JMIR Publications

ABSTRACT

Background:

Access to evidence-based psychological interventions remains limited in many low- and middle-income countries because of shortages of trained mental health professionals, inadequate service provision, and growing demand for mental health care. Digital mental health interventions have the potential to expand access to care, particularly among university students who face multiple barriers to seeking conventional mental health services. However, evidence on the feasibility, acceptability, and effectiveness of locally developed digital mental health interventions in sub-Saharan Africa remains limited.

Objective:

This study evaluated the feasibility, acceptability, and preliminary effectiveness of a locally developed internet-based cognitive behavioural therapy (CBT) intervention for depressive symptoms among clinical students at a Nigerian university.

Methods:

A single-group pre-post pilot study was conducted among clinical students at the University of Ibadan, Nigeria. A total of 353 students completed baseline screening. Students with severe depressive symptoms were referred for specialist care, while those meeting eligibility criteria were invited to participate in a web-based cognitive behavioural therapy programme. The intervention was developed locally and informed by cognitive behavioural therapy principles, with input from students with lived experience of depression and a university student counsellor. Participants completed assessments at baseline and immediately following the intervention. Outcomes included depressive symptoms measured using the Beck Depression Inventory, depression literacy, subjective well-being, feasibility indicators, intervention engagement, and participant satisfaction.

Results:

Of the 55 students who screened positive for depressive symptoms, 51 were eligible for the intervention and 34 enrolled (enrolment rate 66.7%). All participants completed the intervention and post-intervention assessments, yielding a retention rate of 100%. Mean depression scores decreased significantly from 17.35 (SD 4.44) at baseline to 4.62 (SD 5.27) following the intervention (Z=-4.982, p<.001), corresponding to a large effect size (Cohen’s d=-0.85). Depression literacy improved significantly from a mean score of 5.47 (SD 1.48) to 6.15 (SD 1.13) (Z=2.167, p=.030; Cohen’s d=0.37). Satisfaction with life increased from 18.09 (SD 6.28) to 20.88 (SD 5.03), although this change was not statistically significant (Z=1.762, p=.078). Participants reported high levels of satisfaction with the intervention, with 94.1% rating the programme as good or excellent. All participants indicated that they would recommend the programme to a friend. Qualitative feedback highlighted the intervention’s accessibility, flexibility, anonymity, and relevance to student experience.

Conclusions:

This study provides preliminary evidence that a locally developed, minimally guided internet-based CBT intervention is feasible, acceptable, and potentially effective for reducing depressive symptoms among students in Nigerian universities. The high levels of engagement and participant satisfaction suggest that digital mental health interventions may represent a promising and scalable approach to address the mental health treatment gap in settings characterised by limited specialist workforce capacity.