Effectiveness of Mindfulness-Based Stress Reduction on Mental Health and Psychological Quality of Life among University Students: A GRADE-Assessed Systematic Review

Pan, Yuanqing; Li, Fusen; Liang, Haiqian; Shen, Xiping; Bing, Zhitong; Cheng, Liang; Dong, Yi

doi:https://doi.org/10.1155/2024/8872685

Evidence-Based Complementary and Alternative Medicine

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Abstract Introduction Methods Results Discussion Conflicts of Interest Acknowledgments References Copyright Related Articles

Review Article | Open Access

Volume 2024 | Article ID 8872685 | https://doi.org/10.1155/2024/8872685

Effectiveness of Mindfulness-Based Stress Reduction on Mental Health and Psychological Quality of Life among University Students: A GRADE-Assessed Systematic Review

Yuanqing Pan,¹Fusen Li,¹Haiqian Liang,²Xiping Shen,³Zhitong Bing,⁴Liang Cheng,⁵and Yi Dong⁶

Academic Editor: Tadaaki Satou

Received10 Mar 2023

Revised27 Dec 2023

Accepted03 Feb 2024

Published20 Feb 2024

Abstract

Background. Psychological distress is a progressive health problem that has been linked to decreased quality of life among university students. This meta-analysis reviews existing randomized controlled trials (RCTs) that have examined the effects of mindfulness-based stress reduction (MBSR) on the relief of psychosomatic stress-related outcomes and quality of life among university students. Methods. The PubMed, EMBASE, Web of Science, PsycINFO (formerly PsychLit), Ovid MEDLINE, ERIC, Scopus, Google Scholar, ProQuest, and Cochrane Library databases were searched in November 2023 to identify the RCTs for analysis. Data on pathology (anxiety, depression, and perceived stress), physical capacity (sleep quality and physical health), and well-being (mindfulness, self-kindness, social function, and subjective well-being) were analyzed. Results. Of the 276 articles retrieved, 29 met the inclusion criteria. Compared with control therapies, the pooled results suggested that MBSR had significant effects, reducing anxiety (SMD = −0.29; 95% CI: −0.49 to −0.09), depression (SMD = −0.32; 95% CI: −0.62 to −0.02), and perceived stress (SMD = −0.41; 95% CI: −0.60 to −0.29) and improving mindfulness (SMD = 0.34; 95% CI: 0.08 to 0.59), self-kindness (SMD = 0.57; 95% CI: 0.30 to 1.12), and physical health (SMD = −0.59; 95% CI: −1.14 to −0.04). No significant differences were observed in sleep quality (SMD = −0.20; 95% CI: −0.06 to 0.20), social function (SMD = −0.71; 95% CI: −2.40 to 0.97), or subjective well-being (SMD = 0.07; 95% CI: −0.18 to 0.32). The quality of the evidence regarding sleep quality and physical health outcomes was low. Conclusions. MBSR therapy appears to be potentially useful in relieving functional emotional disorders. However, additional evidence-based large-sample trials are required to definitively determine the forms of mindfulness-based therapy that may be effective in this context and ensure that the benefits obtained are ongoing. Future studies should investigate more personalized approaches involving interventions that are tailored to various barriers and students’ clinical characteristics. To optimize the effects of such interventions, they should be developed and evaluated using various designs such as the multiphase optimization strategy, which allows for the identification and tailoring of the most valuable intervention components.

1. Introduction

Mindfulness therapy is a standardized psychological intervention that aims to reduce stress, encourage mindful thinking habits, and allow recipients to manage difficult emotional processing. It focuses on the concentration of one’s attention in the moment, nonsubjective judgment, and openness to accepting personal experience and involves corresponding behavioral training, such as attention training, body scanning, and sitting meditation [1]. Previous research on psychological interventions has found that mindfulness therapy can help reduce stress among university students and affects their overall quality of life and the psychological functions to which they adapt [2].

The theoretical support and the understanding of the operating mode are reasonable but still have differences. Thus, the mental health benefits, potential effects, and limitations of mindfulness therapy for university students warrant further examination. Although education and social support can be effective in preventing and treating the underlying psychological problems among university students with poor mental health, such interventions do not always affect or improve psychological well-being [3, 4].

The most prevalent psychological symptoms among university students are anxiety, mental stress, and emotional distress, which can result in decreased functioning in the context of academic and interpersonal stress. Global mental health surveys conducted by the World Health Organization (WHO) indicate that mental disorders are highly prevalent among university students, with 12-month prevalence rates ranging from 20.3% to 45% of university students over the age of 18 [5–7]. The prevalence rates of insomnia, depressive symptoms, and anxiety symptoms were 37.80%, 48.20%, and 36.70%, respectively, among Chinese university students during the COVID-19 pandemic [8]. In a randomized controlled trial with 11,169 university students conducted by the WHO, students had increasing intentions to use mental health services: The results indicated lifetime use rates of 12.6% and 7.3% for psychotherapy and medication for emotional problems, respectively. Suicidal thoughts and behaviors and nonsuicidal self-injury within the preceding 12 months were also common, with 21.1% of students in the sample reporting suicidal ideation, 10.6% reporting suicide plans, 0.4% reporting suicide attempts, and 6.8% reporting nonsuicidal self-injury [5]. Furthermore, one previous study found that high-compliance mental health services had a significant effect on students’ intention to seek mental health services in the next semester [9–11].

Evidence indicates that mindfulness therapy can result in a significant reduction in burnout, distress, anxiety, depression, and stress and a significant improvement in life satisfaction, positive affect, gratitude, self-compassion, and mindfulness among university students [12, 13]. However, although some studies show that mindfulness-based stress reduction (MBSR) can help relieve psychological symptoms and improve quality of life among university students, there is no reliable evidence that this type of intervention can help prevent or treat psychological abnormalities and, thereby, improve university students’ subjective well-being. In addition, there are disparities between consensus-based conclusions regarding MBSR and clinical recommendations.

