Recursos salutogênicos e a prática de mindfulness online na promoção da saúde mental dos universitários

Abstract

Mental disorders are common among undergraduate students and young adults. When not treated or treated inadequately, they are responsible for reducing quality of life and can cause significant academic losses. A common finding in studies during the COVID-19 pandemic was that the crisis triggered by this event profoundly impacted the health and well-being of populations around the world, worsening anxiety and depression symptoms, as well as other disorders. On the other hand, few studies have focused on psychological resources that can contribute to people’s health in times of stress. Thus, using a salutogenic approach, the first stage of the thesis consisted of verifying the predictive role of four possible psychological resources (sense of coherence, sense of national coherence, perception of social support and trust in institutions) in Brazilians’ mental health. The cross-sectional study was part of an international project called Corona Research Collaboration. Data collection took place from November 2020 to January 2021 using the Qualtrics platform. Standardized and validated instruments in Brazil were used, such as Generalized Anxiety Disorder-7 (GAD-7), Mental Health Continuum – Short Form (MHC-SF), Sense of Coherence-13 (SOC-13), as well as translated questionnaires such as the Sense of National Coherence (SONC), Social Support, Trust in Relevant Institutions and People and The Financial and Health Risks Related to COVID-19. The sample consisted of 1,630 Brazilians, mainly women. For data analysis, Pearson correlation coefficient and multiple linear regression were performed. As a result, there was a high mean anxiety level (M=10.1; SD=5.73) and mental health levels compatible with other countries (M=4.2; SD=1). But the main findings converged on the importance of health promotion interventions that consider psychological resources, since sense of coherence, sense of national coherence and social support were predictors of mental health. Sense of coherence was the only predictor of anxiety [β=-0.61; p<0.001], explaining 38% of the variation in its scores, whereas sense of coherence [β=0.52; p<0.001], sense of national coherence [β=0.16;p<0.001] and social support [β=0.15; p<0.001] were predictors of positive mental health and together explained 51% of the variation in its scores. Based on the findings, strategies capable of strengthening coping resources and promoting mental health were searched in the literature. Among the interventions that contribute to reducing anxiety, depression and well-being in general, with abundant evidence in the university context, mindfulness-based interventions (MBI) stand out. The second stage of this thesis included systematically reviewing the literature on the effects of MBI on undergraduate students’ mental health, which confirmed the benefits of these interventions, and assessing, through a randomized clinical study, the effects of an online MBI on mental health parameters such as stress, anxiety, depression, positive mental health and psychological resources, in the university population. A total of 317 distance learning pedagogy students from Cesumar University participated in the study. Undergraduate students were randomly assigned to receive the 8-week Mindfulness Program for College Students (PMU) or join the waitlist. The program took place from June to August 2023. To assess the possible effects of the intervention, the following standardized and validated instruments in Brazil were used: Generalized Anxiety Disorder-7 (GAD-7), for anxiety; Patient Health Questionnaire-9 (PHQ-9), for depression; and Mental Health Continuum – Short Form (MHC-SF), as a measure of positive mental health. For the secondary outcomes, sense of coherence, resilience, mindfulness and perceived stress, the following instruments were used: Sense of Coherence-13 (SOC-13); Connor-Davidson Resilience Scale-10 Brazil (CD-RISC 10BRASIL); Mindful Attention Awareness Scale (MAAS); and Perceived Stress Scale-10 (PSS-10). We carried out intention-to-treat analysis. To compare outcomes, the linear mixed effects model was used. As a result, evidence suggests the effectiveness of the intervention in improving students’ mental health, since participation in the PMU resulted in a significant increase in positive mental health (d=6.05; 95%CI 3.76 to 8.34; p<0.001); reduction in anxiety (d=-4.49; 95%CI -5.52 to -3.46; p<0.001) and depression (d=-5.54; 95%CI -6.76 to -4.33; p<0.001) and stress (d=-4.42; 95%CI -5.59 to -3.25; p<0.001) symptoms; and development of resilience (d=3.49; 95%CI -2.15 to 4.84; p<0.001), sense of coherence (d=7.54; 95%CI -5.03 to 10.05; p<0.001), and mindfulness (d=0.23; 95%CI -0.04 to 0.41; p=0.018). It is concluded that both stages of the thesis contributed to understanding the needs for mental health interventions for undergraduate students as well as providing evidence on the role of psychological resources, such as sense of coherence, sense of national coherence, perceived social support, mindfulness and resilience in mental health. The results of the literature review and the PMU showed that mindfulness is a component that should be considered when developing interventions and that MBI can be important strategies for promoting mental health for undergraduate students. It is suggested that new research can deepen discussions regarding acceptable, viable and effective mental health strategies, with emphasis on intersectoral partnerships, with the aim of reaching a greater number of students and optimizing results.