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There is a distinct lack of evidence when it comes to the impacts and reach of digital mental health intervention programs (DMHIs), according to a new report from Temple University’s Hope Center, Boston University, and the Healthy Minds Network.
Commissioned by the Ruderman Family Foundation, the report sought to critically review the nine most common DMHIs at colleges and universities, separating them into three categories based on the kinds of services each program offers to students and colleges.
“Self-guided” programs offered digital resources – videos, coursework, and modules – to help teach users coping skills and to help them deal with issues such as anxiety, stress, depression, and sleep problems.
“Multi-component” programs offered such resources as well, in addition to providing support from counselors and other people.
And “connector” programs simply sought to help users make connections with peers and be aware of resources that may be available.
Researchers narrowed their focus on DMHIs that veer outside of traditional telehealth services to instead employ other technologies – such as mobile applications, online platforms, wearables, and virtual reality – and help teach coping skills and support student mental health through them.
It’s a matter of meeting the needs of a student population where demand is outweighing supply, said report co-author Dr. Sarah Lipson, an associate professor in the Department of Health Law Policy and Management at Boston University and principal investigator of the Healthy Minds Network.
“We’re never going to be able to meet the needs that students have by just continuing to invest in mental health therapy and counseling, whether that’s in person or on online platforms,” Lipson said. “So, we really wanted to focus on the potential and the existing evidence around how DMHIs can work from a prevention perspective.”
The report authors’ conversations with higher ed leaders and mental health experts also indicated that there was indeed a desire for more scalable solutions and an interest for further investment in DMHIs, said co-author Dr. Sara Abelson, an assistant professor in the Department of Urban Health and Population Science at Temple University and a senior director at The Hope Center.
According to the report, there are approximately 10,000-20,000 DMHIs available. Many of them offer potential mental health aid that’s convenient and accessible at all hours.
DMHIs can also come with the advantage of not being bound by state licensure laws, the report noted.
“Non-clinical DMHIs, not bound by state licensure laws, and DMHI companies that have licensed clinicians across the U.S. and/or abroad may help to provide continuity of care for students as they move between states or countries – for example, for work, during breaks, internships, or study abroad experiences, or student athletes traveling for inter-state competition,” the report read.
Unfortunately, upon examination, the DMHIs in question were found to have had varying levels of scientific study done about them, from one program having dozens of studies done about it to another having practically none.
In the case of Mantra Health, a multi-component DMHI that is being offered at more than 125 campuses, the authors were unable to find any published outcome studies about it. But data from the company itself showed that the majority of its users appeared to find it helpful, with around 70% saying its services helped them stay and perform in school, according to the report.
On the other hand, Timely Care, another multi-component DMHI that offers counseling and support, was found not to have any formal evaluations about its effectiveness or data about its user engagement.
Looking at Nod, one of the connector programs, the authors discovered one study of college first-years that included sizable portions of non-white students and first-generation students. The study had found “no significant differences” for the DMHI’s users when it came to loneliness, mental health, sleep quality, or college adjustment, according to the report.
SilverCloud by Amwell, a self-guided DMHI with modules to help users address common mental health problems, stood out among the nine for having had dozens of studies done about its outcomes. One of them – conducted with 102 students at a large U.S. university in the Midwest – found that the program resulted in “comparable improvements” and “significant reductions” in issues such as depression, anxiety, and stress for its users.
Growth in the industry has far outpaced research about DMHIs, particularly in regard to college students and diverse student populations, the report read. The call for more research to be done about DMHIs was paramount for the authors.
“I think there is growing research and evidence about DMHIs broadly. But we really were struck by how little research has been done, specifically to examine impact, effectiveness, and user engagement among college students,” Abelson said.
They also urged higher ed leaders to rethink how much money they are dedicating to DMHIs and what that money is being spent on.
“In our interviews, we found that many campuses are constrained to use small discretionary budgets from their health or counseling centers to adopt DMHIs,” the report read. “We have also heard examples when decisions were made at levels above health or counseling centers to purchase certain products without considering how it fits the needs and opportunities for that specific campus.”
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