Harnessing Mobile Technology to Reduce Mental Health Disorders in College Populations (Resubmission)
The prevalence of mental health problems among college populations has risen steadily over the past several decades, and approximately one-third of college students struggle with depression, anxiety, or an eating disorder. Yet, less than 20% of college students with mental disorders receive treatment. Inadequacies in mental health care delivery result in prolonged illness, disease progression, poorer prognosis, and greater likelihood of relapse, highlighting the need for a new approach for detecting mental health problems and providing and engaging college students in services. We have developed a comprehensive, low-cost, population-level mobile health screening and intervention platform for engaging college students with tailored services that address their most common mental health problems. This care delivery system represents an ideal model for service delivery given its use of mobile technology, transdiagnostic approach, and personalized screening and intervention to target service uptake, enhanced engagement, and improved mental health outcomes. Further, our platform harnesses the expertise of our team of leaders in behavioral science, college mental health, technology, and health economics, and bridges our team's work with more than 100 colleges over the past two decades. We propose to test the impact of this mobile mental health platform for service delivery in a large-scale trial across 20 colleges. Students who screen positive for DSM-5 clinical or subclinical depression, anxiety, or an eating disorder or as high risk for one (N=9,200, stratified by disorder) will be randomly assigned to one of two conditions: 1) intervention via the mobile health platform; or 2) referral to usual care (i.e., campus health/counseling center). This study will test between-group differences in uptake of services (Aim 1), reduction of mental health symptoms and improvement of clinical impairment in individuals with a clinical or subclinical disorder (Aim 2a), and reduction of symptom progression and prevention of disorder onset in individuals at high risk for a disorder (Aim 2b). This study will also examine engagement with mental health services as a mediator of outcomes (Aim 3). In an exploratory fashion, we will evaluate stakeholder-relevant outcomes, including cost-effectiveness of the mobile mental health platform compared to usual care (Exploratory Aim 1) and how stakeholder attitudes toward using a mobile mental health platform and perceptions of the actual platform may relate to their intention to use such a mobile mental health platform on their campus following the study, as well as between-group differences in academic impairment and dropout rates (Exploratory Aim 2). We expect that our comprehensive mental health care platform will have clinical benefit to students, appeal to university stakeholders, minimize barriers to implementation sustainability on campuses, and yield an economic return on investment compared to usual care. This population-level approach to service engagement has the potential to improve mental health outcomes for the 20+ million students enrolled in US colleges and universities.
National Institute of Mental Health
Funding Period: 8/23/2018 to 5/31/2023