Cognitive Behavioral Therapy for Depression Among College Students: A Systematic Review Comparing Delivery Methods and Duration in Randomized Controlled Trials

Background and Purpose: Depression is a prominent mental health concern across college campuses with 45% of U.S. college students experiencing difficulty functioning as a result of their depression (ACHA-NCHA, 2019). Cognitive Behavioral Therapy (CBT) has emerged as an effective intervention in reducing depression symptoms among college-aged young adults. However, there have been no reviews of CBT for depression in this population that investigate study rigor and compare delivery methods and duration. With a growing demand for scalable mental health interventions across college campuses, this review is timely and helps fill a gap in existing research. Accordingly, this review addressed the following questions: 1) What interventions are most effective in reducing depression in college-aged young adults in RCTs: in-person versus digital; brief (≤ 4 weeks) versus extended (≥ 6 weeks), and 2) What are the methodological strengths and weaknesses of these studies?

Methods: A systematic search of 16 databases was conducted to identify peer-reviewed publications. The inclusion criteria were: a) written in English, b) empirical evaluation of an intervention conducted within the U.S., c) a program of CBT for the treatment of depression, d) RCT design, e) depression as an outcome variable, and f) sample comprised of college students only. The Methodological Quality Rating Scale (summary score of 11 items) was adapted from Auslander et al. (2012) to assess the rigor of each study. Outcome significance was used to compare effectiveness of each intervention by delivery method and duration.

Results: The initial search yielded 169 studies. Twelve studies met inclusion criteria. Intervention types were categorized in two ways: in-person (n=7) versus digital (n=5), extended (n=9) versus brief (n=3). Six of the 12 studies found significant positive reductions in depression among college students. Comparing delivery methods, 29% (n=2) of the in-person interventions were effective in reducing depression, and 80% (n=4) of the digital interventions effectively reduced depression. Comparing duration, 33% (n=3) of the extended interventions were effective in reducing depression while 100% (n=3) of the brief interventions effectively reduced depression. Methodological rigor of studies was high, with 92% of studies falling at or above the median (9) on a 12-point scale (M= 9.66, SD = 1.15). Methodological strengths include treatment integrity (n=12), appropriate discussion of dropouts (n=10), and adequate power to detect differences in outcomes (n=8). Less than 50% of studies were multi-site designs, and only 33% reported blinding of data collectors.

Conclusions and Implications: Digital CBT interventions demonstrated stronger evidence for reducing depression among college students compared to in-person interventions, and brief CBT interventions were equally as effective as those of longer duration. Both digital and brief CBT interventions may be more cost-effective, and therefore more easily disseminated. Due to the relatively small number of studies in this review, more RCT studies that evaluate the effectiveness of both digital and brief interventions with college students are needed to confirm the findings of this review. Rigor was high for RCT studies in this review. However, there are methodological areas, such as blinding and multi-site trials, which deserve continued attention in future research.