Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study (Preprint)

BACKGROUND University students are increasingly reporting common mental health problems, such as stress, anxiety, and depression, and they frequently face barriers to seeking psychological support because of stigma, cost, and availability of mental health services. This issue is even more critical in the challenging time of the COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy-coping interventions by lowering cost and supporting prevention. OBJECTIVE The goal of this study was to conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, among a population of university students. METHODS In a proof-of-concept study, 71 university students were recruited during the COVID-19 pandemic; 68% (48/71) were female, they were all in their first year of university, and their mean age was 20.6 years (SD 2.4). Enrolled students were asked to use the Atena psychoeducational chatbot for 4 weeks (eight sessions; two per week), which provided healthy-coping strategies based on cognitive behavioral therapy, positive psychology, and mindfulness techniques. The intervention program consisted of conversations combined with audiovisual clips delivered via the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the Five-Facet Mindfulness Questionnaire (FFMQ) at baseline and postintervention to assess effectiveness. They were also asked to complete the User Engagement Scale–Short Form at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena postintervention. RESULTS Participants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. A total of 61 out of 71 (86%) participants completed the first 2 weeks of the intervention and provided data on engagement (10/71, 14% attrition). A total of 41 participants out of 71 (58%) completed the full intervention and the postintervention questionnaires (30/71, 42% attrition). Results from the completer analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t39=0.94; P=.009) and a decrease in stress symptoms as measured by the PSS-10 (t39=2.00; P=.05) for all participants postintervention. Participants also improved significantly in the describing and nonjudging facets, based on their FFMQ subscale scores, and asked for some improvements in the user experience with the chatbot. CONCLUSIONS This study shows the benefit of deploying a digital healthy-coping intervention via a chatbot to support university students experiencing higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions.

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Associations of university student life challenges with mental health and self-rated health

European Journal of Public Health ◽

10.1093/eurpub/ckab164.606 ◽

2021 ◽

Vol 31 (Supplement_3) ◽

Author(s):

F Porru ◽

S Schuring ◽

U Bültmann ◽

I Portoghese ◽

A Burdorf ◽

...

Keyword(s):

Mental Health ◽

University Students ◽

Mental Health Problems ◽

Short Form ◽

Student Life ◽

Self Rated Health ◽

Life Challenges ◽

High Workload ◽

Sf36 Score

Abstract Background Mental health problems are highly prevalent among university students. Stress due to student life challenges may be a risk factor for poorer health. This study investigates to what extent student life challenges and changes therein are associated with mental health and self-rated health. Methods In a longitudinal study with 568 Italian university students mental health was assessed using the Mental Health Inventory-5 (MHI-5) and self-rated health with a single item from the Short Form 36 Health Survey (SF36) (score ranges: 0-100) at baseline and at six months follow-up. Student life challenges were investigated using six subscales (score ranges: 1-4) of the Higher Education Stress Inventory (HESI). A between-within linear regression model was used to investigate whether a higher exposure to life challenges was associated with poorer health (between individuals) and whether changes in student life challenges were associated with changes in health (within individuals). Results Higher exposure to student life challenges was associated with poorer mental health (b ranging from -5.3 to -10.3) and self-rated health (b ranging from -3.1 to -9.6). An increase in student life challenges within individuals was associated with poorer mental health and self-rated health, in particular for high workload (b up to -5.9), faculty shortcomings (b up to -5.7), and unsupportive climate (b up to -5.6). Discussion Exposure to student life challenges and changes therein are associated with university students' health. Our findings suggest that student life challenges may be a target for interventions to improve mental health and self-rated health among university students. Key messages Mental health and self-rated health differ between students and change within-them. Higher exposure to student life challenges is associated with poorer health, and an increase in student life challenges is associated with a decrease in health.

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The Reach, Use, and Impact of a Free mHealth Mindfulness App in the General Population: Mobile Data Analysis (Preprint)

10.2196/preprints.23377 ◽

2020 ◽

Author(s):

Elissa Kozlov ◽

Erin Bantum ◽

Ian Pagano ◽

Robyn Walser ◽

Kelly Ramsey ◽

...

Keyword(s):

