Mental health challenges, including stress, anxiety, and depression, are increasingly prevalent among college students, with significant implications for their academic performance and overall well-being (Wu and Liu, 2024). These concerns are particularly pressing in lower-middle-income countries and among students pursuing health sciences careers, where the convergence of academic, clinical, and social pressures compounds mental health risks (Li et al., 2022; Agyapong-Opoku et al., 2024). As students transition to college, they often face a host of novel stressors—greater academic rigor, new social environments, and increased autonomy—that can trigger or exacerbate mental health conditions if not effectively managed (Felton et al., 2022). Unaddressed psychological distress during these formative years may serve as a precursor to long-term health problems, underscoring the need for timely and effective interventions (Emmerton et al., 2024; Turner and Holdsworth, 2024).

In addition to stress, anxiety, and depression, sleep quality has emerged as a critical yet frequently overlooked aspect of student mental health. Inadequate or fragmented sleep patterns can heighten emotional reactivity, impair cognitive function, and lead to a vicious cycle in which stress and worry further disrupt sleep (Perkinson-Gloor et al., 2013; Sun et al., 2024). Over time, poor sleep quality has been linked to increased symptoms of depression and anxiety and a decline in academic performance (Becker et al., 2018). Another essential factor is social support, the perceived availability of emotional, instrumental, or informational aid from peers, family, or community members (Semmer et al., 2008). Strong social networks have been shown to buffer the negative effects of stress and loneliness, improving overall well-being (Franco-O’Byrne et al., 2023). Conversely, insufficient social support may exacerbate psychological distress and hinder students’ ability to cope with academic and personal challenges (Vungkhanching et al., 2017; Dadandı and Çıtak, 2023).

Life satisfaction, or a person’s overarching evaluation of their quality of life, is closely interlinked with these mental health factors (Bramhankar et al., 2023). High levels of stress, anxiety, and depression often diminish life satisfaction, but strong social support and efficient coping mechanisms enhance it (Chia et al., 2024; Çiçek et al., 2024). Given the multitude of pressures university students confront, there is a growing imperative to develop interventions that address these intersecting domains—stress, anxiety, depression, sleep quality, social support, and life satisfaction—comprehensively.

Mindfulness, rooted in ancient meditative practices, has gained considerable attention as a widely accepted complementary and alternative medicine (CAM) approach for improving mental health outcomes among college students (Simonsson et al., 2021; Zheng and Yang, 2024). Defined as the nonjudgmental awareness and acceptance of the present moment, mindfulness cultivates a compassionate orientation toward one’s experiences, fostering emotional regulation and resilience (Bishop et al., 2004; Kabat-Zinn, 2005).

The theoretical basis for mindfulness lies in its capacity to enhance metacognitive awareness, reduce cognitive reactivity, and regulate the hypothalamic–pituitary–adrenal (HPA) axis, reducing cortisol release and thereby alleviating the physiological and psychological symptoms associated with stress and anxiety (Garland et al., 2015). Furthermore, the theoretical framework for mindfulness includes its ability to enhance interoceptive awareness—an individual’s ability to perceive internal bodily states (Farb et al., 2015). Enhanced interoceptive awareness strengthens the experiential self (moment-to-moment awareness). It reduces overidentification with the narrative self (the self-concept over time), promoting a sense of presence and emotional stability (Gibson, 2019).

Previous literature has shown that mindfulness-based interventions can improve psychological well-being in university students, decreasing symptoms of depression, anxiety, stress, and insomnia (Hall et al., 2018; Gallo et al., 2023; Zhang, 2024). However, a systematic review showed that evidence on sleep quality is inconclusive. Although scientific evidence highlights mindfulness’s great potential for the mental health of university students, further research is needed to clearly understand its effects and how they would work in an academic environment (Dawson et al., 2020; Zuo et al., 2023). Evidence also links mindfulness to enhanced social support and life satisfaction, as the practice can increase empathy, emotional regulation, and interpersonal effectiveness (Wilson et al., 2020; MacDonald et al., 2024). Moreover, much of the current research is derived from Western contexts, raising questions about cultural variability in the acceptance and effectiveness of mindfulness-based interventions. It is essential to explore the effectiveness of these interventions in different cultural settings to develop more inclusive and effective programs.

