Effectiveness of an Eight-Week Web-Based Mindfulness Virtual Community Intervention for University Students on Symptoms of Stress, Anxiety, and Depression: A Randomized Controlled Trial (Preprint)

BACKGROUND A 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 (e.g., mindfulness meditation and cognitive behavioural 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 cognitive behavioral therapy (CBT) constructs and featuring online videos, discussion forums, and videoconferencing was developed to target depression, anxiety, and experiences of excess stress among university students. OBJECTIVE Assessment of an eight-week web-based mindfulness and cognitive behavioural therapy (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. METHODS An 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 condition (WLC) (n = 80). The eight-week intervention consisted of a web-based platform consisting of (1) 12 video-based modules with psycho-education 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 online survey at baseline and at eight weeks post-intervention using the Patient Health Questionniare-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 (GEE) 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 counselling). RESULTS Of 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 post-intervention follow-up, per 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 to WLC. There were no statistically significant differences in perceived stress for MVC (β = .64, P = .48) compared to WLC. CONCLUSIONS With 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 post-secondary populations on a large scale, simultaneously reducing the current burden on traditional counselling services. CLINICALTRIAL https://doi.org/10.1186/ISRCTN12249616.