Computer-delivered and web-based interventions to improve depression, anxiety, and psychological well-being of university students: a systematic review and meta-analysis

Background: Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students’ mental health. The effectiveness of these intervention types requires investigation to identify whether these are viable prevention strategies for university students. Objective: The intent of the study was to systematically review and analyze trials of Web-based and computer-delivered interventions to improve depression, anxiety, psychological distress, and stress in university students. Methods: Several databases were searched using keywords relating to higher education students, mental health, and eHealth interventions. The eligibility criteria for studies included in the review were: (1) the study aimed to improve symptoms relating to depression, anxiety, psychological distress, and stress, (2) the study involved computer-delivered or Web-based interventions accessed via computer, laptop, or tablet, (3) the study was a randomized controlled trial, and (4) the study was trialed on higher education students. Trials were reviewed and outcome data analyzed through random effects meta-analyses for each outcome and each type of trial arm comparison. Cochrane Collaboration risk of bias tool was used to assess study quality. Results: A total of 17 trials were identified, in which seven were the same three interventions on separate samples; 14 reported sufficient information for meta-analysis. The majority (n=13) were website-delivered and nine interventions were based on cognitive behavioral therapy (CBT). A total of 1795 participants were randomized and 1480 analyzed. Risk of bias was considered moderate, as many publications did not sufficiently report their methods and seven explicitly conducted completers’ analyses. In comparison to the inactive control, sensitivity meta-analyses supported intervention in improving anxiety (pooled standardized mean difference [SMD] −0.56; 95% CI −0.77 to −0.35, P<.001), depression (pooled SMD −0.43; 95% CI −0.63 to −0.22, P<.001), and stress (pooled SMD −0.73; 95% CI −1.27 to −0.19, P=.008). In comparison to active controls, sensitivity analyses did not support either condition for anxiety (pooled SMD −0.18; 95% CI −0.98 to 0.62, P=.66) or depression (pooled SMD −0.28; 95% CI −0.75 to −0.20, P=.25). In contrast to a comparison intervention, neither condition was supported in sensitivity analyses for anxiety (pooled SMD −0.10; 95% CI −0.39 to 0.18, P=.48) or depression (pooled SMD −0.33; 95% CI −0.43 to 1.09, P=.40). Conclusions: The findings suggest Web-based and computer-delivered interventions can be effective in improving students’ depression, anxiety, and stress outcomes when compared to inactive controls, but some caution is needed when compared to other trial arms and methodological issues were noticeable. Interventions need to be trialed on more heterogeneous student samples and would benefit from user evaluation. Future trials should address methodological considerations to improve reporting of trial quality and address post-intervention skewed dat

Development and usability of a website-based depression literacy intervention for university students in Nottingham

Purpose: A large proportion of university students experience mental health difficulties, with one review reporting a 30% prevalence rate of depression in this population. Depression affects students’ quality of life and academic performance. Mental health literacy (MHL) encompasses an individual’s knowledge towards, and attitudes and beliefs related to, mental health (e.g. symptom recognition, available treatments/help). Students often do not seek professional help for their mental health, and are more likely to seek support from peers. We have conducted four projects relating to MHL in local students – findings include: a third of students (n=276) screened for elevated depressive and/or anxiety symptomology, with 60% reporting they did not seek professional help; interviews found many students did not perceive GPs as a help source and had concerns about available help; and a vignette-based study found students from non-healthcare/psychology degrees reported lower perceived confidence in helping a friend with depression. Students frequently use internet-based technology; delivering interventions online provides a useful mental health promotion strategy in this population. Based on our findings, we have developed a website-based intervention addressing students’ depression literacy. A usability study with the target population can identify the website’s usefulness and allow us to review it prior to an RCT. Methods: Twenty local undergraduate students will be recruited and will access the website for a week. Afterwards they will complete a usability questionnaire. Results: The usability study will begin in May-June 2014, with an RCT of the website anticipated in late 2014. Conclusion: This study appears to be one of the first website-based interventions to improve depression literacy/MHL in British university students. Feedback from this usability study will be used to alter the intervention prior to an RCT later this year. This RCT will explore the intervention’s effect upon attitudes, intentions and behaviours relating to depression management and help-seeking

Computer and website-based interventions to improve common mental health problems in university students: a meta-analysis

