Digital Therapy Outperforms Campus Clinic Referrals Among College Students

Key Takeaways:

• College students who received a digitally delivered therapy programme were significantly more likely to engage with treatment than those referred to campus counselling services.
  
• Students using the digital intervention were more likely to be symptom free at six weeks, six months and two years after the intervention.
  
• Researchers found the app-based approach not only treated existing mental health disorders but also appeared to help prevent new disorders from developing in students considered at high risk.
  
  
  

A digital alternative to traditional campus counselling

A large U.S. study led by researchers at Penn State has found that college students living with anxiety, depression and eating disorders may benefit more from a digitally delivered therapy programme than from referrals to traditional campus counselling clinics.

Published in Nature Human Behaviour, the study examined whether a proactive digital mental health intervention could improve treatment uptake and mental health outcomes among university students at a time when demand for psychological support services continues to rise sharply.

Researchers noted that between 40% and 60% of college students globally experience a mental health disorder at some stage during their academic life. At the same time, many universities have struggled to expand counselling services quickly enough to meet growing demand.

The research team therefore investigated whether a digitally delivered therapy app based on cognitive behavioural therapy (CBT) principles could provide a scalable and effective alternative to standard referrals for in-person support.

How the digital therapy programme worked

The commercially available app used in the study incorporated CBT-based techniques designed to help individuals identify unhelpful thinking patterns and develop behavioural strategies to manage them.

Students assigned to the digital intervention received access to structured therapeutic modules together with support from trained therapy coaches. The programme offered six to eight modules for each mental health condition, with each module lasting approximately 20 minutes.

Participants in the digital therapy group completed an average of 2.4 modules and received roughly 15 supportive messages from a trained coach during the intervention period.

According to the researchers, students initially focused on modules related to their primary mental health concern before progressing to additional modules targeting co-occurring conditions.

Lead author Michelle Newman, professor of psychology and psychiatry at Penn State, said the team was particularly interested in whether students would meaningfully engage with the digital intervention.

“One of the challenges with any digital intervention is that people sometimes download an app but then do not use it,” said Newman.

“We were also interested in learning the extent to which people actually received services after being randomized to the app or on-campus counseling center. We found that uptake was significantly better in the digital intervention than referral to the counseling center.”

Digital intervention achieved much higher service uptake

One of the clearest findings from the study was the substantial difference in treatment engagement between the two groups.

Researchers found that service uptake was seven times higher among students assigned to the digital intervention compared with those referred to campus counselling centres.

Approximately 74% of participants who received access to the app began the programme. By comparison, only 30% of those referred to university counselling services received at least one therapy session or obtained a new prescription for medication.

The researchers said this suggested that digital interventions may lower some of the practical or psychological barriers that prevent students from accessing conventional mental health support.

Large population-level screening across 26 universities

To conduct the study, researchers partnered with 26 colleges and universities across the United States and used what they described as a population-level recruitment strategy.

Emails inviting participation in a mental health screening were sent to entire student bodies across participating institutions.

A total of 39,194 individuals completed the initial screening. Of these, 6,205 students either had clinical levels of mental health disorders or were identified as being at high risk of developing them.

The disorders assessed included:

• Generalized anxiety disorder
• Panic disorder
• Social anxiety disorder
• Depression
• Eating disorders

Eligible participants then completed a baseline survey before being randomly assigned to one of two groups. One group received six months of access to the coached digital intervention, while the second group received referrals to their campus counselling centres.

Improvements were observed across multiple timepoints

The researchers reported that students using the digital intervention were more likely to be symptom free than students in the campus referral group at every follow-up stage assessed in the study.

Compared with students referred to campus services, participants using the app showed:

• A 4.3% lower prevalence of any mental health disorder at six weeks
• A 4.9% lower prevalence at six months
• A 3.8% lower prevalence at the two-year follow-up

The findings suggested that the digital intervention both treated existing disorders and reduced the likelihood of new disorders emerging over time.

Newman said one distinctive feature of the study was its focus on multiple mental health conditions simultaneously.

“A unique aspect of the work was that we screened for five disorders—generalized anxiety disorder, social anxiety disorder, panic disorder, depression and eating disorders—and measured all disorders at every point in the treatment, because we know that disorders like depression and anxiety often co-occur, but that co-occurrence doesn’t necessarily happen simultaneously,” Newman said.

“The digital intervention overall had a significantly larger number of individuals who had no disorders at every timepoint in the study. We did not just treat individuals with clinical levels of these disorders, but we also prevented the onset in more of those in the digital intervention who screened to be at risk.”

Study conducted during the COVID-19 pandemic

The research took place during the COVID-19 pandemic, with recruitment occurring between October 2019 and November 2021. Data collection was completed by October 2023.

The researchers said the timing highlighted the potential value of digital mental health interventions during periods when access to face-to-face services may be disrupted or limited.

However, Newman suggested the approach could remain valuable well beyond the pandemic and may have applications outside university settings.

“This approach could potentially be used anywhere where you have access to a full population in terms of email addresses, like at a company, to help disseminate mental health services that people might not think about seeking,” she said.

She added that proactive screening could help identify individuals who are both living with mental health disorders and those at high risk of developing them before conditions worsen.

Future research will explore personalised digital mental health support

The next phase of the research will focus on identifying which individuals are most likely to benefit from digital mental health interventions.

Newman said future work, led alongside Penn State graduate student Adam Calderon, will analyse data from the current study and earlier projects conducted by Newman’s laboratory to better understand the personal characteristics that predict successful outcomes with digital therapy approaches.