Some studies have used evidence-based medicine approaches to examine the effects of MBSR treatment on university students’ psychological conditions. A recent study revealed that an MBSR intervention group showed statistically significantly fewer symptoms of stress and distress and had higher mindfulness than the control group. Previous studies of MBSR have emphasized its potential benefits for university students, such as minimizing perceived stress, preserving emotional stability, enhancing social functioning, and increasing the self-attractiveness of the group [14–17]. This study adopted the Cochrane systematic review method to assess the effect of psychological interventions and the overall impact of MBSR treatment on the psychological condition of university students, aiming to provide a scientific basis for the clinical practice of MBSR treatment. Our systematic review aimed to assess and renovate the available objective evidence on the effectiveness of MBSR in improving anxiety, depression, perceived stress, sleep quality, mindfulness, self-kindness, social function, subjective well-being, and physical health among university students. The research was not registered in the International Prospective Registry of Systematic Reviews (PROSPERO).

2. Methods

2.1. Eligibility Criteria

Randomized controlled trials (RCTs) relating to mindfulness and stress reduction were included in this study. The included RCTs were limited to those published in English and that met the following criteria: (1) Participants were aged 18 years or older and (2) participants were university students who were enrolled in higher education institutions at the time of the trial. In the included studies, participants took part in the experiments voluntarily and met the criteria for either an MBSR intervention group or a control group (wait-list, no treatment, health education, and relaxation, etc.). The primary outcome index in the included RCTs included mental health problems and related outcomes that are common among university students (perceived stress, negative emotion, mindfulness, self-kindness, social function, subjective well-being, sleep problems, etc.). The secondary outcome index was physical well-being.

The exclusion criteria were as follows: (1) Participants were not registered university students; (2) their bodily functions could not handle MBSR therapy; (3) participants were diagnosed with mental disorders according to the classification of mental disorders, such as schizophrenia, major depression, panic disorders, or personality disorder; (4) participants were currently using psychoactive medication; (5) participants were currently undergoing individual psychotherapy or group intervention programs; and (6) participants suffered from cardiovascular diseases such as hypertension or arrhythmia. Participants were also excluded if they underwent any type of therapy or coaching during the study period.

2.2. Data Sources and Searches

Studies were identified by searching databases, scanning reference lists, and consulting with MBSR experts. The searched databases included PubMed (1966 to November 2023), EMBASE (1974 to November 2023), the Cochrane Library (issue 4 through 2023), ERIC (1907 to November 2023), the Web of Science (1974 to November 2023), Scopus, Google Scholar, and ProQuest. We used the following search terms: (“university students” [MeSH terms] OR “college students” [MeSH terms] OR “undergraduate” [MeSH terms] OR “academician” [MeSH terms] OR “graduate student” [MeSH terms] AND (“mindfulness-based stress reduction” [MeSH terms] OR “mindfulness-based stress reduction” [title/abstract] OR “mindfulness-meditation” [MeSH terms] OR “mindfulness-meditation” [title/abstract] OR “mind body therapies” [MeSH terms] OR “mind body therapies” [title/abstract] OR “mindfulness-based cognitive therapy” [MeSH Terms] OR “mindfulness-based cognitive therapy” [title/abstract] OR (“MBCT” [MeSH terms] OR “MBCT” [title/abstract]) OR (“mindfulness-based stress reduction” [MeSH Terms] OR “mindfulness-based stress reduction” [title/abstract]) AND (random OR “clinical trials as topic” [Mesh] OR “clinical trial” [publication type]) (see Table 1 at the end of this manuscript for details).

2.3. Study Selection

Duplicate results were removed, and abstracts were screened using NoteExpress (v. 3.9). Two reviewers independently selected and agreed upon the abstracts to be excluded. Two of the authors reviewed the full texts of the included abstracts and discussed and agreed upon their eligibility decisions. Eligible studies addressed the beneficial stress relief and mental health outcomes of MBSR interventions among university students. Following this procedure, the selection process was conducted independently by two other authors, and any disagreements were discussed with a third reviewer if necessary. The data were extracted from the included studies, following the PRISMA checklist. These data mainly comprised the basic characteristics of the studies, characteristics of the study populations (sample size, age, and type of university student), intervention measures (type and specific protocol of the MBSR intervention, duration, and frequency), control measures, and outcome indicators. When the outcome indicators were described by the median and interquartile interval, they were converted to means and standard deviations as per the quantile estimation method.

2.4. Data Abstraction and Assessment of the Risk of Bias

A systematic review was performed following the Cochrane Handbook version 5.2.0 [18]. Three reviewers independently extracted the following information regarding each RCT: author name, publication time, mean age of participants, sample size, basic treatment regimen, control group settings, and outcome measures. The quality of the included studies was evaluated using the risk bias assessment tool provided by the Cochrane Collaboration [19]. Three reviewers independently assessed the methodological quality of the included studies. Two investigators then cross-checked the information, and any disagreements were resolved with a third party. The risk of publication bias across the included studies was examined using a funnel plot [20]. The systematic review and meta-analysis reporting were carried out in accordance with the PRISMA guidelines [21].

2.5. Data Analysis

Data were recorded using Excel 2010, and Stata software (version 10.0) was used for data processing. Statistical analysis was performed on the extracted data using standardized mean differences (SMDs). The effect sizes were expressed as 95% confidence intervals, and the test level wasα = 0.05. Meta-analysis statistical models were weighted according to the combined effect size. A chi-square test was conducted to analyze heterogeneity, and was used to evaluate the magnitude of heterogeneity. When < 50%, a fixed-effects model was used to estimate the combined effect size. If > 50%, the possible sources of heterogeneity were analyzed, and if the source of heterogeneity remained unidentified and unaddressed, a random-effects model was used to estimate the combined effect size.