This study aims to address these gaps by evaluating the effects of a mindfulness meditation program on stress, anxiety, depression, sleep quality, social support, and life satisfaction among college students in a culturally diverse academic setting. By comprehensively analyzing these variables, this research seeks to expand the understanding of mindfulness-based interventions and their adaptability across cultural contexts. Ultimately, these insights aim to inform the development of inclusive and effective mental health programs for college students worldwide, contributing to a holistic approach to mental health in higher education.

Students’ mental health is essential in helping them develop their potential. A positive mental health status improves students’ ability to concentrate, manage stress, and adapt to academic challenges, crucial skills for academic success (Garces et al., 2024). Mindfulness benefits college students by improving mental health, developing coping skills, and promoting adjustment to the educational environment (Ramler et al., 2016).

Several studies agree with our results, revealing that mindfulness interventions reduce symptoms of anxiety, depression, stress, and insomnia (Sousa et al., 2021; Gallo et al., 2023; González-Martín et al., 2023). The psychological and neurological mechanisms that underlie mindfulness act synergistically. Mindfulness enables individuals to observe their thoughts and emotions non-judgmentally. This practice mitigates the activation of the hypothalamic–pituitary–adrenal axis (HPA) axis responsible for stress responses, thus reducing cortisol levels (Bergen-Cico et al., 2014; González-Martín et al., 2023). At the same time, this practice improves emotional regulation of the prefrontal cortex—key in modulating decision-making and emotional responses—and decreases amygdala activity, reducing fear and anxiety (Ng et al., 2023; Zheng et al., 2024). This dual regulation not only alleviates symptoms of anxiety and depression but also enhances sleep quality by reducing mental hyperactivation, a significant barrier to rest.

Furthermore, by reducing rumination, mindfulness interrupts the cycles of repetitive negative thoughts characteristic of depression, fostering emotional well-being (Sommerhoff et al., 2023). This would act as a holistic mechanism whose cascading effect would not only alleviate depressive symptoms but would also reduce anxiety by decreasing constant worry and stress by improving the ability to face difficult situations without an exaggerated emotional reaction. Likewise, greater emotional well-being would translate into greater relaxation and mental tranquility, which can facilitate falling asleep and improve its quality.

However, a study reported that it only found an improvement in sleep quality but without a significant effect on anxiety and depression (Fu et al., 2022). Similarly, another study found more substantial reductions in anxiety levels than in depression (Sun et al., 2022). It is important to note that the connections between stress, anxiety, depression, and sleep quality are clear and well-documented (Mayers et al., 2009; Blake et al., 2018; Kalmbach et al., 2018; Hertenstein et al., 2019). These conditions often coexist and influence each other in complex ways; for instance, not all people with insomnia will develop depression, and not all cases of depression are caused by insomnia (Turek, 2005). The interaction between these conditions is complex, and further research is needed to understand the underlying mechanisms and develop effective interventions.

The pandemic context adds another layer of complexity. Anxiety amplified by quarantine measures probably influenced the effectiveness of mindfulness in anxiety-related symptoms. In contrast, it did not have the same impact on depression, possibly because underlying factors that exacerbate depression, such as prolonged social isolation and hopelessness or experiencing multiple stressors, may have influenced the symptoms to decrease, although not substantially (Ettman et al., 2022).

Additionally, individual variability in mindfulness practice is a key factor that can influence intervention outcomes, especially in contexts where anxiety, depression, and sleep quality are sought. Some participants may be able to integrate mindfulness techniques more quickly, allowing them to experience immediate improvements in areas such as sleep quality and anxiety, which tend to respond promptly to emotional regulation and mental relaxation practices. However, participants with more entrenched depressive symptoms may have difficulty adopting these techniques in a short period as depression is linked to more chronic and complex thought patterns, which require a longer and more sustained approach (Breedvelt et al., 2019). Therefore, the duration of the intervention is another factor to consider, particularly when addressing chronic conditions like depression.

ANCOVA and the HC3 model showed substantial reductions in stress and anxiety, while depression exhibited more modest effects. These findings are consistent with a meta-analysis of mindfulness-based interventions in university students, where researchers reported significant reductions in stress and anxiety. However, the effects on depression were not as consistent; the evidence on sleep quality was inconclusive (Dawson et al., 2020). This suggests that while mindfulness has clear benefits for stress and anxiety, its limitations in treating depression warrant further investigation.

