The incidence of psychological symptoms in adolescents and young adults has risen significantly over the past decade, placing increased stress on university counseling resources. Mindfulness-based interventions may be less staff and time intensive than many traditional mental health interventions. Further, they might achieve positive outcomes at lower cost.
Wagner et al. [BMJ Open] evaluated the cost-effectiveness of a Mindfulness Skills for Students (MSS) program added to mental health services-as-usual to a control group that had access solely to mental health services-as-usual alone.
The researchers randomly assigned 616 British university students (mean age = 23 years; 63% female) with an expressed interest in the MSS program to either the MSS program with access to mental health services-as-usual when needed, or a control group with access to treatment-as-usual when needed. The control group was guaranteed slots in the following year’s MSS program.
The MSS program consisted of 8 weekly 75-90 minute group sessions, each incorporating two periods of meditation, as well as opportunities for reflection and inquiry. Students were encouraged to dedicate 8-25 minutes of daily home practice. Mental health services-as-usual involved access to university individual and group counseling services, along with counseling service workshops. The MSS program was offered during the winter and spring semesters, with results reported separately for these cohorts.
Participants underwent assessments using self-report questionnaires measuring psychological distress and well-being at time of recruitment, post-intervention, during exam week, and at 12 month follow-up. The psychological distress questionnaire formed the basis for computing quality-adjusted life years (QALYs), a standard metric for evaluating quality of life in cost-effectiveness studies.
The cost of the MSS program was determined by calculating the staff time cost per participant. Meanwhile, the cost of treatment-as-usual was calculated based on the staff cost for delivering services at the university counseling center per participant, derived from counseling center records. A small percentage of the participants (<18%) used counselling center resources, and there was no difference in usage between the study groups.
The results indicated that MSS groups had lower levels of distress than the control group at all three outcomes assessments. These differences were statistically significant at all three times for the winter cohort, and at post-intervention and exam time for the spring cohort. Well-being scores were significantly higher for MSS group than controls at all assessment times.
A cost-benefit analysis revealed that the MSS group achieved significantly better mental health outcomes at significantly higher cost than controls. On average, the cost for each MSS participant was $84.96 USD, whereas for those in the control group, it was $24.66 USD.
Using the British National Institute for Health and Care Excellence estimates of willingness to pay for an increase of one quality-adjusted life year, the MSS program was deemed by the authors to be cost-effective.
The study shows that the Mindfulness Skills for Students program significantly decreases psychological distress and improves well-being in university students in a cost-effective manner compared to treatment-as-usual.
The study is limited by relying on students with an interest in mindfulness and the absence of another short-term treatment as a comparator.
Wagner, A. P., Galante, J., Dufour, G., Barton, G., Stochl, J., Vainre, M., & Jones, P. B. (2023). Cost-effectiveness of providing university students with a mindfulness-based intervention to reduce psychological distress: Economic evaluation of a pragmatic randomised controlled trial. BMJ Open, 13(11), e071724.
Link to study