JMIR Publications

ABSTRACT

Background:

Mental health problems are common among university students, yet many students do not seek professional help. Digital mental health interventions (DMHIs) can increase students’ access to support and have been shown to be effective in preventing and treating mental health problems. However, little is known about the extent to which students implement therapeutic skills from these programs in everyday life (i.e., skill enactment), or about the impact of skill enactment on outcomes.

Objective:

This study aimed to assess the effects of a low-intensity video-based intervention, Uni Virtual Clinic Lite (UVC-Lite), in improving skill enactment relative to an attention-control program (primary aim) and examine whether skill enactment moderates the effects of the intervention on symptoms of depression and anxiety (secondary aim). We also qualitatively explored participants’ experiences of, and motivations for, engaging with the therapeutic techniques.

Methods:

We analysed data from a randomised controlled trial testing the effectiveness of UVC-Lite for symptoms of depression and anxiety among university students with mild to moderate levels of psychological distress. Participants (N=487) were randomly assigned to 6 weeks of UVC-Lite or an attention-control program. Quantitative data on skill enactment, depression, and anxiety were collected through baseline, post-intervention, and 3- and 6-month follow-up surveys. Qualitative data were obtained from 29 intervention group participants through open-ended questions during post-intervention surveys (n=17) and semi-structured interviews (n=12) after the intervention period concluded.

Results:

Mixed model repeated-measures analysis of variance demonstrated that the intervention did not significantly improve skill enactment (F3,215.36=0.50, P=.68). Skill enactment was also not found to moderate the effect of the intervention on symptoms of depression (F3, 241.10=1.69, P=.17) or anxiety (F3, 233.71=1.11, P=.35). However, higher levels of skill enactment were associated with lower symptom levels among both intervention and control group participants across time points (depression: F1, 541.87=134.61, P<.001; anxiety: F1, 535.11=73.08, P<.001). Inductive content analysis confirmed low levels of skill enactment among intervention group participants. Participants were motivated to use techniques and skills that were perceived to be personally relevant, easily integrated into daily life, and that were novel or had worked for them in the past.

Conclusions:

The intervention did not improve skill enactment or mental health among students with mild to moderate psychological distress. Low adherence impacted our ability to draw robust conclusions regarding the intervention’s impact on outcomes. Factors influencing skill enactment differed across individuals, suggesting that it may be necessary to tailor therapeutic skills and engagement strategies to the individual user. Theoretically informed research involving collaboration with end users is needed to understand the processes underlying skill enactment in DMHIs. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380146