Harrer, M., S. Adam, H. Baumeister, P. Cuijpers, E. Karyotaki, R. Auerbach, R. Kessler, R. Bruffaerts, M. Berking, and D. Ebert. 2019. “Internet Interventions for Mental Health in University Students: A Systematic Review and Meta-Analysis.” International Journal of Methods in Psychiatric Research 28 (2019): 1–18.
CENTRAL TAKEAWAY
While internet-based psychological interventions are not sufficient replacements for in-person therapies in the treatment of student mental health disorders, they can be a cost-effective alternative, potentially reducing strain on university psychological service providers.
SUMMARY
Students increasingly report mental health disorders; however, universities often struggle to provide adequate treatment and management. Furthermore, such treatment is often costly in terms of personnel and time. Due to their low cost and potential scalability, using internet-based interventions to provide some forms of treatment has been an active area of research over the past two decades. However, overall trends in the research are unclear, and study results are sometimes the product of biased or inadequate methods. These factors make it very difficult for institutional leaders to understand which interventions may be effective and what form they should take.
To address these concerns, this study examined the efficacy of a wide range of internet-based psychological interventions on the mental health of university students. The authors collected 48 high-quality randomized controlled trials. These trials all used samples of students that self-selected into the research, as this most closely mirrors the way in which institutions often provide resources to students (i.e., open to all, but requiring student action to initiate). The results of the meta-analysis were attentive to publication bias, evaluated the rigor of each study, and re-ran estimations with and without including studies with improbably large effect sizes.
DISCUSSION OF THE FINDINGS
Overall, the research literature on internet-based mental health interventions demonstrates moderate efficacy in treating eating disorders and improving student academic, social, or work functioning; however these outcomes remain understudied. The authors suggest that research in this area tends to center on interventions treating depression, anxiety, and stress and has found small intervention effects on these disorders. Finally, the interventions appear to have no effect on student wellness.
For depression and anxiety, effects are stronger when the interventions are based on Cognitive Behavioral Therapy techniques, are four to eight weeks in length, and if the students are identified for inclusion by having symptom severity scores that are above a cut-off point, or due to having high risk factors for the conditions. Researchers suggest that AI systems may be useful in helping to identify students that would most benefit from such interventions. Aspects that make the interventions especially ineffective seem to be using treatment methods like skill training, and using interventions that last fewer than four weeks.
The research is also clear that intervention effects on depression, anxiety, and stress are much weaker in university students than in other populations. Researchers postulate that this might be due to the internet delivery method, but whatever the reason, the small effect size makes the study authors question “the clinical usefulness of treating depressive symptoms in students using internet-based approaches” (p. 17).
IMPLICATIONS FOR ACTION BY CAMPUS LEADERS
Internet-based mental health interventions are potentially helpful, but are not a silver-bullet solution. That they appear less effective than in-person treatment is especially important for decision makers. Depending on the size of the institution, and the specific breakdown of mental health disorders their students usually manifest, it may be more responsible to invest the time and money into traditional mental health support options. Nonetheless, it could be a useful alternative to current mental health delivery modes, and the portability and scalability of internet-based interventions may allow institutions to collaborate to share costs and benefit from economies of scale.
If implemented, it seems vitally important that the interventions be thoughtfully designed, using the most effective practices documented in this study. To reiterate, effective interventions are based on Cognitive Behavioral Therapy techniques, are four to eight weeks in length, identify students for inclusion by having symptom severity scores that are above a cut-off point, or due to having high risk factors for the conditions or depression and anxiety.
ABOUT THE AUTHORS
Mathias Harrer is a researcher at the Technische Universität München.
Sophia Adam is a research assistant in the Department of Clinical Psychology and Psychotherapy at Friedrich-Alexander University at Erlangen-Nuremberg.
Harald Baumeister is a professor and head of the Department of Clinical Psychology and Psychotherapy at Universität Ulm.
Pim Cuijpers is a professor in the Department of Clinical, Neuro-, and Developmental Psychology at Vrije Universiteit Amsterdam.
Eirini Karyotaki is an associate professor in the Department of Clinical, Neuro-, and Developmental Psychology at Vrije Universiteit Amsterdam.
Randy Auerbach is a professor in the Department of Psychiatry at Columbia University.
Ronald Kessler is the McNeil Family Professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School.
Ronny Bruffaerts is a professor in the Universitair Psychiatrisch Centrum in Katholieke Universiteit Leuven.
Matthias Berking is a professor in the Department of Clinical Psychology and Psychotherapy at Friedrich-Alexander University Erlangen-Nuremberg.
David Ebert is a professor of psychology and digital mental health care at the Technische Universität München.
RECOMMENDED FOLLOW-UP LITERATURE
Auerbach, R. P., J. Alonso, W. G. Axinn, P. Cuijpers, D. D. Ebert, J. G. Green, … R. Bruffaerts. “Mental Disorders among College Students in the World Health Organization World Mental Health Surveys.” Psychological Medicine 46 no. 14 (2016): 1–16. https://doi.org/10.1017/ S0033291716001665