Abstract
BackgroundA student mental health crisis is increasingly acknowledged and will only intensify with the COVID-19 crisis. Given accessibility of methods with demonstrated efficacy in reducing depression and anxiety (eg, mindfulness meditation and cognitive behavioral therapy [CBT]) and limitations imposed by geographic obstructions and localized expertise, web-based alternatives have become vehicles for scaled-up delivery of benefits at modest cost. Mindfulness Virtual Community (MVC), a web-based program informed by CBT constructs and featuring online videos, discussion forums, and videoconferencing, was developed to target depression, anxiety, and experiences of excess stress among university students.ObjectiveThe aim of this study was to assess the effectiveness of an 8-week web-based mindfulness and CBT program in reducing symptoms of depression, anxiety, and stress (primary outcomes) and increasing mindfulness (secondary outcome) within a randomized controlled trial (RCT) with undergraduate students at a large Canadian university.MethodsAn RCT was designed to assess undergraduate students (n=160) who were randomly allocated to a web-based guided mindfulness–CBT condition (n=80) or to a waitlist control (WLC) condition (n=80). The 8-week intervention consisted of a web-based platform comprising (1) 12 video-based modules with psychoeducation on students’ preidentified life challenges and applied mindfulness practice; (2) anonymous peer-to-peer discussion forums; and (3) anonymous, group-based, professionally guided 20-minute live videoconferences. The outcomes (depression, anxiety, stress, and mindfulness) were measured via an online survey at baseline and at 8 weeks postintervention using the Patient Health Questionnaire-9 (PHQ9), the Beck Anxiety Inventory (BAI), the Perceived Stress Scale (PSS), and the Five Facets Mindfulness Questionnaire Short Form (FFMQ-SF). Analyses employed generalized estimation equation methods with AR(1) covariance structures and were adjusted for possible covariates (gender, age, country of birth, ethnicity, English as first language, paid work, unpaid work, relationship status, physical exercise, self-rated health, and access to private mental health counseling).ResultsOf the 159 students who provided T1 data, 32 were males and 125 were females with a mean age of 22.55 years. Participants in the MVC (n=79) and WLC (n=80) groups were similar in sociodemographic characteristics at T1 with the exception of gender and weekly hours of unpaid volunteer work. At postintervention follow-up, according to the adjusted comparisons, there were statistically significant between-group reductions in depression scores (β=–2.21, P=.01) and anxiety scores (β=–4.82, P=.006), and a significant increase in mindfulness scores (β=4.84, P=.02) compared with the WLC group. There were no statistically significant differences in perceived stress for MVC (β=.64, P=.48) compared with WLC.ConclusionsWith the MVC intervention, there were significantly reduced depression and anxiety symptoms but no significant effect on perceived stress. Online mindfulness interventions can be effective in addressing common mental health conditions among postsecondary populations on a large scale, simultaneously reducing the current burden on traditional counseling services.Trial RegistrationISRCTN Registry ISRCTN12249616; http://www.isrctn.com/ISRCTN12249616
Highlights
1 in 5 people in Canada experience a mental health problem [1,2], and young people aged 15-24 are more likely to experience mental illness than any other age group [3]
The majority of participants did not have access to private mental health insurance (102/159, 64.1%). These and other characteristics were distributed between the control and intervention groups (Table 2) with the exception of unpaid work, relationship, and gender: compared with the Mindfulness Virtual Community (MVC) group, participants in the waitlist control (WLC) group worked on average more hours (P=.03), were significantly more likely (P=.05) to be single with no relationship, and were significantly less likely to be single in relationship (P=.05)
In relation to anxiety in the MVC group compared with the WLC group, there was a statistically significant reduction in Beck Anxiety Inventory (BAI) score at T2 in both the unadjusted (β=–4.89, P=.004) and adjusted (β=–4.82, P=.006) analyses
Summary
1 in 5 people in Canada experience a mental health problem [1,2], and young people aged 15-24 are more likely to experience mental illness than any other age group [3]. The situation appears similar at universities in the United States [10,11] and worldwide—in 2018, the World Health Organization reported increasing mental disorders in college and university students worldwide [12]. Distress during university attendance is critical to address, especially considering that 70% of all mental health problems appear before the age of 25 and, when untreated, can become long-standing and significant impairments affecting multiple life domains [6]. Given accessibility of methods with demonstrated efficacy in reducing depression and anxiety (eg, mindfulness meditation and cognitive behavioral therapy [CBT]) and limitations imposed by geographic obstructions and localized expertise, web-based alternatives have become vehicles for scaled-up delivery of benefits at modest cost. Mindfulness Virtual Community (MVC), a web-based program informed by CBT constructs and featuring online videos, discussion forums, and videoconferencing, was developed to target depression, anxiety, and experiences of excess stress among university students
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