates of anxiety and depression.

Meditation can improve markers of depression and rates of mild anxiety.

Meditating for 10 - 15 minutes, most days of the week, is all you need to start seeing mental health improvements.

If you want to try the Ten Percent Happier app, you can use this link to access a 30-day free trial. (I think the link/code time out after a period of time, so contact me if it doesn’t work when you try to use it, and I’ll send you a fresh one!)

We’ll be learning and practicing the focused attention form of meditation taught in the TPH app, along with walking meditation at the PCOS Lifestyle Immersion Retreat. Save your spot to learn these impactful techniques!

references

Berni TR, Morgan CL, Berni ER, and Rees DA. 2018. Polycystic Ovary Syndrome Is Associated With Adverse Mental Health and Neurodevelopmental Outcomes. Journal of Clinical Endocrinology Metabolism, 103(6):2116–2125. doi: https://10.1210/jc.2017-02667

Grogan KA. The Use of Mindfulness Meditation Apps Improves Mental Health among Graduate Students in STEM Programs. Not yet published because… life. But the manuscript is available upon request.

Disclaimer: This post is not intended to diagnose or treat any medical issues. It is intended for informational purposes only. I am not a medical practitioner. Always consult a trusted healthcare provider with any questions you may have about a medical condition or treatment and before starting any new health care regimen.