(PS5-C56) Reach and Uptake of Digital Mental Health Interventions Based on Cognitive-behavioral Therapy for College Students: A Systematic Review

Background: Mental health problems are increasing in prevalence among college students, yet few students receive treatment due to barriers such as insufficient resources in college counseling centers. Digital mental health interventions (DMHIs) have potential to overcome barriers and offer accessible, evidence-based care to college students. However, to evaluate the true public health impact of evidence-based DMHIs, it is important to assess the reach and uptake rates of DMHIs on college campuses. We conducted a systematic review in accordance with PRISMA guidelines to examine the reach (i.e., % of invited students who express interest) and uptake (i.e., % of enrolled participants who initiate an intervention) of DMHIs based on cognitive-behavioral therapy (CBT) for college students.

Method: A medical librarian searched eight databases for relevant articles. Inclusion criteria included: (1) college population; (2) experimental design (i.e., randomized or non-randomized); (3) intervention based on CBT; (4) intervention targeting ≥ one specific mental health condition; and (5) use of digital technology (e.g., apps, text messages) for intervention delivery. Article title and abstract screening was conducted, followed by full text reviews. Reach and uptake rates were calculated from data reported. A systematic narrative review framework was used to synthesize results.

Results: Of 10,315 articles identified in the search, 90 were included. Seventeen studies (19%) reported sufficient data to calculate reach; 35 studies (39%) reported uptake rates. Of studies that reported reach or uptake, most evaluated unguided (n = 20) or guided (n = 16) self-help programs. Measurement methods varied widely. Among studies that reported sufficient data to calculate reach, reach was relatively low on average (26%) and variable (range: 0.3% to 93%). Among enrolled participants, uptake was high on average (79%) and variable across studies (range: 32% to 100%). Recruitment methods targeting students with elevated symptoms yielded higher reach and uptake relative to universal recruitment.

Discussion: Despite evidence that improving reach and uptake can increase the public health impact of DMHIs, 81% of included studies did not provide sufficient data to calculate reach, 61% did not report rates of uptake, and 53% did not report either outcome. It is critical for future studies to report the proportion of students reached by DMHIs and specific recruitment strategies used. Despite low reach, studies observed high uptake of DMHIs among enrolled students on average, which may suggest that students who enroll in and initiate DMHIs are highly motivated for treatment or more open to the use of DMHIs. Suggested practices to improve these outcomes, and their reporting, will be discussed.