Mental health services are in high demand in colleges as rates of depression and other psychological disorders have been increasing over the past decades. To meet the demand, online mental health services are quite promising as students seek more services online. However, little is known about whether subclinical college students will be more willing to accept and benefit from online counseling or digital solutions only to improve their mental health. This pilot study aims to assess the efficacy of a mobile mental health support system and to compare its synchronous and asynchronous communication with licensed mental health therapists to improve psychological well-being among college students.
A total 57 college students participated in this 10-week study. By conducting a cross-over research design, 30 participants were randomly assigned to Group A (beginning with 5 weeks of online counseling session (CS) followed by 5 weeks of participation in an online forum session (FS)) and 27 assigned to Group B (beginning with 5 weeks of FS followed by 5 weeks of CS). Participants completed a depression and anxiety screening scale (PHQ-4), General Anxiety Disorder inventory (GAD-7), Depression symptom inventory (PHQ-9), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), the Work and Social Adjustment scale (WSAS), and the Helping Alliance Questionnaire (HAQ-11) at the beginning and end of each session. Repeated measures paired t-test analyses were performed with the set of outcomes at four time points (weeks 1, 5, 6 and 10) and between-group comparisons were conducted.
The program withdrawal rate was higher in CS session than in FS session. Of the participants in Group A, 21 out of 30 (70%) participants withdrew during the CS session; during the FS session 3 out 9 (33%) of the participants withdrew. For Group B 15/27 (55%) withdrew during the FS; during the CS 9/12 (75%) withdrew. Almost all withdrawals occurred before the first week of a new session. For Group A, but not for Group B, those who withdrew reported a higher baseline psychological QoL than those who remained in the study. The pre-post improvement (at alpha = 0.1) was found for Group A during CS, including PHQ-4 (t=1.89, p=.095), GAD-7 (t=2.29, p=.051), psychological QoL (t=-2.18, p=.061) and HAQ-11(-1.95, p=.087). For Group A during FS or for Group B either during FS or CS sessions no pre-post change was found. Between-group differences were found in the first five weeks: psychological QoL improved (F=3.53, p=.076) and WSAS worsened (F=3.48, p=.078) for the CS intervention.
This study suggests a small improvement of psychological well-being by implementing online mental health counseling services. Limitations include high attrition rate and potential carryover effect. Higher attrition prior to starting their first counseling session might indicate that the students were intimidated by an unknown counselor and time commitment. Interactions on an online forum were more acceptable to college students but no clinical benefits were observed. Future research is needed to explore effective ways to facilitate students’ acceptance of online therapy and to understand students’ perceptions of online mental health services.