Limited Data on Effectiveness of Online Mental Health Offerings for College Students

Since the COVID-19 pandemic, colleges and universities have invested in additional online mental health resources to support students, but how effective are these programs, and do they serve all students as many claim?

A May 30 report from The Hope Center at Temple University, commissioned by the Ruderman Family Foundation and in partnership with the Healthy Minds Network and Boston University, analyzed nine common digital mental health interventions at U.S. higher education institutions. Researchers found that while these tools can help improve mental health, there is little direct evidence of how they support student populations.

The greatest benefit of these tools remains access for students who may not otherwise engage in traditional counseling and preventative or health promotional tools to get ahead of student crisis.

What it is: A digital mental health intervention (DMHI) is the use of technologies for mental health support, prevention and treatment which can include behavioral and psychological strategies. Most DMHIs provide preventative resources to support people with less acute needs through self-guided, supported or digital plus solutions.

DMHIs may be websites, mobile apps, virtual reality or online platforms. Among young people, many already use wellness apps for stress, sleep or meditation and those with depression are even more likely to use mobile apps for mental health support.

For the purpose of this report, DMHIs are not traditional counseling offered over virtual platforms, such as Zoom, but instead, consumer-facing, skill-building platforms. Researchers also excluded teletherapy platforms that do not offer additional support services.

What’s the need: Student mental health problems have been on the rise for a long time, but the pandemic brought light to issues and helped people pay attention to the impact of mental health on student success, explains Sara Abelson, assistant professor and senior director of The Hope Center, and one of the report’s authors.

The pandemic required institutions to be more creative in offering telehealth and teletherapy, and more institutions have adopted digital mental health interventions as a result.

DMHIs have also grown as a solution for collegiate mental health supports because a growing number of students are seeking help with more severe concerns and traditional counseling center services cannot meet that need.

A spring 2023 Student Voice survey by Inside Higher Ed, conducted by College Pulse, found half of students with a mental health condition haven’t used any campus counseling services.

Online offerings can be more easily scaled while still being effective and appealing to learners.

While DMHIs are popular, people still hold a preference for in-person therapy, making this an additive solution, not a replacement.

In conversations with campus leaders and counseling centers, report authors learned that DMHIs are seen as a supplement to on-campus counseling services for holistic support, Abelson says.

The findings: Among 89 DMHIs in higher education, 47 percent were effective in improving primary outcomes, 34 percent were partially effective, 11 percent were not effective and 7 percent did not report on mental health outcomes.

While there is research in general that points to the efficacy of DMHIs in improving mental health, the majority of widely used interventions for student populations are lacking, Abelson says. “There really has not been that much work done examining how this is playing out in the real world … [or] a more rigorous controlled study.”

Among those with positive outcomes, none utilized DMHIs that are widely available for college populations and participants in these studies represented a group of highly selected students, who may not represent the average student in the U.S. One review of these studies found 91 percent of research on DMHIs is done at universities, 2.2 percent at four-year colleges, 5.6 percent at professional schools and 1 percent at community colleges.

Another gap in the research was increasing uptake or reach of these interventions, which is one of the advertised benefits of many DMHIs or the number of students who can be impacted by the intervention. Only four of the 89 studies (less than 0.5 percent) noted adoption of the programs. Of people who use a DMHI, most people only use it once. (A caveat is that, among students, the most common number of appointments per student per year at the college counseling center is also one).

Abelson was surprised at the lack of evidence based on the current level of interest and investment that higher education leaders are making in these tools.

“Institutions and sometimes systems and sometimes states are paying a lot of money and administrators don’t necessarily know what that money is going toward or how many students are using this thing,” Abelson says.

So what? Based on the study’s findings, researchers recommend institutional leaders note the effectiveness, data security, user experience and cost of the product they choose to use.

Some additional considerations:

• DMHIs as a piece of holistic support. Online tools cannot replace traditional mental health supports, such as counseling, which have proven effectiveness in improving mental health outcomes among college students. However, “DMHIs are not just supplemental to traditional mental health care, but also preventative resources that support students with less acute needs and potentially reduce the need for future mental health care,” according to the report. Abelson encourages campus leaders to view DMHIs through three lenses: health promotion, prevention and intervention, because all are necessary to support student success in their time at college and beyond.

• The value of research-based decision making. Further investigation is necessary to create a better picture of these tools and how they can or should be employed. Before selecting a tool, institutional leaders should ask providers about their usage data to understand the evidence, Abelson says, which can incentivize providers to provide that information up front.
• Needs and inclusion of diverse student populations. Among present research of DMHIs, few studies are focused on college students, and even fewer with racially and ethnically diverse participants. Before employing a tool to serve the entire campus community, leaders should look for efficacy across populations and survey the campus population to understand needs and preferences for tools.
• Financing of such tools. Interviews with counseling center directors and other experts in the field highlighted small discretionary budgets to adopt DMHIs or that decisions were made above health or counseling centers to purchase products, without consideration for campus-specific needs. “Institutions should be considering expanding budgets so they’re not making tough choices with a limited number of dollars,” Abelson says. Grant programs from the state or federal level should also fund evaluation studies along with the work, addressing the need for further research.

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