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TOPLINE:

Screening followed by guided self-help using digital cognitive-behavioral therapy (CBT) was linked to a substantially reduced risk for mental disorders such as depression, anxiety, and eating disorders (EDs) in college students compared with screening and referral to college-provided care, a new study showed.

METHODOLOGY:

• A randomized controlled superiority trial was conducted across 26 US colleges between 2019 and 2021 and included more than 6200 adult undergraduate students who screened at clinical levels of or high risk for anxiety, depression, and/or EDs.
• About half of the participants were randomly assigned to receive screening and digital CBT-guided self-help, and the other half received screening and referral to college-provided care (control group).
• The digital CBT group received access to three evidence-based guided CBT programs hosted on a mobile platform for 6 months, with each program addressing one mental health problem (anxiety, depression, or EDs), delivered across six to eight modules lasting approximately 20 minutes each and supported by trained coaches.
• The primary outcome was reduced prevalence of any mental disorder at 6 weeks, 6 months, and 2 years, assessed using self-reported validated questionnaires. Secondary outcomes included increased uptake of mental health services along with improvements in dimensional disorder-specific symptoms and quality-of-life (QOL) measures.

TAKEAWAY:

• The digital CBT group had a lower risk for any mental disorder at 6 weeks (odds ratio [OR], 0.80; P < .001), 6 months (OR, 0.77; P < .001), and 2 years (OR, 0.82; P = .002) than the control group.
• The odds of mental health services uptake were nearly seven times higher in the intervention group than in the control group at 6 months (OR, 6.72), which stayed significant at 2 years (OR, 1.83). There was also a higher likelihood of uptake across all subgroups, including non-White, Hispanic or Latino, nonheterosexual, or first-generation students and those with high financial hardship.
• The digital CBT group showed significantly greater reductions in symptoms of depression at 6 weeks (difference in mean change [DMC], -1.08), 6 months (DMC, -0.66), and 2 years (DMC, -0.41); generalized anxiety at 6 weeks (DMC, -0.35); social anxiety and EDs at 6 weeks (DMCs, -0.49 and -0.16, respectively) and 6 months (DMCs, -0.39 and -0.19); and mental health-related QOL at 2 years (DMC, 0.71).
• There were no significant between-group differences for symptoms of panic disorder at any timepoint.

IN PRACTICE:

The investigators of the study noted that the results support “the transdiagnostic prevention and intervention benefits” of digital CBT.

The intervention “reduced the population prevalence of mental disorders, lowered symptom severity across multiple domains, and produced the largest early improvements among students with clinical-level presentations,” they added.

SOURCE:

The study was led by Michelle G. Newman, PhD, The Pennsylvania State University, University Park, Pennsylvania. It was published online on May 7 in Nature Human Behaviour.

LIMITATIONS:

Participants’ engagement with the digital intervention was relatively low and brief. The study was conducted during the COVID pandemic period, which may have affected both the availability of usual care and the demand for digital mental health tools. Participation was voluntary through population-wide email invitations, which may have introduced self-selection bias. Additionally, the intervention did not include facilitated interoceptive exposure, a core component of effective panic disorder treatment.

DISCLOSURES:

The study was funded by the National Institute of Mental Health. Disclosure information for the study investigators is available in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.