Mindful Non-reactivity, Anxiety, Depression, and Perceived Stress as Mediators of the Mindfulness Virtual Community Intervention: Pathways to Enhance Mental Health in University Students (Preprint)

BACKGROUND Mindfulness-based interventions (MBIs) are widely employed in mental health promotion and treatment. Despite widespread evidence of effectiveness in different populations and delivery modes, there are sparse findings concerning mechanisms of action in these interventions. OBJECTIVE This study, based on a secondary evaluation of two randomized controlled trials (RCTs) with student participants, was aimed at understanding mediators of the Mindfulness Virtual Community (MVC) intervention, an 8-week, multi-component, online mindfulness cognitive-behavioral intervention. METHODS Mediation analysis, using structural equation modeling with bootstrap resampling, was used to assess direct and indirect relationships between intervention and study outcomes. In accord with the intervention’s theoretical perspective and direct effects patterns, a model was specified to evaluate whether mindful non-reactivity, as evaluated by the five-factor mindfulness questionnaire, mediated relationships between the MVC intervention and anxiety and depression (as symptom-driven outcomes), and perceived stress and quality of life (as functional outcomes). The model included additional mediating paths for perceived stress through anxiety and depression, and for quality of life through perceived stress. The model was subsequently adjusted for baseline differences in other mindfulness (i.e. observing, describing, activity with awareness, non-judgement, and non-reactivity) facets. RESULTS Direct effects evaluations indicated statistically significant differences at 8 weeks between the MVC intervention and waitlist control (WLC) group on depression (-1.65, P=.003), anxiety (-3.29, P<.001), perceived stress (-2.28, P=.001), and quality of life (4.07, P=.003), and the non-reactivity facet of mindfulness (1.55, P=.001). Mediation analysis supported the mediating roles of the non-reactivity facet of mindfulness, depression, anxiety and perceived stress through single and sequential mediation paths. Results indicated acceptable fit characteristics for the main (CFI=.984; RMSEA=.068; SRMR=.045) and extended (CFI=.978; RMSEA=.078; SRMR=.040) models. CONCLUSIONS This research underscores the importance of mindful non-reactivity, depression, and anxiety as key mediators of MVC intervention benefits. CLINICALTRIAL Trial Registration: https://doi.org/10.1186/ISRCTN12249616 Registration Date: 21/06/2017