A Mixed Methods Evaluation Study of Brief Mindfulness-based Stress Reduction and Brief

In Canada, 42 billion dollars are spent per year treating mental health issues. Given that 53% Canadians undergo postsecondary education, the mental health of university students is of great concern, especially as they experience higher proportions of psychological distress ("stress") compared to the general population. Reports indicate a 42.2% of stress levels in university students, which not only poses a significant impact in their academic performance, but also meaningfully contributes to decreased rates of students completing their studies, and in high rates of long-term maladjustment mental illness including depression (15-30%), and anxiety (32.2%). University students are also prone to develop eating disorders (6%), attention-deficit/hyperactivity disorder (4%), post-traumatic stress disorders (3%), drug/substance abuse (2.1%) , and sleep disturbances (5% to 73%).

As the onset of most psychological disorders occurs at age 24, university students may greatly benefit from mental health assistance provided by academic institutions. At McGill University, high rates of psychological distress are experienced by both undergraduate and graduate students, as observed by concerning rates of suicidality (10% of students have considered attempting suicide while at University), trauma (5 to 16%), and testimonials of experiencing social anxiety (61-65 %) and academic distress (55-66%). Moreover, a steady increase in students seeking mental health or counseling services and the increased complexity and severity of symptoms have placed significant attention in the development of strategies addressing university students' psychological well-being.

Implementation science: mental health care in university settings. Many public-sector services systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Universities represent an optimal setting for reaching young adults with mental health promotion and prevention programs as they are a captive audience, thus reducing adherence problems known to diminish the impact and outcomes of public health interventions in general.

Successful program implementation (i.e., examining the barriers and facilitators of program adherence to an evidence-based program) is directly associated with better outcomes and a translational promise to accelerate knowledge into practice. Efforts to enhance and improve outcome involves ameliorating concordance with evidence-based clinical practice guidelines. However, guidelines for the treatment of mental illnesses are underdeveloped and not routinely well implemented in mental health care, despite the number of evidence-based practices on the rise.

Moreover, studies have found that young people in need of mental health care services show less adherence to prevention and treatment programs, despite the availability of evidence-based practices. In the context of university students, it appears that university students face not only high academic demands and perceived and self-stigmatizing attitudes towards mental illness, but also report limited accessibility (time, transport, and cost) to participate in or adhere to mental health care. Other barriers are related to confidentiality and trust, concern about the characteristics of the provider, difficulty or an unwillingness to express emotion, preferring other sources of help (i.e., family, friends), and worrying about effects on career. In this vein, it remains crucial to systematically study what factors impact program adherence (i.e., attendance on three out of five sessions), and home practice (i.e., continued home practice). Studies also need to understand further how students experience stress and explain the comparative experiences of students participating in different mental health promotion and prevention strategies.