JMIR Publications

ABSTRACT

Background:

Loneliness is a widespread and significant problem on college campuses. Prolonged loneliness in young adulthood is a risk factor for concurrent and future mental health problems, as well as attrition, making college a critical time for support. Cognitive and behavioral interventions show promise for decreasing loneliness, and can be widely disseminated through technology.

Objective:

This pilot randomized controlled trial examined the initial efficacy, feasibility, and desirability of a smartphone app, Nod, designed to deliver cognitive and behavioral skill building exercises to reduce loneliness during the transition to college.

Methods:

First-year college students (n=221; mean age 18.7 years; 59% female) were recruited online during incoming student orientation, and randomized to either immediate access to Nod (“experimental”, N=100) or access after 4 weeks (“control”, N=121). The app delivered skills via fully automated (1) “social challenges”--suggested activities designed to build social connections; (2) reflections--brief cognitive reframing exercises and (3) student testimonials that encouraged a growth mindset towards social connection building. Main ‘intent-to-treat’ analyses compared the conditions on self-assessed loneliness, depressive symptoms, and other mental health and college adjustment outcomes at week 4, controlling for baseline values on those variables. Analyses also tested the hypothesis that the treatment benefits would be particularly pronounced for participants with heightened psychological vulnerability at baseline (i.e., higher baseline depressive symptoms and loneliness).

Results:

Retention was 97% at week 4, and participants viewed an average 36.7 pages of app content. There were no significant condition differences in loneliness at week 4, (F1, 211=0.05, P=.82; ηp2 < .001). However, there was a significant condition x baseline depression interaction to predict week 4 loneliness (F1,209=9.65, P=.002; ηp2 =.04). Simple slope analyses indicated that baseline depression positively predicted week 4 loneliness among control participants (r =0.30, t209=3.81, P<.001), but did not significantly predict week 4 loneliness among experimental participants (r=- 0.09, t209=-0.84, P=.40), suggesting that Nod buffered participants high in baseline depression from experiencing heightened mid-quarter loneliness. Similar moderation by baseline vulnerability was found for week 4 depressive symptoms, sleep quality, and week 4 indices of college adjustment (e.g. perceived social support and campus belonging). Nod had no significant effects on week 4 anxiety or social anxiety, nor did it interact with baseline vulnerability to predict these outcomes.

Conclusions:

Results provide initial evidence that cognitive and behavioral skills delivered via a mobile app can buffer psychologically vulnerable college students against heightened loneliness and depressive symptoms, as well as other negative college adjustment outcomes. Future work will aim to improve upon engagement with the app, and to address loneliness among other key populations. Clinical Trial: ClinicalTrials.gov Identifier: NCT04164654