Promoting Mental Health and Psychological Thriving in University Students: a Randomized Controlled Trial of Three Well-Being Interventions
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CLINICAL TRIAL published: 15 July 2020 doi: 10.3389/fpsyt.2020.00590 Promoting Mental Health and Psychological Thriving in University Students: A Randomized Controlled Trial of Three Well-Being Interventions Emma M. Seppälä 1,2*†, Christina Bradley 1†, Julia Moeller 3, Leilah Harouni 1,4, Dhruv Nandamudi 5 and Marc A. Brackett 1 Edited by: Liam Mason, 1 Yale Child Study Center & Yale Center for Emotional Intelligence, Yale University, New Haven, CT, United States, 2 Center for University College London, Compassion and Altruism Research and Education, Stanford University, Stanford, CA, United States, 3 Department of Education, United Kingdom Leipzig University, Leipzig, Germany, 4 Yale School of Management, Yale University, New Haven, CT, United States, 5 Medical Reviewed by: Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom Carlos Freire, University of A Coruña, Spain Alyson Dodd, This study aimed to address the decline in mental health on U.S. university campuses by Northumbria University, examining the effects of three interventions. University students suffer from high levels of United Kingdom anxiety, depression, and suicide. Counseling centers on university campuses are *Correspondence: Emma M. Seppälä struggling to meet increased demand. The cost to students and universities could be [email protected] buffered by offering preventative, psychoeducational, and skill-building training programs †These authors have contributed that promote mental health and psychological thriving. To date, the research literature has equally to this work not yielded systematically evaluated and recommendable preventative mental health and Specialty section: well-being programs for university students. In a registered, randomized controlled trial, This article was submitted to 131 university students were either placed in a non-intervention control group (N = 47) or Psychological Therapies, received training in one of three 30-hour, eight-week semester-long well-being programs: a section of the journal “ ” “ ” Frontiers in Psychiatry SKY Campus Happiness ( SKY ; N = 29), Foundations of Emotional Intelligence ( EI ; N = “ ” Received: 19 February 2020 21) or Mindfulness-Based Stress Reduction ( MBSR ; N = 34). Compared to the control Accepted: 08 June 2020 group and controlling for variance of baseline measurements and multiple comparisons, Published: 15 July 2020 SKY Campus Happiness showed the greatest impact, benefiting six outcomes: Citation: depression, stress, mental health, mindfulness, positive affect and social Seppälä EM, Bradley C, Moeller J, Harouni L, Nandamudi D and connectedness. EI benefited one outcome: mindfulness. The MBSR group showed no Brackett MA (2020) Promoting change. Delivering SKY or EI to university students may be a cost-effective and efficient Mental Health and Psychological Thriving in University Students: A way to proactively and preventatively address mental health for university students and Randomized Controlled Trial of reduce the financial strain on universities. Three Well-Being Interventions. Front. Psychiatry 11:590. Keywords: emotional intelligence, mindfulness-based stress reduction, Sudarshan Kriya, college mental health, doi: 10.3389/fpsyt.2020.00590 well-being, sky campus happiness, depression, anxiety Frontiers in Psychiatry | www.frontiersin.org 1 July 2020 | Volume 11 | Article 590 Seppälä et al. College Well-Being Programs INTRODUCTION cognitive functions [e.g., attention and memory, essential for succeeding in college (30)]. Finally, these types of interventions The World Health Organization defines health as “a state of are not only applied post-hoc but also focus exclusively on complete physical, mental and social well-being and not merely treating mental illness symptoms without setting up the the absence of disease or infirmity” (1). Similarly, we can think of conditions for psychological resilience and thriving. mental health as not merely the absence of mental illness (e.g., A preventative and proactive approach to mental health that anxiety and depression), but also the presence of psychological provides students with empirically validated tools for psychological thriving (e.g., gratitude, social connectedness, mindfulness). resilience and thriving prior to developing symptoms may be a Mental health in college and university students in the United viable additional support to the efforts made by campus counseling States has declined over the last decade (2). College-aged adults centers. Several studies indicate that skill-building interventions are (18–25 years of age) are at greatest risk for mental illness (3) and effective in improving the lives of