JMIR Publications

ABSTRACT

Background:

Background:

Innovative interventions are needed to address the increasing mental health needs of university-students, particularly wherever traditional services appear to be overwhelmed. Given the demonstrated anxiolytic and antidepressant benefits of mindfulness training, we developed an eight-week online Mindfulness Virtual Community (MVC) intervention informed by Cognitive Behavior Therapy (CBT) constructs.

Objective:

To investigate the efficacy of online MVC intervention in reducing symptoms of depression, anxiety and stress among undergraduate students in Toronto, Canada. The secondary outcomes included quality of life, life satisfaction and mindfulness.

Methods:

The first 4-weeks of full MVC intervention (F-MVC) comprised of i) 12 video-based modules with psycho-education on students’ pre-identified stressful topics and topically applied mindfulness practice; ii) anonymous peer-to-peer discussion forums; and iii) anonymous, group-based, professionally guided, 20-minute live video-conferences. The second 4-weeks of F-MVC gave access only to video-based modules. The eight-week partial MVC (P-MVC) comprised of 12 video-based modules. A randomized controlled trial was conducted with 4 parallel arms: F-MVC; P-MVC; waitlist control (WLC) and group-based face-to-face CBT; results for latter group are presented elsewhere. Multiple recruitment strategies were used and consenting students were randomized: WLC = 40; F-MVC = 40, P-MVC = 39; they learned about allocation after consenting. The online surveys at baseline (T1), 4-weeks (T2) and 8-weeks (T3) included Patient Health Questionnaire-9, Beck Anxiety Inventory, Perceived Stress Scale, Quality of Life Scale, Brief Multi-Dimensional Students Life Satisfaction Scale, and Five-Facet Mindfulness Questionnaire. Analyses employed Generalized Estimation Equation (GEE) methods with AR(1) covariance structures and were adjusted for possible confounding variables (i.e. gender, age, birth-country, paid work, unpaid work, vigorous physical activities and self-rated health).

Results:

Of the 113 students who provided baseline data, 28 males (24.8%) and 85 females (75.2%) reported a mean age of 24.8 years and were mostly Canadian-born (59.3%). Participants in F-MVC (n=39), P-MVC (n=35) and WLC (n=39) groups were similar in socio-demographic characteristics at baseline. At T3 follow-up, per adjusted comparisons, there were statistically significant reductions in depression scores for F-MVC (score change -4.03, P<.001) and P-MVC (score change -4.82, P<.001) when compared to WLC. At T3 there was statistically significant reduction in anxiety scores only for P-MVC (score change -7.35, P=.01) when compared to WLC. There was statistically significant reduction in scores for perceived stress for both F-MVC (score change -5.32, P<.001) and P-MVC (score change -5.61, P=.005) compared to WLC. There were also statistically significant changes at T3 for the quality of life and mindfulness for F-MVC and P-MVC versus WLC, but not for life satisfaction.

Conclusions:

Internet-based mindfulness-CBT-based interventions, such as F-MVC and P-MVC, can result in significant reductions in symptoms of depression, anxiety and stress in a student population. Future research with a larger sample from multiple universities would more precisely test generalizability. Clinical Trial: https://doi.org/10.1186/ISRCTN92827275