Abstract
OBJECTIVE: To systematically evaluate the impact of mindfulness-based interventions on insight and stigma in patients with schizophrenia. METHODS: Randomized controlled trials (RCTs) and quasi-randomized controlled trials investigating the effects of mindfulness-based interventions on insight and stigma in schizophrenia patients were retrieved from databases including CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Embase, and Web of Science, with the search period spanning from inception to June 2025. Statistical analysis was performed using RevMan 5.2 software, with effect sizes expressed as standardized mean difference (SMD) and 95% confidence interval (CI). Heterogeneity was assessed using the I² statistic: a random-effects model was applied when I² ≥ 50% or P < 0.05; otherwise, a fixed-effects model was used. To evaluate the impact of study design on pooled effects, a case-deletion sensitivity analysis was conducted. Publication bias was assessed using funnel plots and Egger's test. Intervention types included mindfulness-based stress reduction, mindfulness-based cognitive therapy, group mindfulness therapy, and mindfulness-informed psychoeducation/skills training, with intervention durations ranging from 4 to 24 weeks. RESULTS: A total of 11 RCTs and 2 quasi-randomized controlled trials involving 2,899 patients were included. The analysis revealed that the intervention group exhibited significantly better insight (SMD=1.05, 95% CI=0.67-1.43, P < 0.00001) and lower stigma (SMD=-0.81, 95% CI=-1.00 to -0.63, P < 0.00001) compared to the control group. CONCLUSION: Mindfulness-based interventions can significantly improve insight and reduce stigma in patients with schizophrenia, holding important clinical implications. Specifically, they may enhance treatment adherence and rehabilitation participation, decrease self-stigma, and promote the restoration of social functioning. Higher-quality, long-term follow-up randomized controlled trials (RCTs) are still needed to further validate and refine the evidence. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, PROSPERO identifier CRD420251172478.