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.
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Mobile App May Help Prevent Excess Weight Gain in Pregnancy
Key Takeaways:
- A digital intervention combining self-monitoring and personalised feedback helped reduce excess weight gain during pregnancy among women with overweight or obesity
- Participants using the programme gained weight more slowly and were less likely to exceed recommended guidelines compared with standard care
- Greater engagement, particularly consistent self-weighing, was linked to better outcomes
Addressing a common challenge in pregnancy
Weight gain during pregnancy is both expected and necessary. However, gaining more than recommended levels is associated with increased health risks for both the pregnant person and the baby. These risks are particularly pronounced among individuals who are already living with overweight or obesity at the start of pregnancy.
Excess gestational weight gain has been linked to complications such as gestational diabetes and preeclampsia. It also increases the likelihood of pre-term birth and larger birthweight, both of which can complicate delivery and raise the child’s long-term risk of obesity.
In the United States, around half of pregnant individuals with overweight or obesity exceed national guidelines for weight gain, highlighting a persistent challenge in routine prenatal care.
The LEAP programme – a technology-enabled approach
To address this issue, researchers at Kaiser Permanente developed the Lifestyle, Eating, and Activity in Pregnancy (LEAP) programme. The intervention was designed to provide scalable, technology-driven support integrated into everyday clinical care.
The study, published in JAMA Network Open on 20 April, evaluated whether this digital approach could help individuals maintain healthier weight gain trajectories during pregnancy.
“Our results are especially exciting because we intentionally designed the LEAP program to be feasible for widespread implementation,” said first author Monique Hedderson, PhD, principal investigator with the Kaiser Permanente Division of Research (DOR). “This study represents the culmination of years of research on what works well for this high-risk population and how to leverage technology to make those benefits achievable across a health system.”
How the intervention worked
Participants in the LEAP group were provided with a digital scale for home use and a wearable activity tracker, either a Fitbit or their own Apple Watch. These devices were connected to a mobile application that delivered automated, personalised feedback on both weight and physical activity.
The programme also included weekly educational sessions delivered through the app, focusing on realistic and achievable goals related to diet and exercise. In parallel, clinicians received guidance on how to discuss gestational weight gain with patients more effectively.
A key feature of the programme was its adaptive design. Individuals whose weight gain began to accelerate received targeted support, including personalised chat messages from a lifestyle coach. If necessary, this support escalated to telephone consultations.
“About half of patients in the LEAP intervention group managed weight well on their own, but for those inching towards the upper limit of recommendations, LEAP provided extra, targeted support,” said Hedderson. “This conserves resources for patients who need help the most.”
Study design and participant outcomes
The effectiveness of the LEAP programme was assessed across 58 clinicians within Kaiser Permanente Northern California. All pregnant patients with overweight or obesity under their care were invited to participate.
Clinicians were randomly assigned to one of two groups:
- Standard care plus the LEAP intervention
- Standard care alone
In total, 1,256 participants were included in the study. Of these, 677 received the LEAP programme, while 588 received standard care.
Standard care involved providing patients with a newsletter at their first prenatal visit outlining healthy weight gain targets and lifestyle advice. At around 20 weeks, clinicians reviewed weight gain against recommended guidelines.
The results showed clear differences between the groups. Participants in the LEAP programme experienced:
- Lower weekly rates of weight gain
- Lower total weight gain during pregnancy
- Reduced likelihood of exceeding recommended guidelines
In addition, fewer individuals in the LEAP group gave birth to infants classified as large for gestational age.
“This study demonstrates that combining wireless self-monitoring tools with an adaptive digital intervention can make a meaningful difference for patients with overweight or obesity at risk of excess weight gain during pregnancy,” said Kari Carlson, MD, director of women’s health for The Permanente Medical Group. “Importantly, it was tested in routine care, making the findings highly relevant for health systems looking for practical solutions.”
Engagement matters
Although all participants assigned to the LEAP group were included in the analysis, only around half actively engaged with the programme. This reflects real-world conditions, where not all individuals fully participate in digital health interventions.
However, among those who did engage, outcomes were notably stronger. Higher levels of interaction with the programme, particularly consistent self-weighing, were associated with lower overall weight gain.
“When we zoomed in on participants who actually engaged, we found that the more they engaged, especially by weighing themselves consistently, the less weight they gained,” Hedderson said.
Participants could view their weight trends in relation to Institute of Medicine guidelines within the app, a feature that appeared to play a particularly important role in supporting behaviour change.
“This seems to be a particularly effective component of the program,” she said.
Implications for clinical practice
The findings suggest that digital, scalable interventions such as LEAP could offer a practical solution to a longstanding challenge in prenatal care. By integrating self-monitoring tools, automated feedback, and targeted coaching into routine workflows, the programme demonstrates how technology can support both patients and clinicians without increasing burden.
“Excess gestational weight gain among these high-risk patients is a common and challenging issue in routine prenatal care,” said senior author Assiamira Ferrara, MD, PhD, a DOR senior research scientist. “What’s compelling about the LEAP study is that it shows we can support healthier weight gain using scalable, technology-enabled tools that fit within real-world clinical workflows, without adding burden for patients or clinicians.”
Looking ahead
The research team continues to follow participants to assess longer-term outcomes for both parents and children. There is optimism that the LEAP programme could be integrated into routine care in the near future.
“Bottom line, using technology to help patients manage their own health can be effective, and patients tend to like it, too,” Hedderson said.
Funding and research team
The study was funded by the National Institutes of Health.
Additional co-authors included Susan D. Brown, PhD; Charles P. Quesenberry, PhD; Fei Xu, MS; Emily Liu, MPH; Karen L. Li, MPH; Sneha B. Sridhar, MPH; Tali Sedgwick, RDN; Page Kissel, BA; and Hillary D. Serrato Bandera, BA, all from the Division of Research. Mibhali M. Bhalala, MD, contributed from Kaiser Permanente Northern California, and Cheryl Albright, PhD, MPH, contributed from the University of Hawaii at Manoa School of Nursing and Dental Hygiene.
About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts epidemiological and health services research aimed at improving health outcomes and healthcare delivery. With more than 720 staff and approximately 630 active research projects, the division focuses on understanding the determinants of illness and advancing the quality and cost-effectiveness of care.
Source: Kaiser Permanente Division of Research
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