The outcome indicators of the included studies were combined for effect size analysis, 95% confidence intervals of the overall parameters were employed for estimation, and the U test hypothesis was used. indicated that the difference in the combined effect size of the included studies was statistically significant. The meta-analysis forest plot was performed using Stata (version 10.0, Stata Corp., College Station, TX, USA) [22] and Review Manager (RevMan, version 5.3) [19].

2.6. Grading of the Evidence

The international Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool (GRADEpro GDT software, McMaster University, Canada, 2015) [23] was employed to assess the quality of evidence for the outcome indicators in the included studies. According to this tool, four factors can reduce the quality of the evidence presented: study limitations, inconsistent findings, indirect findings, and imprecise findings. The quality of the evidence presented in all the RCTs included in the present study was evaluated as moderate or high.

3. Results

3.1. Description of Studies

A total of 276 studies items were initially obtained through the database search. Using NoteExpress, 193 deduplicated studies were obtained, and the remaining 220 items were obtained. After reviewing their titles and abstracts, 135 studies that were of incompatible research types were excluded. A total of 13 articles were further excluded after reading the full text, and the remaining 29 studies [24–53] were retained for data extraction. The baselines of the trials were comparable. The literature search process and results are shown in Figure 1.

3.2. Study Characteristics

Sixteen of the RCTs were conducted in the United States [25–27, 29–33, 36, 37, 40, 43, 47, 48, 53], Canada [28], and Europe [26, 35, 38, 42, 44, 46, 51, 52]. One was conducted in South Korea [41], and three were conducted in China [33, 49, 50]. The participants’ ages ranged from 18 to 30 years.

The inclusion criteria for 24 studies were references to previously published literature or online mindfulness programs [24–27, 30, 32–37, 39–44, 46–48, 50, 51, 53]. One was from the British Association of Mindfulness-Based Approaches 2020 [28], and the rest were from the standard Kabat-Zinn MBSR program [31, 38, 45, 49].

The intensities of the MBSR protocols of the RCTs varied, ranging from twice weekly for 20 min to 1.5 hours each. Treatment durations ranged from 2 to 10 weeks. MBSR prescriptions differed depending on session timeline, content, and frequency. Indications of MBSR mainly focused on mood regulation and an increase in participants’ levels of satisfaction with their quality of life, self-acceptance, social function, subjective well-being, physical health, and sleep quality (Tables 2 and 3).

3.3. Methodological Quality of the Included Studies

Of the 29 RCTs included, none fulfilled all the methodological criteria. Various forms of randomization procedures were adopted in the studies. In 22 of the included RCTs, blocks were concealed and sequences were stored in sealed, opaque, numbered envelopes, or another concealed allocation protocol was used [25–35, 37, 41, 42, 44–53]. Five studies reported the blinding of the research assistant and the participants [28, 33, 34, 37, 53], fourteen reported the blinding of the participants [26, 27, 39, 41, 42, 44–48, 50–52], two reported the blinding of the participants and the therapists [25, 39], and one reported the blinding of the investigators, statistician, and participants and/or the university students [30] (Figure 2 and Table 3).

3.4. Outcome Analysis

Compared with control therapies, the pooled results suggested that MBSR showed significant effects in reducing anxiety (SMD = −0.29; 95% CI: −0.49 to −0.09), depression (SMD = −0.32; 95% CI: −0.62 to −0.02), and perceived stress (SMD = −0.41; 95% CI: −0.60 to −0.29) and improving mindfulness (SMD = 0.34; 95% CI: 0.08 to 0.59), self-kindness (SMD = 0.57; 95% CI: 0.30 to 1.12), and physical health (SMD = −0.59; 95% CI: −1.14 to −0.04). No significant differences were observed in sleep quality (SMD = −0.20; 95% CI: −0.06 to 0.20), social function (SMD = −0.71; 95% CI: −2.40 to 0.97), or subjective well-being (SMD = 0.07; 95% CI: −0.18 to 0.32). No adverse reactions were reported in any of the randomized controlled trials (Figure 3 and Table 4).

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Figure 3

A forest plot of the effects of the group mindfulness-based stress reduction therapies on treatment-related side effects. The width of the horizontal lines represents the 95% confidence intervals (CIs) of the individual studies, and the squares represent the proportional weight of each study. The diamonds represent the pooled odds ratio and 95% CI. (a) Anxious, (b) depression, (c) perceived stress, (d) sleep quality, (e) mindfulness, (f) self-kindness, (g) social function, (h) subjective well-being, and (i) physical health.

Heterogeneity was present in the comparison of studies on anxiety ( = 72.4%), depression ( = 86%), perceived stress ( = 70.7%), sleep quality ( = 63.4%), mindfulness ( = 80.5%), self-kindness ( = 93.2%), social function ( = 98.1%), subjective well-being ( = 78.5%), and physical health ( = 86%). A meta-regression revealed that the effects of age, inclusion criteria, indications, and duration did not explain this heterogeneity. The meta-regression results showed that the effect of the duration of the MBSR therapy on anxiety (), perceived stress (), and subjective well-being () and the effect of the type of control group on depression () partly explained the heterogeneity. Age, recruitment, MBSR duration, control group, and the regional differences of participants were not the sources of heterogeneity for the effects on sleep quality, mindfulness, self-kindness, social function, and physical health (all ) (Table 5).

Further subgroup analyses were conducted to examine the effect of different control groups (no treatment, health education, and social support) on depression. Subgroup analyses were also conducted to examine the effect of MBSR duration (less than 2 weeks, 4–6 weeks, and over 8 weeks) on anxiety, perceived stress, and subjective well-being (Figure 4).

