Effectiveness of an Internet- and App-Based Intervention for College Students With Elevated Stress: Randomized Controlled Trial

Research output: Journal contributionsJournal articlesResearchpeer-review

Authors

  • Mathias Harrer
  • Sophia Helen Adam
  • Rebecca Jessica Fleischmann
  • Harald Baumeister
  • Randy Auerbach
  • Ronny Bruffaerts
  • Pim Cuijpers
  • Ronald C. Kessler
  • Matthias Berking
  • Dirk Lehr
  • David Daniel Ebert

Background: Mental health problems are highly prevalent among college students. Most students with poor mental health, however, do not receive professional help. Internet-based self-help formats may increase the utilization of treatment. Objective: The aim of this randomized controlled trial was to evaluate the efficacy of an internet-based, app-supported stress management intervention for college students. Methods: College students (n=150) with elevated levels of stress (Perceived Stress Scale 4-item version, PSS-4 =8) were randomly assigned to either an internet- and mobile-based stress intervention group with feedback on demand or a waitlist control group. Self-report data were assessed at baseline, posttreatment (7 weeks), and 3-month follow-up. The primary outcome was perceived stress posttreatment (PSS-4). Secondary outcomes included mental health outcomes, modifiable risk and protective factors, and college-related outcomes. Subgroup analyses were conducted in students with clinically relevant symptoms of depression (Center for Epidemiological Studies' Depression Scale >17). Results: A total of 106 participants (76.8%) indicated that they were first-time help-seekers, and 77.3% (intervention group: 58/75; waitlist control group: 58/75) showed clinically relevant depressive symptoms at baseline. Findings indicated significant effects of the intervention compared with the waitlist control group for stress (d=0.69; 95% CI 0.36-1.02), anxiety (d=0.76; 95% CI 0.43-1.09), depression (d=0.63; 95% CI 0.30-0.96), college-related productivity (d=0.33; 95% CI 0.01-0.65), academic work impairment (d=0.34; 95% CI 0.01-0.66), and other outcomes after 7 weeks (posttreatment). Response rates for stress symptoms were significantly higher for the intervention group (69%, 52/75) compared with the waitlist control group (35%, 26/75, P<.001; number needed to treat=2.89, 95% CI 2.01-5.08) at posttest (7 weeks). Effects were sustained at 3-month follow-up, and similar findings emerged in students with symptoms of depression. Conclusions: Internet- and mobile-based interventions could be an effective and cost-effective approach to reduce consequences of college-related stress and might potentially attract students with clinically relevant depression who would not otherwise seek help. Trial Registration: German Clinical Trial Register DRKS00010212; http://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010212 (Archived by WebCite at http://www.webcitation.org/6w55Ewhjd).

Original languageEnglish
Article numbere136
JournalJournal of Medical Internet Research
Volume20
Issue number4
Number of pages16
ISSN1439-4456
DOIs
Publication statusPublished - 23.04.2018

Bibliographical note

Funding Information:
The study was partly funded by BARMER, a major health care insurance company in Germany.

Publisher Copyright:
© Mathias Harrer, Sophia Helen Adam, Rebecca Jessica Fleischmann, Harald Baumeister, Randy Auerbach, Ronny Bruffaerts, Pim Cuijpers, Ronald C Kessler, Matthias Berking, Dirk Lehr, David Daniel Ebert.

    Research areas

  • randomized controlled trial, stress, psychological, depression, telemedicine, students, help-seeking behavior
  • Psychology

Documents

DOI

Recently viewed

Publications

  1. Temporal variability in native plant composition clouds impact of increasing non-native richness along elevational gradients in Tenerife
  2. Effects of Soil Properties, Temperature and Disturbance on Diversity and Functional Composition of Plant Communities Along a Steep Elevational Gradient on Tenerife
  3. A cultural approach toward the notion of the instrument
  4. Temporal discrimination as a function of marker duration
  5. Der Strukturgitter-Ansatz
  6. Contributions of Net-Map to sustainability action research
  7. Work Design and Performance
  8. Rechtschreiben unterrichten
  9. Entry, Exit and Productivity
  10. It Matters to Whom You Compare Yourself
  11. 'I Cannot Overreach the Senate': Orienting to the Macro-Context of Legislative Debates of the Nigerian Senate
  12. Psychophysiological Correlates of Flow-Experience
  13. Polarization of Time and Income - A Multidimensional Analysis for Germany
  14. Chagga women´s connections with nature: fostering relationality through arts-based methods
  15. Freiheit in Liebe. Eine Einführung
  16. What Does it Mean when Burma is a Sideshow in World Politics
  17. Coupling stakeholder assessments of ecosystem services with biophysical ecosystem properties reveals importance of social contexts
  18. Special Issue: Embracing Contrarian Thinking
  19. Business model patterns of sustainability pioneers - Analyzing cases across the smartphone life cycle
  20. Einführung in das Buch
  21. Unobtrusive Vital Sign Acquisition in the Domain of AAL
  22. The effects of differentiated instruction on teachers’ stress and job satisfaction