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. The “Reliable Change Index” was also calculated to determine what percentage of users in each program had a reduction in their clinical symptoms from Pre to Post that was large enough to be statistically significant (at P<.05). A variety of potential moderator factors (age, gender, number of lessons used, duration of use, live coach support, live teammate support) were examined separately using Chi-square tests within each program and also together in a multivariate approach using a logistic multiple regression model conducted in the total sample. Follow-up survey data (n=136) were also collected to explore the level of user satisfaction and outcomes.

Results:

Significant reductions (all P<.001) were found on clinical measures for each of the programs and each result was associated with a large size statistical effect: Anxiety program (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). The percentage of students within each program that had clinically meaningful size of reduction in symptoms was 46% for the Anxiety program, 40% for the Insomnia program, 32% for the Depression program, and 24% for the Social Anxiety program. Overall, tests of the moderating factors indicated that achieving an improvement after program use (based on the Reliable Change Index status outcome) was greater when using more lessons, when using a live coach, and among male users. An examination 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.

Conclusions:

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