Our results also showed a significant improvement in social support and life satisfaction. Mindfulness training enhances the perception of social support and diminishes interpersonal sensitivity and negative emotions (Zhang, 2023). This may be because mindfulness fosters greater self-awareness and emotional regulation, helping people better manage their emotional reactions in social interactions (Freudenthaler et al., 2017). This allows individuals to be more empathetic and less reactive, improving the quality of their relationships and, therefore, the perception of social support (Acoba, 2024). Mindfulness practice also develops greater compassion toward oneself and others, encouraging more open and non-judgmental attitudes in social interactions (O’Connor et al., 2015; Godward et al., 2019).

This openness facilitates the construction of more substantial and genuine relationships, increasing the perception of social support. Mindfulness may enhance social awareness and relationship skills, which are essential components of social intelligence (Feuerborn and Gueldner, 2019) and are key to establishing good relationships in an academic context.

Besides, the mindfulness-to-meaning model indicates that mindfulness improves positive cognitive reappraisal and emotional regulation, leading to increased well-being (Garland et al., 2015). This improvement in self-perception and emotional regulation translates into greater life satisfaction. Evidence also suggests that both core self-evaluation and negative affect mediate the effect of trait mindfulness on life satisfaction, aligning with the mindfulness-to-meaning perspective. In particular, trait mindfulness influences life satisfaction through two mediation pathways— “core self-evaluation → positive affect” and “core self-evaluation → negative affect”—highlighting the combined significance of cognitive and emotional factors in understanding how trait mindfulness fosters life satisfaction (Li et al., 2022). These insights advance the theoretical understanding of how trait mindfulness relates to life satisfaction and offer valuable guidance for enhancing overall well-being.

In addition, ANCOVA and the HC3 model support these results, showing the most robust result for social support. This implies that mindfulness interventions help improve individual well-being and social dynamics, enhancing the sense of belonging to a community (Fagioli et al., 2023). Social support is a critical buffer against stress and promotes resilience, particularly in demanding settings such as university life or high-pressure workplaces (Hefner and Eisenberg, 2009; Feeney and Collins, 2015). By cultivating mindfulness skills, people may become more attuned to their social environments, foster more supportive connections, and have increased feelings of belonging and general well-being (Lindsay et al., 2019). This highlights the need to integrate mindfulness-based interventions into comprehensive strategies to improve social connectedness and mental health in educational settings. However, our results did not show a significant mediation effect of sleep quality, social support, or life satisfaction on anxiety, stress, or depression. Therefore, these variables are not mechanisms that explain the effect of mindfulness on stress and anxiety; instead, more specific mechanisms, such as rumination, worry, self-compassion, cognitive reactivity, aversion, attention regulation skills, and positive affect, could explain these effects (Maddock and Blair, 2023). However, in the case of depression with more established cognitive patterns, changes may be inconsistent depending on the severity and duration of symptoms (Diehr et al., 2006).

Regarding moderation, the results also showed no significant effects on sleep quality, social support, or life satisfaction as moderators in the relationships between mindfulness and anxiety, stress, or depression. A study found that factors such as the intensity and duration of stressors can affect the success of mindfulness in buffering stress or anxiety. However, these moderating effects depend on the specific types of stressors they face and how well individuals integrate mindfulness techniques into their daily lives (Westphal et al., 2021). In their study, these researchers also found that mindfulness moderated the adverse impact of low social support on depression, suggesting that individuals with higher levels of dispositional mindfulness were less affected by limited social support. At the same time, our study did not observe significant moderating effects of social support. This implies that the observed effects of the mindfulness intervention appear to be direct, at least in the context, population, and variables we studied, requiring further research on the possible mechanisms through which mindfulness impacts mental health.

Furthermore, a study emphasized the role of mindfulness in improving emotional regulation and reducing stress, suggesting that mindfulness facilitates better coping mechanisms by helping people decenter from negative emotions and reframe their experiences (Galindo et al., 2020). This resonates with the Mindfulness-to-Meaning Theory (Garland et al., 2015), which provides a theoretical framework that aligns with this study’s findings. According to this theory, mindfulness enables individuals to decenter from stress evaluations, fostering a metacognitive state that broadens attention to novel information. This process facilitates positive cognitive reappraisal, enhances emotional regulation, and fosters a sense of meaning in life. Therefore, mindfulness possesses the capacity to target core emotional and cognitive processes. These mechanisms may elucidate why mindfulness directly impacted stress, anxiety, and depression in this study without significant mediation through variables such as sleep quality or social support.