Website-based and computer-delivered interventions could improve common mental health problems experienced by university students, as their help-seeking is limited. This review analysed RCT trials of these interventions to improve depression, anxiety and psychological well-being in university students. Studies aimed to trial computer-delivered/website-based interventions to improve symptoms of depression, anxiety, psychological distress and stress in university students. Seventeen trials of fourteen distinct interventions were identified – nine were CBT-based. Compared to inactive controls, interventions were supported in improving anxiety (SMD-0.56, CI -0.77 - -0.35, P=.05). Website-based and computer-delivered interventions can be effective in improving students’ mental health when compared to inactive controls, but caution is needed when compared to other conditions and methodological issues require consideration

Development and usability of a website-based depression literacy intervention for university students in Nottingham

Purpose: A large proportion of university students experience mental health difficulties, with one review reporting a 30% prevalence rate of depression in this population. Depression affects students’ quality of life and academic performance. Mental health literacy (MHL) encompasses an individual’s knowledge towards, and attitudes and beliefs related to, mental health (e.g. symptom recognition, available treatments/help). Students often do not seek professional help for their mental health, and are more likely to seek support from peers. We have conducted four projects relating to MHL in local students – findings include: a third of students (n=276) screened for elevated depressive and/or anxiety symptomology, with 60% reporting they did not seek professional help; interviews found many students did not perceive GPs as a help source and had concerns about available help; and a vignette-based study found students from non-healthcare/psychology degrees reported lower perceived confidence in helping a friend with depression. Students frequently use internet-based technology; delivering interventions online provides a useful mental health promotion strategy in this population. Based on our findings, we have developed a website-based intervention addressing students’ depression literacy. A usability study with the target population can identify the website’s usefulness and allow us to review it prior to an RCT. Methods: Twenty local undergraduate students will be recruited and will access the website for a week. Afterwards they will complete a usability questionnaire. Results: The usability study will begin in May-June 2014, with an RCT of the website anticipated in late 2014. Conclusion: This study appears to be one of the first website-based interventions to improve depression literacy/MHL in British university students. Feedback from this usability study will be used to alter the intervention prior to an RCT later this year. This RCT will explore the intervention’s effect upon attitudes, intentions and behaviours relating to depression management and help-seeking

Computer and website-based interventions to improve common mental health problems in university students: a meta-analysis

Website-based and computer-delivered interventions could improve common mental health problems experienced by university students, as their help-seeking is limited. This review analysed RCT trials of these interventions to improve depression, anxiety and psychological well-being in university students. Studies aimed to trial computer-delivered/website-based interventions to improve symptoms of depression, anxiety, psychological distress and stress in university students. Seventeen trials of fourteen distinct interventions were identified – nine were CBT-based. Compared to inactive controls, interventions were supported in improving anxiety (SMD-0.56, CI -0.77 - -0.35, P=.05). Website-based and computer-delivered interventions can be effective in improving students’ mental health when compared to inactive controls, but caution is needed when compared to other conditions and methodological issues require consideration

Objective methods for reliable detection of concealed depression

Recent research has shown that it is possible to automatically detect clinical depression from audio-visual recordings. Before considering integration in a clinical pathway, a key question that must be asked is whether such systems can be easily fooled. This work explores the potential of acoustic features to detect clinical depression in adults both when acting normally and when asked to conceal their depression. Nine adults diagnosed with mild to moderate depression as per the Beck Depression Inventory (BDI-II) and Patient Health Questionnaire (PHQ-9) were asked a series of questions and to read a excerpt from a novel aloud under two different experimental conditions. In one, participants were asked to act naturally and in the other, to suppress anything that they felt would be indicative of their depression. Acoustic features were then extracted from this data and analysed using paired t-tests to determine any statistically significant differences between healthy and depressed participants. Most features that were found to be significantly different during normal behaviour remained so during concealed behaviour. In leave-one-subject-out automatic classification studies of the 9 depressed subjects and 8 matched healthy controls, an 88% classification accuracy and 89% sensitivity was achieved. Results remained relatively robust during concealed behaviour, with classifiers trained on only non-concealed data achieving 81% detection accuracy and 75% sensitivity when tested on concealed data. These results indicate there is good potential to build deception-proof automatic depression monitoring systems

Enhanced relapse prevention for bipolar disorder: A qualitative investigation of value perceived for service users and care coordinators

