Abstract
SummaryBackgroundThe rising number of young people going to university has led to concerns about an increasing demand for student mental health services. We aimed to assess whether provision of mindfulness courses to university students would improve their resilience to stress.MethodsWe did this pragmatic randomised controlled trial at the University of Cambridge, UK. Students aged 18 years or older with no severe mental illness or crisis (self-assessed) were randomly assigned (1:1), via remote survey software using computer-generated random numbers, to receive either an 8 week mindfulness course adapted for university students (Mindfulness Skills for Students [MSS]) plus mental health support as usual, or mental health support as usual alone. Participants and the study management team were aware of group allocation, but allocation was concealed from the researchers, outcome assessors, and study statistician. The primary outcome was self-reported psychological distress during the examination period, as measured with the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE–OM), with higher scores indicating more distress. The primary analysis was by intention to treat. This trial is registered with the Australia and New Zealand Clinical Trials Registry, number ACTRN12615001160527.FindingsBetween Sept 28, 2015, and Jan 15, 2016, we randomly assigned 616 students to the MSS group (n=309) or the support as usual group (n=307). 453 (74%) participants completed the CORE–OM during the examination period and 182 (59%) MSS participants completed at least half of the course. MSS reduced distress scores during the examination period compared with support as usual, with mean CORE–OM scores of 0·87 (SD 0·50) in 237 MSS participants versus 1·11 (0·57) in 216 support as usual participants (adjusted mean difference −0·14, 95% CI −0·22 to −0·06; p=0·001), showing a moderate effect size (β −0·44, 95% CI −0·60 to −0·29; p<0·0001). 123 (57%) of 214 participants in the support as usual group had distress scores above an accepted clinical threshold compared with 88 (37%) of 235 participants in the MSS group. On average, six students (95% CI four to ten) needed to be offered the MSS course to prevent one from experiencing clinical levels of distress. No participants had adverse reactions related to self-harm, suicidality, or harm to others.InterpretationOur findings show that provision of mindfulness training could be an effective component of a wider student mental health strategy. Further comparative effectiveness research with inclusion of controls for non-specific effects is needed to define a range of additional, effective interventions to increase resilience to stress in university students.FundingUniversity of Cambridge and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England.
Highlights
Supporting young people’s health and wellbeing is an investment that results in considerable economic benefit.[1]
Mindfulness Skills for Students (MSS) reduced distress scores during the examination period compared with support as usual, with mean Clinical Outcomes in Routine Evaluation Outcome Measure (CORE–OM) scores of 0·87 (SD 0·50) in 237 MSS participants versus 1·11 (0·57) in 216 support as usual participants, showing a moderate effect size (β –0·44, 95% CI –0·60 to –0·29; p
Interpretation Our findings show that provision of mindfulness training could be an effective component of a wider student mental health strategy
Summary
Supporting young people’s health and wellbeing is an investment that results in considerable economic benefit.[1] Participation in higher education is growing among young people, including students from increasingly diverse backgrounds; more than a third of each generation attends university in England.[2] Prevalence of mental illness in first-year undergraduates is lower than in the general population, but becomes higher during the second year.[3] The number of students accessing university counselling in some services in the UK grew by 50% from 2010 to 2015, surpassing the growth in the number of university entrants in the same period.[4] Reasons for this increase are unclear, with little consensus about whether students are experiencing more mental disorders, are less resilient than in the past, whether there is less stigma in accessing support, and how all these factors affect academic attainment.[5,6,7] the journey through university provides a golden, yet underused, opportunity for prevention of mental illness in young people.[8]
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