Effects of mindfulness-based stress reduction on depression, anxiety, stress and mindfulness in Korean nursing students

Abstract

Background

Nursing students often experience depression, anxiety, stress and decreased mindfulness which may decrease their patient care effectiveness. Mindfulness-based stress reduction (MBSR) effectively reduced depression, anxiety and stress, and increased mindfulness in previous research with other populations, but there is sparse evidence regarding its effectiveness for nursing students in Korea.

Objectives

To examine the effects of MBSR on depression, anxiety, stress and mindfulness in Korean nursing students.

Design

A randomized controlled trial.

Participants/Setting

Fifty (50) nursing students at KN University College of Nursing in South Korea were randomly assigned to two groups. Data from 44 students, MBSR (n = 21) and a wait list (WL) control (n = 23) were analyzed.

Methods

The MBSR group practiced mindfulness meditation for 2 h every week for 8 weeks. The WL group did not receive MBSR intervention. Standardized self-administered questionnaires of depression, anxiety, stress and mindfulness were administered at the baseline prior to the MBSR program and at completion (at 8 weeks).

Results

Compared with WL participants, MBSR participants reported significantly greater decreases in depression, anxiety and stress, and greater increase in mindfulness.

Conclusion

A program of MBSR was effective when it was used with nursing students in reducing measures of depression, anxiety and stress, and increasing their mindful awareness. MBSR shows promise for use with nursing students to address their experience of mild depression, anxiety and stress, and to increase mindfulness in academic and clinical work, warranting further study.

Introduction

Over 29% of college students reported depression in Korea and the United States (ACHA-NCHA, 2013, Chung and Kim, 2010). Depression is known to lead to societal problems or to suicide. Indeed, suicide is a serious problem in Korea and is the leading cause of death of Koreans in their twenties (Statistics Korea, 2012). In the U.S., to identify effective depression prevention strategies, the American College Health Association (ACHA) has implemented the nationwide mental health needs of college students and promoted the health programs (Buchanan, 2012).

Anxiety and depression are often experienced simultaneously. Depression affects about 67% of college students with anxiety, and anxiety was a major predictor of depression for nursing students (Mahmoud et al., 2012, Song, 2011). Anxiety has been shown to be affected by emotion-oriented coping styles including emotional responses, self-preoccupation, and fantasizing reactions; thus, it is likely that an adaptive coping program such as mindfulness-based stress reduction (MBSR) program may decrease depression, anxiety, and stress (Shikai et al., 2009, Warnecke et al., 2011).

Stress is an important psycho-social factor in the educational process that may influence academic performance and student well-being (Jimenez et al., 2010). Significantly profound stress is experienced by nursing students as they work with patients in the clinical setting. The most stressful aspect of student nurses' clinical practice was seeing the pain and suffering of the patients (Jimenez et al., 2010). However, for nursing students, the level of academic stress was even higher than that of clinical stress (Chan et al., 2011). Nursing students who graduate from nursing schools often take positions as nurses in stressful or anxiety-provoking roles in the provision of patient care; furthermore, their patients may be experiencing similar emotions. Thus, nursing students need to know how to manage their stress and emotions. A program teaching self-management of stress and anxiety such as MBSR may provide benefits to the students in their academic program and, if practiced, it may enhance their future professional nursing practice.

Mindfulness is viewed not as something to get or to acquire, but as an internal resource that already exists, patiently awaiting to be reawakened (Center for Mindfulness, 2014). Increased mindfulness has been found to be related to improved psychological functions, and it led to reductions in suffering; it has been shown to be an important predictor of depression in nursing students (Baer, 2009, Song, 2011).

MBSR programs have been shown to be effective (Chen et al., 2013, Dobkin and Zhao, 2011, Warnecke et al., 2011), however, the potential benefits of MBSR to decrease depression, anxiety, stress and increased mindfulness are less well-established among nursing students in Korea. Therefore, the purpose of this study was to examine whether MBSR is effective, and has potential as an intervention to decrease depression, anxiety and stress, and to improve mindfulness of Korean nursing students.