JMIR Publications

ABSTRACT

Background:

University represents transition period for students that often coincides with the emergence of mental health and substance use challenges. Digital interventions have been identified as a promising means of supporting students due to their scalability, adaptability and acceptability. Minder is a mental health and substance use mobile application that was co-developed with university students.

Objective:

To examine the effectiveness of the Minder mobile app in improving mental health and substance use outcomes in a general population of university students.

Methods:

A 2-arm parallel assignment single-blinded 30-day RCT was used to evaluate Minder using an intention-to-treat analysis. 1489 participants were recruited from the university and randomly assigned to the intervention condition (n=743) or the waitlist control condition (n=746). The Minder app delivers evidence-based content through an automated chatbot and connects participants with services and social groups at the university. Participants are also provided a trained peer coach to support them throughout the trial. The primary outcomes were measured through in-app self-assessments and include changes in general anxiety symptomology, depressive symptomology, and alcohol consumption risk measured by the General Anxiety Disorder 7-Item scale (GAD-7), Patient Health Questionnaire 9-Item scale (PHQ-9), and US Alcohol Use Disorders Identification Test-Consumption Scale (USAUDIT-C) from baseline to follow-up at 30 days. Secondary outcomes included measures related to changes in the frequency of substance use (cannabis, alcohol, opioids, and non-medical stimulants), and mental well-being. Generalized linear mixed-effect models were used to examine each outcome.

Results:

80% of participants in the intervention group (n=589) and 83% of participants in the control group (n=619) completed the follow-up survey. The intervention group had significantly greater average reductions in anxiety symptoms measured by the GAD-7 (adjusted group mean difference = -0.85, (95% Confidence Interval (CI) -1.27, -0.42), Cohen’s d= -0.17) and depressive symptoms measured by the PHQ-9 (adjusted group mean difference = -0.63 (95% CI -1.08, -0.17), Cohen’s d= -0.11). A reduction on the USAUDIT-C among intervention participants was also observed but was not significant. Statistically significant differences in favour of the intervention group were found for mental wellbeing and reductions in the frequency of cannabis use and typical number of drinks consumed when drinking. 496 participants from the intervention group (67%) accessed at least one app component during the study period.

Conclusions:

In a general population sample of university students, the Minder app was effective in reducing symptoms of anxiety and depression with provisional support for increasing mental wellbeing and reducing frequency of cannabis and alcohol use. These findings highlight the potential ability for e-tools focused on prevention and early intervention to be integrated into existing university systems to support student needs. Clinical Trial: ClinicalTrials.gov NCT05606601; https://clinicaltrials.gov/ct2/show/NCT05606601