adolescents and college students have the highest prevalence of any type of mental illness [25.8%; (31–33). A recent meta-analysis of universal mental health (4)]. The most common self-reported concerns by university prevention programs on university campuses showed that the students visiting counseling centers in the United States between most successful programs included skill-building with supervised 2017 and 2018 were anxiety (58.9%), depression (48.0%) and practice (34). These programs, as compared with skill-building stress (46.9%) (5, 6). A 2018 American College Health programs without supervised practice or those with only Association survey of 88,178 college students across 140 psychoeducational curricula, were significantly more successful in campuses reported that 60% of students self-reported reducing anxiety, stress, depression, and distress and improving experiencing overwhelming anxiety and 40% self-reported social and emotional skills (34). feeling so depressed they had difficulty functioning (7). However, most mental health prevention programs offered by Mentalillnessinterfereswithstudentlearningandis campuses tend to fail due to a primary focus on psychoeducation significantly associated with lower GPA (7, 8). Mental illness is (34). Without the components of skill-building (including practice also associated with substance abuse in university students in the time, reflection, questions and discussion) and supervised practice, United States (9), which further negatively impacts academic integration of the material is challenging (34). Overall, the research performance (10) and exacerbates mental illness. literature has not yielded systematically evaluated and Mental illness and substance abuse are associated with more recommendable skill-building protocols for psychological than 90% of all cases of suicide in the United States (11, 12). resilience that university administrators can implement (35). Our While suicide is the tenth leading cause of death in the United study aimed to address this gap in the literature: we examined the States (13), it is the second leading cause of death for college-aged impacts of three different skill-building prevention interventions students, after traffic accidents (14). Recent years have seen a with supervised practice that past research suggests could improve record increase in suicides by young adults aged 15–24 years old student mental health. (13). The highest number of suicides ever reported for this age We selected SKY Campus Happiness (SKY) because it has group was in 2017 (2, 13, 15). From 2000 to 2016, over 10% of been shown to increase psychological resilience (36, 37), decrease students reported having seriously considered suicide in the past stress (38) and reduce impulsive behavior (39) in students. In year (2, 5–7, 11, 13, 16). general populations, SKY has also been shown to improve Whereas social connection, a measure of psychological emotion regulation (40), decrease stress (41–43), anxiety and thriving, is predictive of emotional health, mental illness is depression (44–50), and reduce PTSD (51, 52). often associated with loneliness and isolation which in turn The second program we selected was Foundations in can further deteriorate mental health and increase suicidal Emotional Intelligence (EI), a program that was adapted from ideation (17–24). both a university course and a pre-existing evidence-based Campus counseling centers are inadequately prepared to meet approach to social and emotional learning, RULER (53). increased demand for services. From 2009 to 2014, campus RULER has shown promising results for school-aged children counseling centers experienced an average increase of 30% of in quasi-experimental and randomized controlled studies. In students seeking treatment for an average 6% institutional particular, RULER, has been shown to increase social and enrollment increase (25). Ninety-four percent of counseling emotional competence (54), improve academic grades (54), center directors report an increasing number of students with emotion skills (54), cooperation (55), social problem-solving severe diagnosed mental health problems presenting on their skills (56), and student-teacher relationships (57). campuses (26), and 57% of directors indicate that their resources The third program we selected was Koru Mindfulness. are insufficient to meet students’ needs (5). Mindfulness-based interventions have been shown to reduce The traditional approach to addressing mental illness is to psychological distress (58, 59), stress (60), and anxiety (61)in address symptoms after they have presented themselves. university students. In general populations it has also been Students are typically diagnosed and then prescribed shown to reduce depression (62), anxiety (62), and stress medication, counseling or a combination thereof (27,