JMIR Publications

ABSTRACT

Background:

University communities, especially in low-resource settings like Peru’s Andean region, experience high rates of depression, anxiety, and stress that harm academic performance and well-being. Traditional mental health services often remain inaccessible, creating a need for scalable, self-guided solutions. While digital mental health interventions have shown promise broadly, evidence is scarce for fully self-administered platforms in low resource university environments.

Objective:

We aimed to evaluate the efficacy of a self-administered digital mental health service in members of a public university to reduce symptoms of depression, anxiety, and perceived stress.

Methods:

We conducted a double-blind, parallel-group randomized controlled trial with 1:1 allocation to the DMHSS or a 30-day waiting-list control. Recruitment in May–June 2024 yielded 427 eligible participants (students, teachers, administrative staff) reporting mild to moderate symptoms of depression, anxiety and stress. Participants were randomized via simple randomization and blinded through automated platform assignment. The intervention comprised six sequential five-day modules grounded in Acceptance and Commitment Therapy, mindfulness, and behavioral activation, delivered via videos, daily text prompts, workbooks, and a responsive chatbot. SMS/WhatsApp reminders promoted adherence. Depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), and perceived stress (PSS-10) were assessed at baseline and immediately post-intervention (day 30). Secondary outcomes in the intervention arm included usability (CSUQ), satisfaction (CSQ-8), and subjective commitment (TWEETS). Analysis of covariance (ANCOVA) adjusted for baseline scores, and multivariate ANCOVA accounted for correlations among outcomes. Effect sizes were quantified using Cohen’s d and partial epsilon-squared (ε²ₚ).

Results:

Of 427 randomized, 85 (19.9%) completed all assessments (intervention n=30; control n=55). Baseline demographic and clinical characteristics were comparable between groups. Post-intervention, the DMHSS group exhibited significantly greater reductions in mean PHQ-9 scores (mean difference 2.78; Cohen’s d 0.64; p=0.006), GAD-7 scores (2.13; d 0.56; p=0.015), and PSS-10 scores (4.08; d 0.69; p=0.003) compared to controls. ANCOVA confirmed robust group effects for depression (F₁,₈₂ = 9.78; p=0.002; ε²ₚ = 0.31) and anxiety (F₁,₈₂ = 8.28; p=0.005; ε²ₚ = 0.32), with a trend toward stress reduction (F₁,₈₂ = 3.73; p=0.057; ε²ₚ = 0.46). MANCOVA demonstrated a significant multivariate effect (F₄,₁₂ = 7.23; p=0.015). Among intervention completers, 100% scored below the CSQ-8 satisfaction threshold (<24), 60% rated platform usability as low (CSUQ < 64), yet 96.7% reported high subjective commitment (TWEETS ≥ 18), indicating strong engagement despite interface challenges.

Conclusions:

A self-administered digital self-care service effectively reduced depression, anxiety, and stress symptoms in a Peruvian university community. High user commitment underscores the platform’s relevance, while low satisfaction and usability highlight the need for interface optimization—such as streamlined navigation, adaptive personalization, and feedback mechanisms—to enhance user experience and support scalable implementation in low-resource educational settings. Clinical Trial: The clinical trial protocol was registered on the OSF platform (https://osf.io/m4epv/).