Mental Health ◽

General Population ◽

Mobile Apps ◽

Short Form ◽

Extended Period ◽

Health Impact ◽

User Engagement ◽

Five Facet Mindfulness Questionnaire ◽

Design Strategies ◽

Average Rating

BACKGROUND As smartphones are now used by most Americans, it is increasingly possible for mental health mobile apps to be disseminated to the general public. However, little is known about how mobile mental health apps are used by the general population outside of a controlled research design. OBJECTIVE Our objective is to describe how the general population engages with Mindfulness Coach, an iOS- and Android-based app designed to deliver a mindfulness training course. METHODS Using anonymous download and analytics data, we characterized the reach, usage, retention, and impact of Mindfulness Coach. We included mobile analytics data from all unique downloads of Mindfulness Coach between August 1, 2018, and April 8, 2019 (N=104,067) as well as starred reviews from all Mindfulness Coach users who provided reviews of the app as of March 1, 2020. Mindfulness characteristics were measured by an in-app assessment using the Five-Facet Mindfulness Questionnaire–Short Form (FFMQ-SF). RESULTS Users engaged, on average, in 4.3 visits to the app (SD 8.8; median 2; 90th percentile 8) and associated with an average total of 49.2 interactions with the app (ie, clicks within the app) (SD 113.8; median 19; 90th percentile 105). Users spent an average of 16.2 minutes (SD 63.1) engaged with the app over the full study time period. There were strong linear effects of app engagement on total FFMQ-SF scores. For example, FFMQ-SF scores were associated with more time spent engaged with the app (R2=.23; P<.001). Mindfulness Coach has been reviewed in the Google Play Store 3415 times, with an average rating of 4.7 out of 5 stars, and over 2000 times in the Apple App Store, with an average rating of 4.8 out of 5 stars. CONCLUSIONS These findings suggest that Mindfulness Coach has achieved substantial and sustained reach in the general population; however, it was used less frequently by many downloaders than researchers and designers intended. There was a subpopulation of users who engaged in the app regularly over an extended period of time, and there was a clear relationship between app use and improvements in mindfulness. To strengthen Mindfulness Coach’s public health impact, more research is needed to understand who is using the app and how, and to design strategies to increase user engagement in order for users to receive a larger dose of mindfulness treatment.

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The Reach, Use, and Impact of a Free mHealth Mindfulness App in the General Population: Mobile Data Analysis

JMIR Mental Health ◽

10.2196/23377 ◽

2020 ◽

Vol 7 (11) ◽

pp. e23377

Author(s):

Elissa Kozlov ◽

Erin Bantum ◽

Ian Pagano ◽

Robyn Walser ◽

Kelly Ramsey ◽

...

Keyword(s):

Mental Health ◽

General Population ◽

Mobile Apps ◽

Short Form ◽

Extended Period ◽

Health Impact ◽

User Engagement ◽

Five Facet Mindfulness Questionnaire ◽

Design Strategies ◽

Average Rating

Background As smartphones are now used by most Americans, it is increasingly possible for mental health mobile apps to be disseminated to the general public. However, little is known about how mobile mental health apps are used by the general population outside of a controlled research design. Objective Our objective is to describe how the general population engages with Mindfulness Coach, an iOS- and Android-based app designed to deliver a mindfulness training course. Methods Using anonymous download and analytics data, we characterized the reach, usage, retention, and impact of Mindfulness Coach. We included mobile analytics data from all unique downloads of Mindfulness Coach between August 1, 2018, and April 8, 2019 (N=104,067) as well as starred reviews from all Mindfulness Coach users who provided reviews of the app as of March 1, 2020. Mindfulness characteristics were measured by an in-app assessment using the Five-Facet Mindfulness Questionnaire–Short Form (FFMQ-SF). Results Users engaged, on average, in 4.3 visits to the app (SD 8.8; median 2; 90th percentile 8) and associated with an average total of 49.2 interactions with the app (ie, clicks within the app) (SD 113.8; median 19; 90th percentile 105). Users spent an average of 16.2 minutes (SD 63.1) engaged with the app over the full study time period. There were strong linear effects of app engagement on total FFMQ-SF scores. For example, FFMQ-SF scores were associated with more time spent engaged with the app (R2=.23; P<.001). Mindfulness Coach has been reviewed in the Google Play Store 3415 times, with an average rating of 4.7 out of 5 stars, and over 2000 times in the Apple App Store, with an average rating of 4.8 out of 5 stars. Conclusions These findings suggest that Mindfulness Coach has achieved substantial and sustained reach in the general population; however, it was used less frequently by many downloaders than researchers and designers intended. There was a subpopulation of users who engaged in the app regularly over an extended period of time, and there was a clear relationship between app use and improvements in mindfulness. To strengthen Mindfulness Coach’s public health impact, more research is needed to understand who is using the app and how, and to design strategies to increase user engagement in order for users to receive a larger dose of mindfulness treatment.

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The Factor Structure of the Korean version of the Mental Health Continuum-Short Form (MHC-SF) : A Study of University Students

Korean Journal of Youth Studies ◽

10.21509/kjys.2019.06.26.6.105 ◽

2019 ◽

Vol 26 (6) ◽

pp. 105-121

Author(s):

Young Shin Na ◽

Young-Jin Lim

Keyword(s):

Mental Health ◽

University Students ◽

Factor Structure ◽

Short Form ◽

Korean Version

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From Stress to Psychopathology: Relationship with Self-Reassurance and Self-Criticism in Czech University Students

International Journal of Mental Health and Addiction ◽

10.1007/s11469-021-00516-z ◽

2021 ◽

Author(s):

Yasuhiro Kotera ◽

Jaroslava Dosedlova ◽

Denise Andrzejewski ◽

Greta Kaluzeviciute ◽

Makoto Sakai

Keyword(s):