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The subgroup analysis showed that different control groups had different effects on the outcome indicators of depression. The intervention effect of the blank control group was the most pronounced (SMD = −0.69; 95% CI: −1.43 to 0.04). The subgroup analysis also demonstrated that MBSR programs of 2–4 weeks or more than 6–8 weeks improved the outcome indicators of anxiety (SMD = −0.29; 95% CI: −0.49 to 0.09), stress perception (SMD = −0.41; 95% CI: −0.60 to −0.22), and subjective well-being (SMD = 0.29; 95% CI: 0.10 to 0.48) (Figure 4). Egger’s test showed that there was no indication of publication bias for any of the outcomes (Figure 5).

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3.5. GRADE Assessment

The quality of the evidence presented in the reviewed studies was assessed with the GRADEpro GDT software tool. Table 3 shows a summary of the overall assessment of the quality of evidence regarding the effect of MBSR on the outcome control measures. The quality classification for the evidence for each variable was as follows: anxiety: moderate; depression: moderate; perceived stress: moderate; sleep quality: moderate; mindfulness: moderate; self-kindness: moderate; social function: moderate; subjective well-being: moderate; and physical health: moderate. The evidence for sleep quality and physical health was downgraded for indirectness (Table 6).

4. Discussion

Mindfulness decompression interventions are considered one of the most popular forms of psychological intervention [54]. Well-designed related studies on the efficacy of mindfulness for mental disorders have been conducted since Dr. Jon Kabat-Zinn founded mindfulness decompression therapy in 1982 [55]. Mindfulness decompression therapy continues to be gradually recognized in an increasing number of professional fields [56, 57]. In this type of therapy, participants are guided to reflect on their personality and mental tendencies and release internal conflicts and stressors. Participants also explore the potential of self-orientation in order to achieve meditation and intellectual flow, stabilize and adjust their emotions, reduce or eliminate negative feelings, and achieve a mild healing effect through physical and mental balance [58].

Existing research generally recognizes that mindfulness decompression psychological interventions can promote communication, enhance individual self-esteem, relieve emotions, and improve behavior. However, it is difficult to quantify the effect of such interventions; thus, this represents an important direction for researchers in related fields as they continue to expand the evidence base supporting mindfulness decompression interventions [59, 60].

Our meta-analysis showed that there was heterogeneity between groups in relation to the effects of the duration of MBSR therapy on anxiety, depression, perceived stress, and subjective well-being. In our meta-analysis and systematic review, the subgroup analysis demonstrated that timed MBSR therapy intervention protocols had clear benefits for anxiety, depression, and perceived stress. The subgroup analysis also revealed a linear relationship between the duration of the intervention and antinegative emotions and improved self-positive acceptance concepts, suggesting that relatively short interventions (e.g., two weeks) had a potential impact on the management of negative emotions and buffered stress. As long as the psychological intervention of mindfulness therapy was prescribed, the intervention of the study participants was effective. Due to its design, the current study could not determine the results of subsequent long-term follow-up.

The subgroup analysis of depression control groups showed that the degree of remission of depressive symptoms in the no-treatment control group was significantly lower than that in the support and health education control groups. In the subgroup analyses of the effects of interventions on anxiety, perceived stress, and mindfulness, different intervention durations showed a mild improvement effect. MBSR attaches importance to an individual’s physical condition, flexibility, and perception of physical and mental activities and attaches more importance to the adjustment and adaptation of their overall function. These factors reflect the difficulty and complexity of MBSR research, while also presenting opportunities and challenges for the integration of general practice via the existing MBSR research methodology.

The subgroup analysis also revealed that the effects of MBSR interventions on depression outcome indicators were sensitive to the type of control group. As the MBSR intervention had a minimal impact on students in the control groups, it may be that the type of control group affected the initial positive findings.

The evaluation of the effect size of the control groups in the RCTs included in this review highlighted that when there was an imbalance in the baseline of control participants, the statistical data may be unstable, masked, or magnified. Each MBSR RCT adopted a different study design and implemented control groups differently. For some variables, the choice of the control group had far more influence than the MBSR protocol on the research outcomes: This deficiency was partly due to the design of the control groups.

The meta-regression showed that there was heterogeneity between the length of the MBSR intervention and the control group, and the subgroup analysis showed that whether the effect of MBSR was pronounced or not was closely related to the duration of MBSR and the control groups. Practice heterogeneity and methodological heterogeneity are the main sources of heterogeneity in meta-analyses. Consequently, appropriate interpretation and analysis methods must be adopted to ensure the reliability of meta-analysis results.

The prevalence of physical function and sleep problems among university students is relatively high, and sleep problems tend to last for years after the end of treatment [61, 62]. University students’ psychological and social adaptation difficulties may reflect the negative consequences of poor physical health and sleep quality. Previous studies have revealed that more than half (52.7%) of university students sleep 6 to 8 hours per night, 37% sleep less than 6 hours, and 40% go to sleep after 2 am [63–65]. Our meta-analysis observed no significant difference in improvement in sleep disorders following MBSR interventions. The included studies evaluated sleep quality after intervention and at 4–12 weeks postintervention. In the studies on sleep quality in our meta-analysis, the average follow-up time was 6.67 weeks, which was likely not long enough. Future RCTs examining the effects of MBSR intervention on sleep quality and physical health should standardize follow-up times and aim to establish the content validity of the domains of sleep quality and physical health that are assessed.

Our meta-analysis suggests that mindfulness decompression psychological intervention is conducive to the psychological and behavioral health of university students. The positive results of this type of intervention are manifested in the release of negative emotions, such as anxiety, depression, and perceived stress. MBSR interventions also show a positive effect on the establishment of self-confidence among university students. The blinding of participants, personnel, and outcome assessors was performed in most studies in our meta-analysis and systematic evaluation. However, defects in these studies’ research methods limit the interpretation of the effectiveness of these findings. The sample sizes of the eligible studies were small, and their methods of estimating these sample sizes were unclear. Globally, there is an overall lack of high-quality random comparison studies of MBSR interventions involving university students.