Background: Enhanced relapse prevention (ERP) is a psychological intervention delivered by mental health professionals to help individuals with bipolar disorder (BD) recognise and manage early warning signs for mania and depression. ERP has an emerging evidence base and is recommended as good practice for mental health professionals. However, without highly perceived value to both those receiving (services users) or delivering it (health professionals), implementation will not occur. The aim of this study is to determine what values of ERP are perceived by service users (SUs) and mental health professionals (care coordinators, CCs) providing community case management. Methods: A nested qualitative study design was employed as part of a randomised controlled trial of ERP. Semi-structured interviews were conducted with a purposive sub-sample of 21 CCs and 21 SUs, and an iterative approach used to develop a framework of conceptual categories that was applied systematically to the data. Results: The process of implementing and receiving ERP was valued by both SUs and CCs for three similar sets of reasons: improved understanding of BD (where a knowledge deficit of BD was perceived), enhanced working relationships, and improved ways of managing the condition. There were some differences in the implications these had for both CCs and SUs who also held some reservations. Conclusion: CCs and SUs perceive similar value in early warning signs interventions to prevent relapse, and these have particular benefits to them. If this perceived value is maintained, CCs and SUs in routine practice may use ERP long-term

Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database

Objective To assess associations between different antidepressant treatments and rates of three cardiovascular outcomes (myocardial infarction, stroke or transient ischaemic attack, and arrhythmia) in people with depression. Design Cohort study. Setting UK general practices contributing to the QResearch primary care database. Participants 238 963 patients aged 20 to 64 years with a first diagnosis of depression between 1 January 2000 and 31 July 2011. Exposures Antidepressant class (tricyclic and related antidepressants, selective serotonin reuptake inhibitors, other antidepressants), dose, duration of use, and commonly prescribed individual antidepressant drugs. Main outcome measures First diagnoses of myocardial infarction, stroke or transient ischaemic attack, and arrhythmia during five years’ follow-up. Cox proportional hazards models were used to estimate hazard ratios, adjusting for potential confounding variables. Results During five years of follow-up, 772 patients had a myocardial infarction, 1106 had a stroke or transient ischaemic attack, and 1452 were diagnosed as having arrhythmia. No significant associations were found between antidepressant class and myocardial infarction over five years’ follow-up. In the first year of follow-up, patients treated with selective serotonin reuptake inhibitors had a significantly reduced risk of myocardial infarction (adjusted hazard ratio 0.58, 95% confidence interval 0.42 to 0.79) compared with no use of antidepressants; among individual drugs, fluoxetine was associated with a significantly reduced risk (0.44, 0.27 to 0.72) and lofepramine with a significantly increased risk (3.07, 1.50 to 6.26). No significant associations were found between antidepressant class or individual drugs and risk of stroke or transient ischaemic attack. Antidepressant class was not significantly associated with arrhythmia over five years’ follow-up, although the risk was significantly increased during the first 28 days of treatment with tricyclic and related antidepressants (adjusted hazard ratio 1.99, 1.27 to 3.13). Fluoxetine was associated with a significantly reduced risk of arrhythmia (0.74, 0.59 to 0.92) over five years, but citalopram was not significantly associated with risk of arrhythmia even at high doses (1.11, 0.72 to 1.71 for doses ≥40 mg/day). Conclusions This study found no evidence that selective serotonin reuptake inhibitors are associated with an increased risk of arrhythmia or stroke/transient ischaemic attack in people diagnosed as having depression between the ages of 20 to 64 or that citalopram is associated with a significantly increased risk of arrhythmia. It found some indication of a reduced risk of myocardial infarction with selective serotonin reuptake inhibitors, particularly fluoxetine, and of an increased risk with lofepramine

Neutrinos from Dark Matter annihilations at the Galactic Centre

We discuss the prospects for detection of high energy neutrinos from dark matter annihilation at the Galactic centre. Despite the large uncertainties associated with our poor knowledge of the distribution of dark matter in the innermost regions of the Galaxy, we determine an upper limit on the neutrino flux by requiring that the associated gamma-ray emission does not exceed the observed flux. We conclude that if dark matter is made of neutralinos, a neutrino flux from dark matter annihilations at the GC will not be observable by Antares. Conversely, the positive detection of such a flux would either require an alternative explanation, in terms of astrophysical processes, or the adoption of other \DM candidates, disfavouring the case for neutralinos.Comment: 8 pages, 7 figures, submitted to PR