Mental Health in Higher Education: Can a Digital Strategy Help?

Many young adults in higher education face substantial adjustments throughout their undergraduate years. Epidemiologically, early adulthood (18–25 years old) is the peak age at which serious mental health disorders emerge. Moreover, many of these students experience situational depression as they transition to higher education. During this time, they have to largely replace parental support with peer support structures—a challenge that is compounded by academic pressure. Given these factors, along with increased awareness of mental health, the percentage of students reporting mental health disorders has risen precipitously. Data from the American College Health Association in 2019 indicate that one in three college students reported some kind of mental health disorder and more than 40 percent sought mental health treatment at some point within the four years of their undergraduate education. For comparison, only one in ten students reported a mental health disorder in the early 2000s.¹

With this increased prevalence of reported mental health disorders and expectations on the part of students and parents for accessible treatment, higher education institutions have been scrambling to provide more services with limited mental health staff, time, and overall resources. As a result, they have been innovative. In addition to offering individual therapy including cognitive behavioral therapy, many often offer group therapy, which can be an effective and efficient way to reach more students with extant, finite resources.

Despite the increased awareness of mental health, some students still do not seek needed treatment. In particular, students who feel a stigma associated with having mental health issues or using services may depend on family and friends in lieu of formal services. Studies have indicated that male students, students of color, and international students have less positive health-seeking attitudes than their counterparts and thus have lower utilization, despite ongoing needs.² Hence, addressing the problem of making mental health services accessible to students requires finding ways to deliver services with less stigma, particularly for some groups.

Technology may help expand mental health services to those who seek support and may also help reach students who otherwise resist seeking treatment—particularly since students are already connected to technology during much of their school hours. Although some studies have warned that overuse of technology and social media may put students at risk for added stress and feelings of social isolation,³ it is also possible that technology can offer a new access point for students looking for mental health support. Key to success in this area will be ensuring that technology is applied for both prevention and treatment, as both are necessary to effectively address mental health issues. For instance, the University of Michigan has implemented a YouTube channel focusing on mental health; the channel has over 70,000 views. This success is consistent with contemporary research, which has shown that a majority of college and university students surveyed were willing to use online mental health services.⁴ Online outreach to students could improve access to information regarding mental health, promote healthy coping strategies, encourage help-seeking behaviors, and generally improve the campus climate around mental health.

Digital mental health encompasses mental health information, teaching, and interventions that are delivered via internet websites and mobile apps. These interventions can be offered alone or in concert with professional support. The technologies are convenient and highly accessible. Moreover, they offer complete privacy, mitigating some forms of stigma, particularly for students who are reluctant to use in-person services. A recent meta-analysis of digital interventions concluded that they can be effective in improving depression, anxiety, and stress levels in students.⁵ Many may prefer mobile methods of treatment and monitoring, as might be expected given their digital literacy, and digital mental health can be offered alone or in concert with professional support.

In addition to using texting or traditional internet technology, digital mental health services can also be packaged with wearable devices for ambulatory assessment of needs. Such apps might have built-in sensors to collect information on typical behavior patterns and to signal detected behavioral changes that may be concerning (e.g., changes in voice or speech tone, disturbances in sleep patterns, changes in typing speed or general activity levels). Some apps are stand-alone programs that focus on improving knowledge, memory, or thinking skills; other apps can be used to connect students to a peer counselor or to a health care professional.

For students who are having trouble adjusting to college, digital technologies that apply principles of positive psychology can help increase resilience, happiness, and well-being.⁶ Some tools deliver interventions online as individual exercises and present users with daily sets of activities. A recent randomized, controlled trial evaluated the efficacy of using an app that focused on techniques grounded in positive psychological interventions (e.g., gratitude, kindness, strengths-building), cognitive-behavioral therapy, and/or mindfulness-based stress-reduction techniques. Participants who used the app for two or three activities per week over an eight-week period showed post-intervention decreases in anxiety and depression and increases in resilience, compared with an online psychoeducational learning comparison group.⁷

Internet Cognitive Behavioral Therapy (iCBT) also shows promising results. With iCBT, participants use their home computers to review psychoeducational material and practice CBT exercises. Such programs teach participants core cognitive skills (e.g., recognizing affective biases in information processing), as well as behavioral skills (e.g., problem-solving strategies). iCBT can include informational and supportive automated emails, brief weekly phone calls with a therapist providing encouragement and clarification of exercises, text-based communication, and longer web-based CBT sessions. Although iCBT involves a therapist, the therapist's time is far less than would be required in traditional face-to-face methods. In randomized controlled trials, iCBT has been shown to have approximately equivalent efficacy as face-to-face CBT.⁸

Although the evidence base for digital mental health interventions for college and university students remains limited, current meta-analyses suggest that digital mental health technologies can improve depression, anxiety, and stress levels.⁹ Given this early favorable outcome data, larger and more rigorous studies with longitudinal follow-up are warranted. Better data on which interventions are most effective for which groups of students would be particularly helpful, so that digital mental health programs can be tailored to maximize student engagement and learning.