Not all the included studies adopted the standard design of mindfulness decompression psychological intervention programs. They also did not all describe (1) whether the implementer had received professional mindfulness decompression psychological intervention training; (2) the professional knowledge of the mindfulness decompression psychological intervention practitioners; or (3) the frequency, intensity, content, or duration of the mindfulness decompression psychological intervention. Furthermore, the settings of the control groups and the heterogeneity of the basic physical and sociological characteristics of the university student participants affect the reliability of the conclusions drawn in these studies. Such inconsistencies and imprecision were major reasons for downgrading the accuracy and quality of the evidence recommending the use of MBSR therapy in research involving university students. They also show underlying insignificant psychological efficacy.

There were further serious concerns related to four GRADE domains (risk of bias, inconsistency, indirectness, and imprecision) across the three studies that measured MBSR. As such, the certainty of the evidence that MBSR promotes well-being through improved sleep quality was very low. We identified 29 studies that employed a range of mindfulness meditation methods, of which all but nine were published within the past decade. Nevertheless, there were relative consistency concerns related to two or more GRADE domains (risk of bias, inconsistency, and indirectness or imprecision) across the studies, implying a moderate certainty in the evidence that MBSR reduces psychological distress and promotes well-being among university students.

In addition, the results indicate that it is important that the mental health gains generated by mindfulness stress reduction practices among college students are sustained over time. After some time, students may become more aware of the improvements in their well-being and mental health owing to MBSR interventions—they will feel better about themselves and realize that improvements in their physical health, stress levels, and well-being were gained through meditation training. Thus, though the effects of MBSR training can be validated immediately after an intervention, they may not yet be consolidated to the point that recipients consciously recognize all of these effects. The effects of meditation practice are gentle, accumulate slowly, and become more pronounced over time as students practice what they have learned. Furthermore, among university students, medical students tend to better perceive the benefits of training when exposed to stressful situations. When the knowledge learned in training can be put into practice in challenging specific situations, students can evaluate the effectiveness of meditation practices as a stress management tool; however, a nonmedical intervention group of students is likely to be unaffected by these infrequent events.

It should also be noted that despite the widespread adoption of the blind method, assessing perceived improvement in students’ psychological distress and well-being is a complex issue because the assessments were conducted by students themselves. As such, they are subjective, even when considering the heterogeneity of the questionnaire tools used to validate such assessments. It should also be considered that in the psychological context, no measure can fully define the complexity of behavior in the real world, and measures of abstract mental constructions can only provide an indirect assessment. The psychological questionnaire instruments in the included studies involved self-reporting by students; therefore, the potential bias caused by self-reporting, for example, social desirability bias, could not be controlled for. However, given that the instruments used to measure quality of life in the analyzed studies were all psychometrically sound, this limitation is unlikely to be serious. Egger’s test funnel plot ruled out the probability of publication bias.

This meta-analysis has some limitations. Owing to our research design, we only included RCTs that were published in English; therefore, there is a possibility that some important, high-quality findings that were not published in English may not have been included. Moreover, the quality of the included RCTs was generally adequate; however, though there was no indication of publication bias, the low number of studies decreases the reliability of this result. Given the small sample size of the included RCTs, high-quality, large-scale clinical studies are needed to provide further evidence in the future. Multicenter studies with large samples are required to explore standardized intervention protocols, MBSR practitioners’ professional knowledge, the inconsistent design of MBSR protocols (frequency, intensity, content, and duration), the heterogeneity of control groups, and university students’ physical and sociological characteristics. These factors may greatly affect the clinical significance of MBSR in terms of the average effect of the intervention on university students’ overall quality of life. These clinical and methodological factors may, consequently, have affected the reliability of the conclusions drawn in extant research.

The effects and influences of mindfulness decompression psychological interventions on psychological outcomes, quality of life, emotional habits, and behavioral disorder symptoms among university students remain unclear. Intervention elements, such as the environment of mindfulness decompression psychological intervention in colleges and universities, university students’ mindfulness communication and expression abilities, the level of language communication, and the standardized implementation guidelines for different intervention subtypes require further research. Future studies should aim to use larger samples, different forms of mindfulness, and long-term follow-up. They should also aim to obtain detailed information on sociodemographic variables and the intermediary and regulatory variables of mindfulness decompression psychological interventions. All these factors need to be explored further.

Conflicts of Interest

All the authors declare that they have no conflicts of interest.

Acknowledgments

This work was supported by the Planning Fund of Humanities and Social Sciences Project of the Ministry of Education of China: Construction and Empirical Research of Evidence-Based Systems of Mental Health in University View (Grant No: 21YJAZH063) and the 2021 Key Research Topic of Education work of Tianjin Education Commission, China: Research of utilization of evidence-based psychological intervention guidelines for university students in China based on database resources (JYDY-20211029).