Mental Health ◽

University Students ◽

Mental Health Problems ◽

Cross Sectional Study ◽

Health Problems ◽

Transactional Model ◽

Cross Sectional ◽

Convenience Sample ◽

Path Analyses ◽

As Stress

AbstractPsychological stress has become a major concern, potentially leading to diverse health problems including psychopathology such as depression and anxiety. Transactional Model of Stress and Coping is an established model, conceptualizing stressful experiences via person–environment relationship. This cross-sectional study aimed to explore the pathway from stress to depression/anxiety, with a focus on self-criticism (inadequate-self and hated-self) and self-reassurance (reassured-self) in Czech students who suffered from high prevalence of mental health problems. Convenience sample of 119 undergraduates completed the Depression Anxiety and Stress Scale-21 and the Forms of the Self-Criticizing/Attacking & Self-Reassuring Scale. Correlation and path analyses were conducted. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were used to aid an accurate and complete report of the study. Depression, anxiety, and stress were positively associated with inadequate-self and hated-self while negatively associated with reassured-self. Both inadequate-self and hated-self partially mediated the stress–depression and stress–anxiety relationships, whereas reassured-self only partially mediated the stress–depression relationship. Inadequate-self had greater impact on the stress–depression/anxiety pathways than hated-self and reassured-self. Findings indicate that clinical treatment may benefit from targeting the feelings of inadequacy to prevent stress progressing to psychopathology. This is particularly relevant as stress levels are rising globally. Our findings offer developments to the Transactional Model, and help practitioners and educators identify solutions to protect mental health of Czech university students.

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Adolescents’ stress - a challenge for adults in charge - The Improve the Youth project

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1158 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Kleszczewska ◽

J Mazur ◽

A Dzielska ◽

T Gaspar ◽

M Gaspar de Matos

Keyword(s):

Mental Health ◽

Young People ◽

Quantitative Research ◽

Mental Health Problems ◽

Short Form ◽

High Stress ◽

Social Institutions ◽

Youth Policy ◽

Implementation Phase ◽

Advisory Boards

Abstract Background The project was an answer to the results of the HBSC (Health Behaviour of School-aged Children) study 2013/2014 which indicated an alarming situation regarding the adolescents' mental health. The aim was to investigate mental health problems of Polish and Portuguese youth and to create tools and materials which can be a professional help in this matter. Improve the youth project consisted of two main elements: research and implementation phase. The mixed-method approach was applied in the project. Quantitative and qualitative research methods were used. 2004 pupils (aged 13-19) were surveyed in 89 schools in 2017/ 2018 in Poland. Findings form qualitative study were guidelines for quantitative research. Perception of stress among young people was selected as the leading subject. Short Form Perceived Stress Scale (PSS-4) in a shorter version of 4-statement were used. There were two advisory boards: first - practitioners (psychologists, pedagogists, teachers, social workers) and second - adolescents. Both were consulted to prepare all materials. Results Stress levels are higher in girls than in boys, and they increase with age: between 13 and 19 year of age the increase in the prevalence of high stress level was 5,3% in boys and 12.5% in girls. Family affluence, school achievements and school burden were identified as stress determinants of adolescents. Materials presenting the data and giving practical information and tools on how to support adolescents in coping with stress: guide for adults, guide for youth created by youth and scenario of workshops. 20 workshops for young people run by young people were organised in both countries for about 200 adolescents Results and materials were presented to youth organizations, social institutions and decision makers responsible for youth policy during two 'Improve the Youth' conferences in Poland and in Portugal.

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Depressive Symptoms in Swiss University Students during the COVID-19 Pandemic and Their Correlates

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041458 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1458 ◽

Cited By ~ 1

Author(s):

Thomas Volken ◽

Annina Zysset ◽

Simone Amendola ◽

Anthony Klein Swormink ◽

Marion Huber ◽

...

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

University Students ◽

Mental Health Problems ◽

Binary Logistic Regression ◽

Cross Sectional ◽

Logistic Regression Models ◽

National Population ◽

Student Cohorts ◽

Containment Measures

Background: COVID-19 containment measures and the uncertainties associated with the pandemic may have contributed to changes in mental health risks and mental health problems in university students. Due to the high burden of the disease, depression is of particular concern. However, knowledge about the prevalence of depressive symptoms in Swiss university students during the pandemic is limited. We therefore assessed the prevalence of depressive symptoms and their change during the COVID-19 pandemic in a large sample of Swiss university students. Methods: We assessed depressive symptoms in two cross-sectional cohorts of university students (n = 3571) in spring and autumn 2020 during the COVID-19 pandemic and compared them with a matched sample of the Swiss national population (n = 2328). Binary logistic regression models estimated prevalence with corresponding 95% confidence intervals (95% CI). Results: Adjusted prevalence of depressive symptoms in female (30.8% (95% CI: 28.6–33.0)) and male students (24.8% (95% CI: 21.7–28.1)) was substantially higher than in the matching female (10.9% (95% CI: 8.9–13.2)) and male (8.5% (6.6–11.0)) pre-pandemic national population. Depressive symptoms in the two consecutive student cohorts did not significantly differ. Conclusions: More than a quarter of Swiss university students reported depressive symptoms during the COVID-19 pandemic, which was substantially higher as compared to the matched general population. Universities should introduce measures to support students in such times of crisis and gain an understanding of the factors impacting mental health positively or negatively and related to university structures and procedures.

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