Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 21, 2024
Open Peer Review Period: Oct 22, 2024 - Dec 17, 2024
Date Accepted: Dec 10, 2024
(closed for review but you can still tweet)
Trends in Mental Health Outcomes in College Students Amid the Pandemic: A 3-Year mHealth App-Based Longitudinal Study
ABSTRACT
Background:
The mental health crisis among college students intensified amid the COVID-19 pandemic, suggesting an urgent need for innovative solutions to support them. Previous efforts to address mental health concerns have been constrained, often due to the underutilization and/or shortage of services. Mobile health (mHealth) technology holds significant potential for providing resilience-building support and enhancing access to mental health care.
Objective:
This study aimed to observe outcomes in health-related quality of life (HRQOL) among college students as the COVID-19 pandemic progressed over a three-year period, and whether the use of a positive psychology-based mHealth app (Roadmap app) was associated in these outcomes.
Methods:
A longitudinal study was conducted remotely from a large public academic institution in the Midwestern United States, evaluating mental health and well-being outcomes among college students using the Roadmap mHealth app over three fall semesters from 2020 to 2022. The study enrolled 2,164 college students in Year I, with 1,128 and 1,033 students returning in Years II and III, respectively. Participants completed various self-reported measures, including PHQ-9 for depression, GAD-7 for anxiety, and additional metrics for coping, flourishing, and loneliness.
Results:
Results indicated an evolving trajectory in students' mental health. Depression and anxiety levels were stable between Year I and Year II, later showing significant improvements by Year III (from Year I to Year III; P=0.005 and P=0.046, respectively). Problem-focused coping initially decreased from Year I to Year II (P<0.01), then increased between Years II and III (P=0.024), while emotion-focused and avoidant coping decreased continuously across all study years (from Year I to Year III; P<0.001 and P=0.02, respectively). Furthermore, decreases in loneliness (from Year I to Year III; P<0.001) were accompanied by increases in flourishing (from Year I to Year III; P<0.001). App usage analysis revealed that activities, such as Positive Piggy Bank and Gratitude Journal were most favored. Greater app engagement was positively correlated with enhanced flourishing, after adjusting for demographic and socio-behavioral characteristics (P=0.03).
Conclusions:
Over the three years, students' mental health and well-being improved, with notable reductions in depression, anxiety, and loneliness, associated with an increase in flourishing. The Roadmap mHealth app did not appear to worsen mental health outcomes for students. Based on the usage pattern, it is possible the app enhanced positive psychology-based practices. Future research should explore the efficacy of similar mHealth interventions through randomized controlled trials to further understand their impact on college students' mental health outcomes. Clinical Trial: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.