Promoting mental health for university students in China through mindfulness: A randomized controlled trial across six universities

In-person mindfulness instruction:
● The in-person mindfulness instruction will consist of weekly 90-minute group sessions, held in a university classroom over eight consecutive weeks, not including an introductory session prior to the formal start of classes.
● Participants will learn foundational principles related to the role of mindfulness, as well as formal and informal mindfulness practices
● Participants will be asked to commit to completing assigned mindfulness practice independently outside of class throughout the intervention period.

Control group:
● Participants assigned to the control group will receive no other intervention during the program (pure control).

2025-10-16

2025-12-26

1. Depression symptoms (PHQ-9)
2. Anxiety symptoms (GAD-7)

1. Physiological stress will be measured using cortisol levels. The cortisol levels will be measured via saliva samples starting one week prior to the intervention, three times on the same day at consistent times. At the end of the intervention, the cortisol levels will be measured one week after the course ends, three times on the same day (at the same times as before the intervention).
2. Perceived stress is measured using the Perceived Stress Scale (PSS), measured at baseline, weekly during the intervention, at endline, and in several follow-ups at three months, six months, and four years after the intervention
3. Emotion regulation will be measured using the Emotion Regulation Questionnaire (ERQ) at baseline, weekly during the intervention, at endline, and in several follow-ups at three months, six months, and four years after the intervention
4. Coping strategies will be measured using the Coping Strategies Scale at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
5. Trait mindfulness will be measured using the short-form of the Five Facet Mindfulness Questionnaire (FFMQ-SF) at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
6. State mindfulness will be measured using the Multidimensional State Mindfulness Questionnaire (MSMQ) at baseline and endline, measured weekly during the intervention, and in several follow-ups at three months, six months, and four years after the intervention
7. Loneliness will be measured using the short-form of the 6-item UCLA Loneliness Scale at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
8. Recent stressful events will be measured using the Adolescent Self-Rating Life Events Check list (ASLEC) at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
9. Sleep quality will be measured using the Pittsburgh Sleep Quality Index (PSQI) at baseline, at endline, and in several follow-ups at three months, six months, and four years after the intervention
10. Flourishing will be measured using the Flourishing Scale (FS) at at baseline, weekly during the intervention, at endline, and in several follow-ups at three months, six months, and four years after the intervention
11. Life satisfaction will be measured using the Satisfaction with Life Scale (SWLS) at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
12. Academic performance will be measured using the semester GPA and national English test results at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
13. Lifestyle behaviors will be measured using items asking about the amount and frequency of behaviors such as screen use and exercise at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
14. Face will be measured using the CPAI-2 at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
15. Somatic symptoms will be measured using the brief version of the Somatic Symptom Scale (SSS), at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
16. Perceived benefits and adverse effects and helpfulness of the program will be measured with Likert-type items measured weekly during the intervention, and in several follow-ups at three months, six months, and four years after the intervention
17. Compliance with mindfulness practice will be measured based on self-report length and frequency of practice, measured weekly during the intervention, and in several follow-ups at three months, six months, and four years after the intervention
18. Acceptability of the intervention will be measured via qualitative interviews and focus groups with students and instructors
19. Self-compassion will be measured using the Self-Compassion Scale, measured at baseline and endline, as well as weekly during the intervention, and in several follow-ups at three months, six months, and four years after the intervention
20. Sense of purpose will be measured using the Meaning of Life Questionnaire, measured at baseline and endline, weekly during the intervention, and in several follow-ups at three months, six months, and four years after the intervention
21. Experiential avoidance will be measured using the Brief Experiential Avoidance Questionnaire at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
22. Emotion reactivity and instability will be measured using the RIPOST-Y at baseline, endline, weekly during the intervention, and in several follow-ups at three months, six months, and four years after the intervention
23. Career outcomes will be measured using items asking about post-graduation trajectories four years following the intervention
24. Interpersonal tolerance will be measured using the CPAI-2 at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
25. Perceived ostracism will be measured using the Ostracism experience scale (OES-A), measured at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
26. Fear of negative evaluation will be measured using the Brief Fear of Negative Evaluation Scale (BFNE-II), measured at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
27. Neuroticism will be measured using the Big Five Personality Inventory (brief version), at baseline and endline
28. Openness will be measured using the Big Five Personality Inventory (brief version), at baseline and endline
29. Emotion reactivity will be measured using the Perth Emotion Reactivity Scale, measured at baseline and endline
30. Gratitude will be measured using the five-item Gratitude Questionnaire, measured at baseline and endline, weekly during the intervention, and in several follow-ups at three months, six months, and four years after the intervention
31. Stress mindset will be measured using the Stress Mindset Scale, measured at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention
32. Positive and negative emotions will be measured using the PANAS, measured at baseline, endline, weekly during the intervention, and in several follow-ups at three months, six months, and four years after the intervention
33. Interpersonal tolerance will be measured using the tolerance scale of the CPAI-2, measured at baseline and endline, and in several follow-ups at three months, six months, and four years after the intervention




Ecological momentary assessment scales:
1. State mindfulness (MSMQ-9)
2. Depression (PHQ-2)
3. Anxiety (GAD-2)
4. Life satisfaction (SWLS-2)
5. Positive and negative emotions (14 emotion words, drawn from the I-PANAS-SF, PANAS-X, and parts of the LAPA)
6. Sleep duration and quality (one item each from the PSQI)
7. Perceived stress (one self-developed item)
8. Emotion regulation efficacy (two self-developed items)
9. Negative and positive events (seven self-developed items each)
10. Overall daily emotional stability (adapted from the TIPI)

We will conduct a randomized study with 360 undergraduate students recruited from six universities in China. Using the RCT method of impact evaluation, we will be able to ensure that the intervention and control groups have similar characteristics at baseline, which is vital for drawing a causal connection between the intervention and any changes in student outcomes. By assuring the similarity of characteristics (such as sex, baseline mental health, etc.) between the treatment and control groups at baseline, we can confidently attribute any significant differences in outcomes between the control and intervention group to the program.

In conjunction with the baseline and follow-up measurements, we will also employ an ecological momentary assessment (EMA) design to explore variations in immediate experiences prior to and following the intervention. For this part of the data collection, 150 of the participants will participate, with 75 participants in the control and 75 in the intervention groups, distributed across three of the six experimental schools. (See above for EMA outcomes measured.) This will include brief periods of data collection four times a day, one week before the intervention and one week after the intervention (Monday through Friday). Based on previous research (Myin-Germeys et al., 2018), each assessment will be brief (take no more than 5 minutes to complete), and will be held during the participants' break periods (between/after classes).

Not available

Randomization will be conducted via a statistical software program (Stata 16)

Individual

No

N/A

360

180 students control, 180 students mindfulness intervention

0.30 SD