References

W. E. B. Sipe and S. J. Eisendrath, “Mindfulness-based cognitive therapy: theory and practice,” Canadian Journal of Psychiatry, vol. 57, no. 2, pp. 63–69, 2012.
View at: Publisher Site | Google Scholar
J. Wielgosz, S. B. Goldberg, T. R. A. Kral, J. D. Dunne, and R. J. Davidson, “Mindfulness meditation and psychopathology,” Annual Review of Clinical Psychology, vol. 15, no. 1, pp. 285–316, 2019.
View at: Publisher Site | Google Scholar
K. Tsaras, I. V. Papathanasiou, D. Mitsi et al., “Assessment of depression and anxiety in breast cancer patients: prevalence and associated factors,” Asian Pacific Journal of Cancer Prevention, vol. 19, no. 6, pp. 1661–1669, 2018.
View at: Publisher Site | Google Scholar
T. Ishii, H. Tachikawa, Y. Shiratori et al., “What kinds of factors affect the academic outcomes of university students with mental disorders? A retrospective study based on medical records,” Asian Journal of Psychiatry, vol. 32, pp. 67–72, 2018.
View at: Publisher Site | Google Scholar
D. D. Ebert, M. Franke, F. Kählke et al., “Increasing intentions to use mental health services among university students. Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student Initiative,” International Journal of Methods in Psychiatric Research, vol. 28, no. 2, 2019.
View at: Publisher Site | Google Scholar
R. P. Auerbach, J. Alonso, W. G. Axinn et al., “Mental disorders among college students in the world health organization world mental health surveys,” Psychologie Medicale, vol. 46, no. 14, pp. 2955–2970, 2016.
View at: Publisher Site | Google Scholar
R. P. Auerbach, P. Mortier, R. Bruffaerts et al., “WHO world mental health surveys international college student Project: prevalence and distribution of mental disorders,” Journal of Abnormal Psychology, vol. 127, no. 7, pp. 623–638, 2018.
View at: Publisher Site | Google Scholar
X. Chi, K. Liang, S.-T. Chen et al., “Mental health problems among Chinese adolescents during the COVID-19: the importance of nutrition and physical activity,” International Journal of Clinical and Health Psychology, vol. 21, no. 3, 2021.
View at: Publisher Site | Google Scholar
S. K. Lipson, E. G. Lattie, and D. Eisenberg, “Increased rates of mental health service utilization by U.S. College students: 10-year population-level trends (2007-2017),” Psychiatric Services, vol. 70, no. 1, pp. 60–63, 2019.
View at: Publisher Site | Google Scholar
D. D. Ebert, P. Mortier, F. Kaehlke et al., “Barriers of mental health treatment utilization among first-year college students: first cross-national results from the WHO World Mental Health International College Student Initiative,” International Journal of Methods in Psychiatric Research, vol. 28, no. 2, 2019.
View at: Publisher Site | Google Scholar
D. D. Ebert, M. Franke, F. Kählke et al., “Increasing intentions to use mental health services among university students. Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student Initiative,” International Journal of Methods in Psychiatric Research, vol. 28, no. 2, 2019.
View at: Publisher Site | Google Scholar
G. González-Valero, F. Zurita-Ortega, J. L. Ubago-Jiménez, and P. Puertas-Molero, “Use of meditation and cognitive behavioral therapies for the treatment of stress, depression and anxiety in students. A systematic review and meta-analysis,” International Journal of Environmental Research and Public Health, vol. 16, no. 22, p. 4394, 2019.
View at: Publisher Site | Google Scholar
A. F. Dawson, W. W. Brown, J. Anderson et al., “Mindfulness-based interventions for university students: a systematic review and meta-analysis of randomised controlled trials,” Applied Psychology: Health and Well-Being, vol. 12, no. 2, pp. 384–410, 2020.
View at: Publisher Site | Google Scholar
C. C. G. da Silva, C. V. Bolognani, F. F. Amorim, and A. M. Imoto, “Effectiveness of training programs based on mindfulness in reducing psychological distress and promoting well-being in medical students: a systematic review and meta-analysis,” Systematic Reviews, vol. 12, no. 1, p. 79, 2023.
View at: Publisher Site | Google Scholar
A. M. González-Martín, A. Aibar-Almazán, Y. Rivas-Campo, and Y. Castellote-Caballero, “Mindfulness to improve the mental health of university students. A systematic review and meta-analysis,” Frontiers in Public Health, vol. 11, 2023.
View at: Publisher Site | Google Scholar
V. Yogeswaran and C. El Morr, “Effectiveness of online mindfulness interventions on medical students' mental health: a systematic review,” BMC Public Health, vol. 21, no. 1, p. 2293, 2021.
View at: Publisher Site | Google Scholar
T. Ostermann, M. Pawelkiwitz, and H. Cramer, “The influence of mindfulness-based interventions on the academic performance of students measured by their GPA. A systematic review and meta-analysis,” Frontiers in Behavioral Neuroscience, vol. 16, 2022.
View at: Publisher Site | Google Scholar
J. P. T. Higgins and S. Green, “Cochrane Handbook for systematic reviews of interventions version 5.1.0,” 2020, https://handbook-5-1.cochrane.org/.
View at: Google Scholar
T. Cochrane, “Cochrane RevMan,” 2020, https://training.cochrane.org/online-learning/core-software-cochrane-reviews/revman.
View at: Google Scholar
H. Rothstein, A. Sutton, and M. Borenstein, Publication Bias in Meta-Analysis: Prevention, Assessment and Adjustments, John Wiley and Sons, England, UK, 2006.
D. Moher, A. Liberati, J. Tetzlaff, and D. G. Altman, “Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement,” International Journal of Surgery, vol. 8, no. 5, pp. 336–341, 2010.
View at: Publisher Site | Google Scholar
Stata Corp, “Stata (version 10.0) [Computer program],” 2008, http://www.sassy-software.com.
View at: Google Scholar
G. Guyatt, A. D. Oxman, E. A. Akl et al., “GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables,” Journal of Clinical Epidemiology, vol. 64, no. 4, pp. 383–394, 2011.
