Effects of Mobile Mindfulness Meditation on the Mental Health of University Students: Systematic Review and Meta-analysis
Authors: Chen Bin , Yang Ting , Xiao Lei , Xu Changxia , Zhu Chunqin 
Published: September 2022

Background
Mobile mindfulness meditation (MMM) is a mindfulness meditation intervention implemented using mobile devices such as smartphones and apps. MMM has been used to help manage the mental health of university students.

Objective
This study aims to evaluate the effectiveness of MMM on the mental health of university students in the areas of stress, anxiety, depression, mindfulness, well-being, and resilience.

Methods
We conducted a systematic review and meta-analysis of the effectiveness of MMM on the mental health of university students. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic literature search was performed on PubMed, Web of Science, EBSCO, Cochrane Library, and Embase databases, from inception to July 16, 2021. This study was conducted to identify studies that reported the effects of MMM on the primary outcomes including stress, anxiety, and depression, and on the secondary outcomes including mindfulness, well-being, and resilience. Two reviewers retrieved articles, evaluated quality, and extracted data independently. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Standardized mean differences (SMDs) for continuous outcomes and risk ratios for dichotomous outcomes were calculated. Sensitivity analyses and subgroup analyses were performed for results with high heterogeneity. The RevMan version 5.3 was used to perform meta-analysis.

Results
A total of 10 studies, including 958 university students, were selected for this meta-analysis. Results of the primary outcome showed that the MMM groups were more effective than the control groups in decreasing stress (SMD –0.41, 95% CI –0.59 to –0.23; P<.001) and alleviating anxiety (SMD –0.29, 95% CI –0.50 to –0.09; P=.004). However, there was no difference between the MMM groups and the control groups in depression (SMD –0.14, 95% CI –0.30 to 0.03; P=.11). The use of either waitlist control or traditional face-to-face intervention in the control group was identified as the source of heterogeneity. Specifically, the waitlist control subgroup (SMD –0.33, 95% CI –0.53 to –0.13; P=.002) was superior when compared with the face-to-face subgroup (SMD 0.29, 95% CI –0.01 to 0.59; P=.06). Results of the secondary outcome showed that the MMM groups were more effective than the control groups in enhancing well-being (SMD 0.30, 95% CI 0.11-0.50; P=.003) and improving mindfulness (SMD 2.66, 95% CI 0.77-4.55; P=.006). Whether commercial sponsorship was obtained was considered as the source of heterogeneity. The “without company support” group (SMD 17.60, 95% CI 11.32-23.87; P<.001) was superior to the “with company support” group (SMD 1.17, 95% CI –0.82 to 3.15; P=.25) in raising the level of mindfulness. However, there was no difference between the MMM and control groups in resilience (SMD –0.06, 95% CI –0.26 to 0.15; P=.59). The evidence level of the results from the 10 studies was determined to be moderate to low.

Conclusions
MMM was an effective method to reduce stress and anxiety, and to increase the well-being and mindfulness of university students. However, further studies are needed to confirm our findings.

Trial Registration
PROSPERO International Prospective Register of Systematic Reviews CRD42022303585; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=303585