Cultural factors also play a role in mindfulness interventions among university students. Indeed, a Turkish version of an internet-based mindfulness intervention demonstrated feasibility and acceptability, although it showed limited improvements in depression and anxiety (Balci et al., 2024). In Indonesia, a culturally adapted internet-delivered mindfulness intervention significantly improved psychological distress and well-being among university students (Listiyandini et al., 2024). Besides, research on Asian American and European American college students found that acting with awareness and nonjudging were inversely associated with negative mental health outcomes in all groups, while observing was positively linked to anxiety and stress among Asian Americans (Jo and Pan, 2024). These findings underscore the importance of cultural and contextual factors in shaping mindfulness outcomes. The coastal Peruvian population studied here, distinct in its exposure to Westernized practices and stressors, likely influences the acceptance and effectiveness of mindfulness interventions. This may explain the moderate results observed for depression in this study, as well as the lack of significant mediation and moderation effects in the analyzed variables. However, Peru’s cultural diversity suggests that these findings might differ in highland or jungle populations, where traditional values and stressors are distinct. Moreover, these findings reinforce that mindfulness interventions may have direct effects in certain contexts, as observed here, rather than being mediated through variables such as social support or sleep quality. This direct effect could also be attributed to the unique socio-cultural dynamics of the coastal Peruvian population, suggesting that mindfulness practices must be adapted to resonate with specific cultural needs and expectations. By addressing these gaps, this research contributes to the growing body of evidence on mindfulness interventions’ global adaptability and limitations, particularly in underrepresented cultural contexts such as Peru. It also emphasizes the need for culturally tailored mindfulness practices to optimize outcomes in diverse populations.

The limitations of this study must also be considered. Although the sample size was adequate according to the power analysis, and the groups were homogeneous, coinciding with other similar studies in the Peruvian context (Alvarado García et al., 2018; Alvarado-García et al., 2022a, 2023a), a more significant number of participants could have increased the precision of the results, especially in moderation and mediation analysis. This would have allowed for greater generalization. Furthermore, the quasi-experimental design introduces a potential bias, limiting the ability to attribute the observed effects exclusively to the mindfulness intervention. The duration of the intervention, 12 sessions, may have been insufficient to observe significant improvements in some variables, such as depression, which may require more time to show changes. Likewise, the lack of long-term follow-up prevents the evaluation of the durability of the effects. In addition, only self-report instruments were used, which introduces the risk of response biases, such as social desirability bias or lack of precision in self-assessment. Physiological measures (such as heart rate variability or cortisol) were not included to complement self-reports and more objectively assess the effects of mindfulness on stress and anxiety. Another potential limitation is the selection of sections based on the willingness to participate, which can introduce a risk of selection bias. While the differences in willingness were not statistically significant, participants in these groups could have had higher initial motivation. This could influence their engagement with the intervention and the generalizability of the findings to less motivated populations. Future studies should consider randomized group assignments to mitigate this risk. In addition, future research may explore other moderating factors, such as resilience and family support. These limitations may guide future studies toward more robust designs with greater controls to generate a more complete understanding of the effects of the mindfulness intervention.

In addition, our findings underscore the practical value of incorporating mindfulness programs into university settings to reduce stress and anxiety and to enhance social support and life satisfaction. They also suggest that mindfulness primarily operates through emotional self-regulation and focused awareness mechanisms, as sleep quality and social support showed no significant mediating effects. This opens avenues for further research on cultural factors, the duration and intensity of mindfulness training, and other potential mediators—such as self-compassion and metacognition. Finally, the importance of adapting mindfulness interventions to specific sociocultural contexts, especially in regions with limited contemplative traditions, underscores the need for culturally sensitive approaches to optimize acceptance and impact.

The findings of this study indicate that the mindfulness intervention was effective in improving the mental health of university students, generating direct and significant effects on reducing stress, anxiety, and depression, as well as improving sleep quality, social support, and life satisfaction. The analyses performed, both ANCOVA and the robust HC3 model, support these findings, showing that the most robust improvements occurred in social support, highlighting the importance of this variable in general psychological well-being. However, no significant evidence of mediation or moderation by sleep quality, social support, or life satisfaction was found in the relationships between mindfulness and psychological variables, suggesting that the effects of mindfulness were direct in this context. Despite these limitations, the results support the implementation of mindfulness interventions to improve mental well-being in the university setting.