JMIR Publications

ABSTRACT

Background:

Undergraduate students frequently experience negative emotional states and sleep quality, which is believed to have worsened following the COVID-19 pandemic.

Objective:

This study piloted the use of a popular mobile mindfulness app (Calm) as a potential intervention to improve state depression, anxiety, stress, and sleep quality in undergraduate students attending a Canadian university, following the COVID-19 pandemic.

Methods:

Undergraduate students were randomly assigned to a control or treatment group and completed a series of three questionnaires to evaluate baseline psychosocial health (Depression Anxiety Stress Scale 42-item version, Perceived Stress Scale 10-item version, and Pittsburgh Sleep Quality Index). Treatment group participants were instructed to engage with the Calm app’s sleep section for 30 days: 20 minutes daily, five days a week, along with an additional 30 minutes of interaction with other app sections each week, resulting in a goal of 130 minutes per week. The control participants were instructed to continue with everyday life and refrain from the use of mindfulness-based apps for 30 days. Following the 30-day intervention period, all participants completed the set of three questionnaires again. The impact of the intervention on all outcomes was examined using linear mixed model analyses. Independent samples t-tests were used to determine if psychosocial health or sleep scores differed between baseline and follow-up and if differences in such scores were present between the groups.

Results:

A total of 80 students met the inclusion criteria and were randomly assigned to the control (N=40) or treatment (N=40) group. One control participant was lost to follow up and three treatment participants discontinued the intervention. Both control (N=39) and treatment (N=37) groups began with similar demographic, emotional state, and sleep characteristics. Treatment participants engaged with the Calm app’s sleep section for an average of 234 minutes per week; however, 54.1% met the minimum prescribed interaction time across all four weeks. Following the 30-day intervention, compared to the control group, the treatment group’s state anxiety (14 +/- 7.4 vs. 12 +/- 7.8, P=.002), state stress (20 +/- 8.8 vs. 15 +/- 8.5, P<.001 [DASS-42]; 22 +/- 5.9 vs. 19 +/- 5.9, P=.02 [PSS-10]), and sleep quality (7.7 +/- 2.7 vs. 6.4 +/- 3.5, P<.001) improved. Post-intervention, state stress and perceived stress severity was lower in the treatment vs. control group (P=.02 [DASS-42], P=.03 [PSS-10] respectively).

Conclusions:

These pilot findings indicate that a mindfulness app may be an effective tool for reducing state anxiety and stress, as well as enhancing sleep quality among undergraduate university students. A larger, randomized controlled trial should confirm these findings. Clinical Trial: Given that this study was a pilot investigation, the protocol was not registered within a clinical trials database.