Date on Master's Thesis/Doctoral Dissertation

8-2022

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Health Promotion and Behavioral Sciences

Degree Program

Public Health Sciences with a specialization in Health Management, PhD

Committee Chair

Creel. Liza

Committee Co-Chair (if applicable)

Karimi, Seyed

Committee Member

Karimi, Seyed

Committee Member

Johnson, David

Committee Member

Walter, Bernadette

Author's Keywords

digital mental health interventions; mental health; young adults; college students

Abstract

BACKGROUND: The growing prevalence of common mental health problems poses a serious hindrance to young adults, and the majority of those in need of mental health support do not seek professional psychological services. Digital mental health interventions (DMHIs) that allow for self-management of mental health symptoms could provide a useful adjunctiveto traditional one-on-one counseling or therapy and offer a useful prevention tool for students at risk for experiencing mental health crises. This dissertation explored the efficacy of self-guided DMHIs targeting college students, the factors associated with help-seeking in young adults, and the impact of implementing an evidence-based DMHI at a public 4-year university for first-year students. METHODS: The first analysis employed a systematic review guided by the PRISMA protocol to examine the effectiveness of technology-delivered interventions (e.g., mobile app) in reducing, improving, or preventing symptoms associated with depression, anxiety, psychological distress, or stress in college students from 2008 to 2021. The second analysis used the Healthy Minds Study (HMS) data from 2015-16 to 2020-21 to analyze help-seeking associations of college students through a binary logistic regression model. The final paper proposed a cost consequences model using HMS data from 2018-19 to 2020-21 to identify differences in cost-effectiveness of digital versus traditional mental health services. The RE-AIM model and Aday and Anderson’s Framework for the Study of Access guided the final analysis. FINDINGS: Certain evidence-based mindfulness, cognitive behavioral therapy (CBT), and acceptance commitment therapy (ACT) apps effectively improved symptoms associated with common mental health problems in college-aged students, though adherence was a common challenge faced by researchers. As young adults experience an increase in severity of their mental health symptoms, the odds that they seek professional help diminishes. This trend was more pronounced in students with depressive symptoms compared to those presenting anxiety symptoms. Non-Latinx Black students presented the greatest lack in help-seeking in the study sample. Non-Latinx White, Latinx, and multi/other race students demonstrated a steady increase in help-seeking behavior prior to the COVID-19 pandemic. However, by 2018, help-seeking began to plateau and decline in the years leading up to and during the pandemic. Headspace, an evidence-based mindfulness app, demonstrated promising outcomes as a cost-effective intervention that may serve to complement traditional campus mental health services and prevent the onset of common mental health problems when integrated early in the college experience. CONCLUSIONS: Leaders and mental health professionals in higher education continue to face serious challenges as they navigate the increasing severity and complexity of student mental health needs in the wake of the COVID-19 pandemic. Although utilization of mental health services has steadily increased in the last decade, colleges and universities are not able to keep up with demand. Most students in need of mental health services will never seek professional services. When integrated thoughtfully into different aspects of campus life, certain evidence-based, self-guided DMHIs offer a versatile and cost-effective approach to improving student access to a wider range of quality mental health services.

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