View at: Publisher Site | Google Scholar
S. Bai, S. Elavsky, M. Kishida, K. Dvořáková, and M. T. Greenberg, “Effects of mindfulness training on daily stress response in college students: ecological momentary assessment of a randomized controlled trial,” Mindfulness (N Y), vol. 11, no. 6, pp. 1433–1445, 2020.
View at: Publisher Site | Google Scholar
J. N. Baumgartner and T. R. Schneider, “A randomized controlled trial of mindfulness-based stress reduction on academic resilience and performance in college students,” Journal of American College Health, vol. 71, no. 6, pp. 1916–1925, 2023.
View at: Publisher Site | Google Scholar
E. M. Seppälä, C. Bradley, J. Moeller, L. Harouni, D. Nandamudi, and M. A. Brackett, “Promoting mental health and psychological thriving in university students: a randomized controlled trial of three well-being,” Interventionsront Psychiatry, vol. 15, no. 11, p. 590, 2020.
View at: Publisher Site | Google Scholar
J. Huberty, J. Green, C. Glissmann, L. Larkey, M. Puzia, and C. Lee, “Efficacy of the mindfulness meditation mobile app calm to reduce stress among college students: randomized controlled trial,” JMIR Mhealth Uhealth, vol. 7, no. 6, 2019.
View at: Publisher Site | Google Scholar
P. Ritvo, F. Ahmad, C. El Morr, M. Pirbaglou, and R. Moineddin, “A mindfulness-based intervention for student depression, anxiety, and stress: randomized controlled trial,” JMIR Ment Health, vol. 8, no. 1, p. e23491, 2021.
View at: Publisher Site | Google Scholar
O. Simonsson, O. Bazin, S. D. Fisher, and S. B. Goldberg, “Effects of an eight-week, online mindfulness program on anxiety and depression in university students during COVID-19: a randomized controlled trial,” Psychiatry Research, vol. 305, 2021.
View at: Publisher Site | Google Scholar
S. B. Danitz and S. M. Orsillo, “The mindful way through the semester: an investigation of the effectiveness of an acceptance-based behavioral therapy program on psychological wellness in first-year students,” Behavior Modification, vol. 38, no. 4, pp. 549–566, 2014.
View at: Publisher Site | Google Scholar
J. M. Greeson, M. K. Juberg, M. Maytan, K. James, and H. Rogers, “A randomized controlled trial of Koru: a mindfulness program for college students and other emerging adults,” Journal of American College Health, vol. 62, no. 4, pp. 222–233, 2014.
View at: Publisher Site | Google Scholar
J. Galante, G. Dufour, M. Vainre et al., “A mindfulness-based intervention to increase resilience to stress in university students (the Mindful Student Study): a pragmatic randomised controlled trial,” The Lancet Public Health, vol. 3, no. 2, pp. e72–e81, 2018.
View at: Publisher Site | Google Scholar
K. Cavanagh, C. Strauss, F. Cicconi, N. Griffiths, A. Wyper, and F. Jones, “A randomised controlled trial of a brief online mindfulness-based intervention,” Behaviour Research and Therapy, vol. 51, no. 9, pp. 573–578, 2013.
View at: Publisher Site | Google Scholar
Y. Chen, X. Yang, L. Wang, and X. Zhang, “A randomized controlled trial of the effects of brief mindfulness meditation on anxiety symptoms and systolic blood pressure in Chinese nursing students,” Nurse Education Today, vol. 33, no. 10, pp. 1166–1172, 2013.
View at: Publisher Site | Google Scholar
D. Martínez-Rubio, J. Navarrete, and J. Montero-Marin, “Feasibility, effectiveness, and mechanisms of a brief mindfulness- and compassion-based program to reduce stress in university students: a pilot randomized controlled trial,” International Journal of Environmental Research and Public Health, vol. 19, no. 1, p. 154, 2021.
View at: Publisher Site | Google Scholar
L. C. Delgado, P. Guerra, P. Perakakis, M. N. Vera, G. Reyes del Paso, and J. Vila, “Treating chronic worry: psychological and physiological effects of a training programme based on mindfulness,” Behaviour Research and Therapy, vol. 48, no. 9, pp. 873–882, 2010.
View at: Publisher Site | Google Scholar
K. Dvořáková, M. Kishida, J. Li et al., “Promoting healthy transition to college through mindfulness training with first-year college students: pilot randomized controlled trial,” Journal of American College Health, vol. 65, no. 4, pp. 259–267, 2017.
View at: Publisher Site | Google Scholar
M. Vibe, S. Ida, R. Tyssen et al., “Mindfulness training for stress management: a randomised controlled study of medical and psychology students,” BMC Medical Education, vol. 13, no. 13.
View at: Publisher Site | Google Scholar
Y. Gu, G. Xu, and Y. Zhu, “A randomized controlled trial of mindfulness-based cognitive therapy for college students with ADHD,” Journal of Attention Disorders, vol. 22, no. 4, pp. 388–399, 2018.
View at: Publisher Site | Google Scholar
H. Hazlett-Stevens and Y. Oren, “Effectiveness of mindfulness-based stress reduction bibliotherapy: a preliminary randomized controlled trial,” Journal of Clinical Psychology, vol. 73, no. 6, pp. 626–637, 2016.
View at: Publisher Site | Google Scholar
Y. S. Kang, S. Y. Choi, and E. Ryu, “The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea,” Nurse Education Today, vol. 29, no. 5, pp. 538–543, 2009.
View at: Publisher Site | Google Scholar
P. Kvillemo, Y. Brandberg, and R. Bränström, “Feasibility and outcomes of an internet-based mindfulness training program: a pilot randomized controlled trial,” JMIR Ment Health, vol. 3, no. 3, p. e33, 2016.
View at: Publisher Site | Google Scholar
C. A. Luethcke, L. McDaniel, and C. B. Becker, “A comparison of mindfulness, nonjudgmental, and cognitive dissonance-based approaches to mirror exposure,” Body Image, vol. 8, no. 3, pp. 251–258, 2011.
View at: Publisher Site | Google Scholar
B. Lever Taylor, C. Strauss, K. Cavanagh, and F. Jones, “The effectiveness of self-help mindfulness-based cognitive therapy in a student sample: a randomised controlled trial,” Behaviour Research and Therapy, vol. 63, pp. 63–69, 2014.
