Ritvo Paul, Ahmad Farah, El Morr Christo, Pirbaglou Meysam, Moineddin Rahim
School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada.
School of Health Policy and Management, York University, Toronto, ON, Canada.
JMIR Ment Health. 2021 Jan 11;8(1):e23491. doi: 10.2196/23491.
University students are experiencing higher levels of distress and mental health disorders than before. In addressing mental health needs, web-based interventions have shown increasing promise in overcoming geographic distances and high student-to-counselor ratios, leading to the potential for wider implementation. The Mindfulness Virtual Community (MVC) program, a web-based program, guided by mindfulness and cognitive behavioral therapy principles, is among efforts aimed at effectively and efficiently reducing symptoms of depression, anxiety, and perceived stress in students.
This study's aim was to evaluate the efficacy of an 8-week MVC program in reducing depression, anxiety, and perceived stress (primary outcomes), and improving mindfulness (secondary outcome) in undergraduate students at a large Canadian university. Guided by two prior randomized controlled trials (RCTs) that each demonstrated efficacy when conducted during regular university operations, this study coincided with a university-wide labor strike. Nonetheless, the students' response to an online mental health program on a disrupted campus can provide useful information for anticipating the impact of other disruptions, including those related to the COVID-19 pandemic as well as future disruptions.
In this parallel-arm RCT, 154 students were randomly allocated to an 8-week MVC intervention (n=76) or a wait-list control (WLC) condition (n=78). The MVC intervention included the following: (1) educational and mindfulness video modules, (2) anonymous peer-to-peer discussions, and (3) anonymous, group-based, professionally guided, 20-minute videoconferences. Study outcomes were evaluated at baseline and at 8-week follow-up using the following: Patient Health Questionnaire-9 (PHQ-9), the Beck Anxiety Inventory (BAI), the Perceived Stress Scale (PSS), and the Five Facets Mindfulness Questionnaire Short Form (FFMQ-SF). Generalized estimation equations with an AR (1) covariance structure were used to evaluate the impact of the intervention, with outcome evaluations performed on both an intention-to-treat (ITT) and per-protocol (PP) basis.
Participants (n=154) included 35 males and 117 females with a mean age of 23.1 years. There were no statistically significant differences at baseline between the MVC and WLC groups on demographics and psychological characteristics, indicating similar demographic and psychological characteristics across the two groups. Results under both ITT and PP approaches indicated that there were no statistically significant between-group differences in PHQ-9 (ITT: β=-0.44, P=.64; PP: β=-0.62, P=.053), BAI (ITT: β=-2.06, P=.31; PP: β=-2.32, P=.27), and FFMQ-SF (ITT: β=1.33, P=.43; PP: β=1.44, P=.41) compared to WLC. There was a significant difference for the PSS (ITT: β=-2.31, P=.03; PP: β=-2.38, P=.03).
During a university labor strike, the MVC program led to statistically significant reductions in PSS compared to the WLC group, but there were no other significant between-group differences. Comparisons with previous cycles of intervention testing, undertaken during nondisrupted university operations, when efficacy was demonstrated, are discussed.
ISRCTN Registry ISRCTN92827275; https://www.isrctn.com/ISRCTN92827275.
与以往相比，大学生正经历着更高水平的困扰和心理健康问题。在满足心理健康需求方面，基于网络的干预措施在克服地理距离和高学生与咨询师比例问题上显示出越来越大的前景，从而具有更广泛实施的潜力。正念虚拟社区（MVC）项目是一个基于网络的项目，以正念和认知行为疗法原则为指导，是旨在有效且高效减轻学生抑郁、焦虑和感知压力症状的众多努力之一。
本研究的目的是评估一个为期8周的MVC项目在减轻加拿大一所大型大学本科生的抑郁、焦虑和感知压力（主要结局）以及提高正念（次要结局）方面的疗效。在两项先前的随机对照试验（RCT）的指导下，这两项试验在正常大学运营期间均证明了疗效，本研究恰逢全校范围的罢工。尽管如此，学生们在校园混乱期间对在线心理健康项目的反应可为预测其他干扰的影响提供有用信息，包括与COVID-19大流行相关的干扰以及未来的干扰。
在这项平行组随机对照试验中，154名学生被随机分配到为期8周的MVC干预组（n = 76）或等待名单对照组（WLC）（n = 78）。MVC干预包括以下内容：（1）教育和正念视频模块，（2）匿名的 peer-to-peer 讨论，以及（3）匿名的、基于小组的、由专业人员指导的20分钟视频会议。使用以下工具在基线和8周随访时评估研究结局：患者健康问卷-9（PHQ-9）、贝克焦虑量表（BAI）、感知压力量表（PSS）和五因素正念问卷简表（FFMQ-SF）。采用具有AR（1）协方差结构的广义估计方程来评估干预的影响，并在意向性分析（ITT）和符合方案分析（PP）的基础上进行结局评估。
参与者（n = 154）包括35名男性和117名女性，平均年龄23.1岁。MVC组和WLC组在基线时的人口统计学和心理特征方面没有统计学上的显著差异，表明两组在人口统计学和心理特征方面相似。ITT和PP方法下的结果均表明，与WLC相比，PHQ-9（ITT：β = -0.44，P = 0.64；PP：β = -0.62，P = 0.053）、BAI（ITT：β = -2.06，P = 0.31；PP：β = -2.32，P = 0.27）和FFMQ-SF（ITT：β = 1.33，P = 0.43；PP：β = 1.44，P = 0.41）在组间没有统计学上的显著差异。PSS有显著差异（ITT：β = -2.31，P = 0.03；PP：β = -2.38，P = 0.03）。
在大学罢工期间，与WLC组相比，MVC项目导致PSS有统计学上的显著降低，但组间没有其他显著差异。讨论了与在正常大学运营期间进行的、证明了疗效的先前干预测试周期的比较。
ISRCTN注册库ISRCTN92827275；https://www.isrctn.com/ISRCTN92827275。
