{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:59:55Z","timestamp":1790269195931,"version":"4.1.0"},"reference-count":45,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychother Psychosom"],"abstract":"<jats:p>Introduction: The high prevalence of psychological distress and shortage of mental health professionals create a service gap for highly symptomatic populations exceeding routine care capacity. We evaluated a hybrid digital mindfulness intervention (MIED) delivered via a train-the-trainer (TTT) model for reducing psychological distress and providing economic value. Methods: In this randomized controlled trial in China, adults with significant psychological distress (Kessler-10 score \u226522) were assigned (1:1) to 8-week MIED plus services as usual (SAU), or SAU alone. The primary outcome was the 8-week trajectory of psychological distress. Secondary outcomes included mental health indicators and short-term cost-utility. Intention-to-treat analyses used generalized estimating equations (GEEs). Results: Between November 1 and 8, 2024, 1,281 participants were assigned (MIED: n = 641; SAU: n = 640). GEE revealed a significant Group \u00d7 Time interaction for distress (\u03c72 (4) = 143.611, p &lt; 0.001), with the intervention group demonstrating greater reductions than SAU (Cohen\u2019s d = \u22120.526 at Week 8). Secondary indicators also improved (p &lt; 0.001). From a societal perspective, MIED incurred lower mean costs (993 CNY [\u223cUSD 140] vs. 1,326 CNY [\u223cUSD 186]; p &lt; 0.001) with 95% probability of cost-effectiveness at 9,246 CNY [\u223cUSD 1,299] per quality-adjusted life-year. Adherence was high (mean, 6.04 of 8 sessions). No severe adverse events were identified, and self-reported meditation-related adverse experiences declined over time within the intervention group. Conclusions: Compared with SAU, TTT-delivered MIED is a safe, effective, and potentially cost-saving adjunct strategy for scaling MIED delivery in resource-constrained systems. Future research should evaluate long-term sustainability beyond 8 weeks.<\/jats:p>","DOI":"10.1159\/000553463","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:24:52Z","timestamp":1786724692000},"page":"1-19","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness and Cost-Effectiveness of a Digital Mindfulness-Based Intervention for Psychological Distress Delivered by Trainee Instructors: A Randomized Controlled 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