Smartphone-based intervention helps improve mental health of university students

Mobile Mindfulness Meditation (MMM) demonstrates effectiveness in reducing stress and anxiety among university students, leading to better mental health, according to a study.

“In general, the effectiveness of MMM on the mental health of university students was superior to that of traditional mindfulness meditation,” the investigators said. “There were positive effects of MMM in decreasing stress, alleviating anxiety, enhancing well-being, and improving mindfulness of university students.” [J Med Internet Res 2023;25:e39128]

This systematic review and meta-analysis of the effectiveness of MMM on the mental health of university students followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The investigators searched the databases of PubMed, Web of Science, EBSCO, Cochrane Library, and Embase from inception to 16 July 2021.

Studies reporting the effects of MMM on stress, anxiety, and depression, as well as mindfulness, well-being, and resilience, were identified. Two independent reviewers retrieved the articles, evaluated quality, and extracted data.

Using the Cochrane criteria for risk-of-bias assessment, the investigators determined the methodological quality of the selected studies. They also calculated the standardized mean differences (SMDs) for continuous outcomes and risk ratios for dichotomous outcomes. Sensitivity and subgroup analyses were conducted for results with high heterogeneity. Meta-analysis was done using the RevMan version 5.3.

Ten studies, including 958 university studies, met the eligibility criteria. MMM was more effective than control in reducing stress (SMD, ‒0.41, 95 percent confidence interval [CI], ‒0.59 to ‒0.23; p<0.001) and relieving anxiety (SMD, ‒0.29, 95 percent CI, ‒0.50 to ‒0.09; p=0.004). On the other hand, no between-group difference was seen in depression (SMD, ‒0.14, 95 percent CI, ‒0.30 to 0.03; p=0.11).

The source of heterogeneity in the control group was the use of either waitlist control or traditional face-to-face intervention. In particular, the waitlist control subgroup (SMD, ‒0.33, 95 percent CI, ‒0.53 to ‒0.13; p=0.002) was superior to the face-to-face subgroup (SMD, 0.29, 95 percent CI, ‒0.01 to 0.59; p=0.06).

Mindfulness

In terms of the other outcomes, MMM was also more effective than control in improving well-being (SMD, 0.30, 95 percent CI, 0.11‒0.50; p=0.003) and mindfulness (SMD, 2.66, 95 percent CI, 0.77‒4.55; p=0.006). Whether commercial sponsorship was obtained was deemed as the heterogeneity source.

Additionally, the “without company support” group (SMD, 17.60, 95 percent CI, 11.32‒23.87; p<0.001) showed superiority over the “with company support” group (SMD, 1.17, 95 percent CI, ‒0.82 to 3.15; p=0.25) in increasing the level of mindfulness. No between-group difference was observed in resilience (SMD, ‒0.06, 95 percent CI, ‒0.26 to 0.15; p=0.59).

“The evidence level of the results from the 10 studies was determined to be moderate to low,” the investigators said.

This study was limited by the small sample size, the selection of only English-language articles and the use of different smartphones and apps in each study. In addition, different measures were applied for each mental health outcome.

“MMM is a mindfulness meditation intervention implemented using mobile devices such as smartphones and apps,” the investigators said. “MMM has been used to help manage the mental health of university students.”