Mindfulness-Based Interventions Across Chronic Diseases: An Umbrella Review and Second-Order Meta-Analysis of Depressive Symptoms and Patient-Centered Outcomes

Chronic diseases impose sustained psychological and behavioral burdens that can amplify symptoms, reduce adherence, and impair quality of life. Mindfulness-based interventions (MBIs) are increasingly used as adjuncts to chronic disease care, but their effects are dispersed across disease-specific reviews. This umbrella review synthesized systematic reviews and meta-analyses of MBIs in adults with chronic diseases and performed a second-order meta-analysis of comparable depression outcomes. PubMed/MEDLINE and the Cochrane Library were searched from inception to July 1, 2026, with backward citation searching and targeted searches of journal repositories. Eligible reports were systematic reviews with meta-analysis of randomized or controlled trials evaluating structured MBIs in chronic disease populations. To limit double counting, one condition-specific estimate per disease category was selected for the quantitative synthesis. Standardized mean differences (SMDs) were harmonized so negative values favored MBIs and pooled with a random-effects restricted maximum likelihood model using Hartung-Knapp inference.

Twelve reviews informed the umbrella synthesis and 10 condition-specific estimates entered the second-order meta-analysis. Across cancer, fibromyalgia, type 2 diabetes, multiple sclerosis, Parkinson disease, chronic pain, inflammatory bowel disease, coronary artery disease, post-stroke populations, and hypertension, MBIs were associated with lower depressive symptom burden (pooled SMD = -0.62, 95% CI -0.80 to -0.43). Heterogeneity was moderate (I² = 51.1%; Q = 18.41, p = 0.031), and the 95% prediction interval (-1.01 to -0.23) remained in the direction of benefit. Leave-one-out estimates ranged from -0.66 to -0.58. Benefits were most consistent for depression, anxiety, stress, pain-related coping, and quality of life, whereas physiological outcomes such as blood pressure and glycemic control were more condition-dependent and supported by lower-certainty evidence. MBIs appear to provide a clinically meaningful adjunctive strategy across chronic diseases, particularly for psychological distress, but implementation should complement rather than replace disease-specific treatment.