With growing interest in mental health technologies, researchers are evaluating potential drawbacks and are offering solutions. Some adverse effects reported by clients include technical difficulties, dissatisfaction, and implementation problems—although these negative aspects can be minimized with therapist support to address concerns, provide feedback, and facilitate understanding. Further research will be needed to evaluate these unintended negative effects and other potential concerns, including data privacy and the regulation of mental health technologies.

Technology-based interventions could revolutionize mental health care in higher education. With innovative approaches, colleges and universities can envision new intervention paradigms that build on traditional models to improve mental health and well-being in the lives of their students.

Notes

1. American College Health Association, National College Health Assessment II: Reference Group Executive Summary, Fall 2009 (Linthicum, MD: ACHA, 2009); American College Health Association, National College Health Assessment II: Undergraduate Student Executive Summary, Spring 2019 (Silver Spring, MD: ACHA, 2019). ↩
2. D. Eisenberg et al., "Mental Health Service Utilization among College Students in the United States," Journal of Nervous and Mental Disease 199, no. 5 (2011); S. K. Lipson et al., "Mental Health Disparities among College Students of Color," Journal of Adolescent Health 63, no. 3 (2018); A. Masuda, P. L. Anderson, and S. T. Sheehan, "Mindfulness and Mental Health among African American College Students," Complementary Health Practice Review 14, no. 3 (2009); A. Masuda et al., "Help-Seeking Experiences and Attitudes among African American, Asian American, and European American College Students," International Journal for the Advancement of Counselling 31, no. 3 (2009); J. Twentyman, M. Frank, and L. Lindsey, "Effects of Race and Ethnicity on Mental Health and Help-Seeking amongst Undergraduate University Students," Journal of Undergraduate Ethnic Minority Psychology 3 (2017). ↩
3. J. M. Twenge, G. N. Martin, and W. K. Campbell, "Decreases in Psychological Well-Being among American Adolescents after 2012 and Links to Screen Time during the Rise of Smartphone Technology," Emotion 18, no. 6 (2018). ↩
4. M. S. Dunbar et al., "Unmet Mental Health Treatment Need and Attitudes toward Online Mental Health Services among Community College Students," Psychiatric Services 69, no. 5 (2018); S. March et al., "Attitudes toward e-Mental Health Services in a Community Sample of Adults: Online Survey," Journal of Medical Internet Research, 20, no. 2 (2018). ↩
5. E. B. Davies, R. Morriss, and C. Glazebrook, "Computer-Delivered and Web-Based Interventions to Improve Depression, Anxiety, and Psychological Well-Being of University Students: A Systematic Review and Meta-Analysis," Journal of Medical Internet Research 16, no. 5 (2014). ↩
6. S. M. Schueller and A. C. Parks, "Disseminating Self-Help: Positive Psychology Exercises in an Online Trial," Journal of Medical Internet Research 14, no. 3 (2012); D. Yaden, J. C. Eichstaedt, and J. D. Medaglia, "The Future of Technology in Positive Psychology: Methodological Advances in the Science of Well-Being," Frontiers in Psychology 9, no. 962 (2018); L. S. Wachsmuth, T. Y. Tan, and M. M. Tugade, "Examining Life As It Is Lived: Experience Sampling Methodology for Positive Psychology Intervention Research," Journal of Positive Psychology (in press, May 2020). ↩
7. A. C. Parks et al., "Testing a Scalable Web and Smartphone-Based Intervention to Improve Depression, Anxiety, and Resilience: A Randomized Controlled Trial," International Journal of Wellbeing 8, no. 2 (2018). ↩
8. G. Andrews et al., "Computer Therapy for the Anxiety and Depression Disorders Is Effective, Acceptable and Practical Health Care: An Updated Meta-Analysis," Journal of Anxiety Disorders 55 (2018);  P. Carlbring et al., "Internet-Based vs. Face-to-Face Cognitive Behavior Therapy for Psychiatric and Somatic Disorders: An Updated Systematic Review and Meta-Analysis," Cognitive Behavioral Therapy 47, no. 1 (2019). ↩
9. Davies, Morriss, and Glazebrook, "Computer-Delivered and Web-Based Interventions." ↩

Elizabeth H. Bradley is President and Professor of Science, Technology, and Society and Political Science at Vassar College.

Michele M. Tugade is Professor in the Department of Psychological Science at Vassar College.