JMIR Publications

ABSTRACT

Background:

The growing behavioral health needs of college and university students has resulted in counseling center reports of difficulties in meeting student demand.

Objective:

This study tested the real-world voluntary use by college students of four digital, self-directed mental health modules based on a cognitive-behavioral therapy (CBT) clinical model.

Methods:

Archival operational data were extracted for student users at four colleges and universities in the Midwest region of the United States (total sample N=951). Inclusion criteria included having clinical symptoms above the established levels (moderate severity or higher) and use of 2 or more of the 8 lessons of a program within a 6-month period. Unique users in each program included 347 for Depression, 325 for Stress, Anxiety & Worry, 203 for Social Anxiety, and 76 for Insomnia. Paired t-tests compared the average level of change over time from Pre to Post on a standardized measure of clinical symptoms appropriate to each program. Cohen d measures of statistical effect size were calculated on this result for each program. Potential moderator factors (age, gender, preliminary comprehensive assessment, number of lessons, duration, live coach support, live teammate support) were tested together in a multivariate ANCOVA model in the full sample. Follow-up survey data (n=136) were also collected to explore the level of user satisfaction and outcomes. Select data from another study of the same service by employee users (N=707) were examined for comparison.

Results:

The percentage of users who improved to no longer be at clinical risk status after program use was: Stress Anxiety & Worry program 45.8% (149/325), Insomnia program 43.4% (33/76), Depression program 35.7% (124/347), and Social Anxiety program 22.2% (45/203). Significant reductions (all P<.001) and large size statistical effects were found for the reduction from Pre to Post on in mean scores clinical measures for each program: Stress Anxiety & Worry (t324=16.21, d=1.25), Insomnia program (t75=6.85, d=1.10), Depression program (t346=12.71, d=0.91), and Social Anxiety program (t202=8.33, d = 0.80). ANCOVA tests of the moderating factors across programs indicated that greater improvement was strongly associated with using more lessons and also differed by programs, by gender (males demonstrated more improvement than females) and by use of live supports. Analyses of survey data found high satisfaction, improved academic outcomes, and successful integration of digital tools into the university counseling ecosystem through a variety of promotional practices and campus counseling center referrals. The operational profile and the primary outcomes of the college students in this study was also similar to employee users of the same programs from our other study. Thus, this study provided a replication.

Conclusions:

Digital mental health modules using evidence-based tools show promise as a supplement to traditional counseling services in college counseling centers.