Mindfulness in schools for internal migrant children at risk of anxiety and depression: A randomized trial

Rapid urbanization and unequal urban-rural development have driven large-scale internal migration in low- and middle-income countries, placing internal migrant children at increased risk for psychological distress and sociocultural marginalization. Although schools are critical settings for prevention, targeted interventions that support migrant students' psychological ("feeling well") and sociocultural ("doing well") adaptation remain limited. Mindfulness training shows promise for youth mental health, yet its feasibility among socioeconomically disadvantaged migrant youth remains underexamined. This randomized controlled trial evaluated a 16-week school-based mindfulness program against an active psychoeducation control among 259 internal migrant students in China (ages 9-12; 47.1% female; 68.7% low-income) at risk for anxiety-depression. Psychological outcomes (anxiety-depression symptoms, resilience, emotional states) and sociocultural outcomes (school and sociocultural adjustment), along with parent-reported behavioral functioning, were assessed at baseline, midpoint, postintervention, and 1-year follow-up. Both programs were implemented with high fidelity. Between-group differences were not statistically significant for most outcomes. Compared with psychoeducation, mindfulness showed greater improvements only in positive affect and learning autonomy at mid-test and mindful acceptance at follow-up. Subgroup analyses indicated that effects were confined to a few outcomes in specific groups: reduced internalizing problems among students with clinical-level symptoms and selective sociocultural gains among fifth graders and girls. As schools worldwide serve growing numbers of migrant and immigrant students, equitable approaches are needed to support their adaptation amid structural disadvantage. In internal migrant students, mindfulness training showed no consistent advantage over psychoeducation and only modest, outcome- and subgroup-specific benefits, highlighting the need for context-sensitive, targeted prevention strategies.