ABSTRACT

Introduction Worldwide, increasing numbers of young people go to university, but there is concern about students’ rising need for mental health services. Young people’s journey through university provides a golden yet under-used opportunity for prevention. Mindfulness meditation training is popular amongst young people, but its effectiveness to increase wellbeing and resilience to stress in university students needs confirmation. Objective To address these issues the University of Cambridge has funded an implementation and evaluation project co-produced between the University Counselling Service, the Academic Division and the Department of Psychiatry. We designed a pragmatic, randomised controlled trial assessing the impact of providing mindfulness teaching before examinations to test the main hypothesis that it reduces students’ distress. Methods University of Cambridge students without severe mental illness or related crisis were randomly allocated to join an 8-week mindfulness course adapted for university students, or to just continue accessing to mental health support as usual (SAU). The main outcome was self-reported psychological distress during the examination period measured with the CORE Outcome Measure. Other results included the Warwick-Edinburgh Mental Wellbeing Scale, and adverse events. Main outcome analysis was masked to random allocation. An Advisory Reference Group involved students and other stakeholders. An independent committee provided oversight. Results A sample of 616 students took part (median age 22 years, 63% women); 309 were allocated to mindfulness, and 307 to SAU. Participants’ initial distress was higher than the general student population, but lower than students attending counselling; 74% completed the main outcome questionnaire. During the exam season mindfulness participants’ distress score was on average 0.25 CORE-OM points lower (95% confidence interval (CI) 0.16 to 0.34) than SAU participants’ distress. This difference bridges the gap between participants’ initial distress (0.99) and the general student population mean (0.76). Mindfulness participants were one third less likely to be in the clinical range of distress than SAU participants (risk ratio 0.65, 95%CI 0.53 to 0.80). SAU participants’ distress increased over the academic year whereas mindfulness group distress decreased after the course and was maintained during the exam period. Mindfulness also increased wellbeing. Effects were extremely unlikely to be due to chance (p<0.001). Mindfulness did not cause any significant adverse events. Conclusion Findings confirm that the provision of an 8-week mindfulness course effectively reduces distress and enhances wellbeing in university students. We hope that these results will impact significantly on student welfare policy, with mindfulness being implemented at universities more widely.