View at: Publisher Site | Google Scholar
M. Erogul, G. Singer, T. McIntyre, and D. G. Stefanov, “Abridged mindfulness intervention to support wellness in first-year medical students,” Teaching and Learning in Medicine, vol. 26, no. 4, pp. 350–356, 2014.
View at: Publisher Site | Google Scholar
R. E. Recabarren, C. Gaillard, M. Guillod, and C. Martin-Soelch, “Short-term effects of a multidimensional stress prevention program on quality of life, well-being and psychological resources. A randomized controlled trial,” Frontiers in Psychiatry, vol. 10, no. 10, p. 88, 2019.
View at: Publisher Site | Google Scholar
S. Sun, D. Lin, S. Goldberg et al., “A mindfulness-based mobile health (mHealth) intervention among psychologically distressed university students in quarantine during the COVID-19 pandemic: a randomized controlled trial,” Journal of Counseling Psychology, vol. 69, no. 2, pp. 157–171, 2022.
View at: Publisher Site | Google Scholar
Y. Song and R. Lindquist, “Effects of mindfulness-based stress reduction on depression, anxiety, stress and mindfulness in Korean nursing students,” Nurse Education Today, vol. 35, no. 1, pp. 86–90, 2015.
View at: Publisher Site | Google Scholar
Y. Gu, G. Xu, and Y. Zhu, “A randomized controlled trial of mindfulness-based cognitive therapy for college students with ADHD,” Journal of Attention Disorders, vol. 22, no. 4, pp. 388–399, 2018.
View at: Publisher Site | Google Scholar
C. K. Phang, F. Mukhtar, N. Ibrahim, S. L. Keng, and S. Mohd Sidik, “Effects of a brief mindfulness-based intervention program for stress management among medical students: the Mindful-Gym randomized controlled study,” Advances in Health Sciences Education, vol. 20, no. 5, pp. 1115–1134, 2015.
View at: Publisher Site | Google Scholar
I. van Dijk, P. L. B. J. Lucassen, R. P. Akkermans, B. G. M. van Engelen, C. van Weel, and A. E. M. Speckens, “Effects of mindfulness-based stress reduction on the mental health of clinical clerkship students: a cluster-randomized controlled trial,” Academic Medicine, vol. 92, no. 7, pp. 1012–1021, 2017.
View at: Publisher Site | Google Scholar
E. Warnecke, S. Quinn, K. Ogden, N. Towle, and M. R. Nelson, “A randomised controlled trial of the effects of mindfulness practice on medical student stress levels: effects of mindfulness practice on student stress levels,” Medical Education, vol. 45, no. 4, pp. 381–388, 2011.
View at: Publisher Site | Google Scholar
E. Yang, E. Schamber, R. M. L. Meyer, and J. I. Gold, “Happier healers: randomized controlled trial of mobile mindfulness for stress management,” Journal of Alternative and Complementary Medicine, vol. 24, no. 5, pp. 505–513, 2018.
View at: Publisher Site | Google Scholar
S. G. Hofmann and A. F. Gómez, “Mindfulness-based interventions for anxiety and depression,” Psychiatric Clinics of North America, vol. 40, no. 4, pp. 739–749, 2017.
View at: Publisher Site | Google Scholar
J. Kabat-Zinn, “Mindfulness-based interventions in context: past, present and future,” Clinical Psychology: Science and Practice, vol. 10, no. 2, pp. 144–156, 2003.
View at: Publisher Site | Google Scholar
E. B. Loucks, R. S. Crane, M. A. Sanghvi et al., “Mindfulness-based programs: why, when, and how to adapt?” Global Advances in Health and Medicine, vol. 11, no. 11, 2022.
View at: Publisher Site | Google Scholar
A. An, H. Hoang, L. Trang et al., “Investigating the effect of Mindfulness-Based Stress Reduction on stress level and brain activity of college students,” IBRO Neuroscience Reports, vol. 12, pp. 399–410, 2022.
View at: Publisher Site | Google Scholar
D. Zhang, E. K. P. Lee, E. C. W. Mak, C. Y. Ho, and S. Y. S. Wong, “Mindfulness-based interventions: an overall review,” British Medical Bulletin, vol. 138, no. 1, pp. 41–57, 2021.
View at: Publisher Site | Google Scholar
M. Godara, S. Silveira, H. Matthäus et al., “Investigating differential effects of socio-emotional and mindfulness-based online interventions on mental health, resilience and social capacities during the COVID-19 pandemic: the study protocol,” PLoS One, vol. 16, no. 11, 2021.
View at: Publisher Site | Google Scholar
L. G. Hilton, N. J. Marshall, A. Motala et al., “Mindfulness meditation for workplace wellness: an evidence map,” Work, vol. 63, no. 2, pp. 205–218, 2019.
View at: Publisher Site | Google Scholar
L. Zhang, H. Zheng, M. Yi et al., “Prediction of sleep quality among university students after analyzing lifestyles, sports habits, and mental health,” Frontiers in Psychiatry, vol. 13, 2022.
View at: Publisher Site | Google Scholar
X. Liu, L. Lang, R. Wang et al., “Poor sleep quality and its related risk factors among university students,” Annals of Palliative Medicine, vol. 10, no. 4, pp. 4479–4485, 2021.
View at: Publisher Site | Google Scholar
H. L. Rusch, M. Rosario, L. M. Levison et al., “The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials,” Annals of the New York Academy of Sciences, vol. 1445, no. 1, pp. 5–16, 2019.
View at: Publisher Site | Google Scholar
M. Suardiaz-Muro, M. Morante-Ruiz, M. Ortega-Moreno, M. A. Ruiz, P. Martín-Plasencia, and A. Vela-Bueno, “Sleep and academic performance in university students: a systematic review,” Revue Neurologique, vol. 71, no. 2, pp. 43–53, 2020.
View at: Publisher Site | Google Scholar
M. Carpi, D. R. Marques, A. Milanese, and A. Vestri, “Sleep quality and insomnia severity among Italian university students: a latent profile analysis,” Journal of Clinical Medicine, vol. 11, no. 14, p. 4069, 2022.
View at: Publisher Site | Google Scholar

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Copyright © 2024 Yuanqing Pan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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