Abstract
BackgroundYouth in general and college life in particular are characterized by new educational, vocational, and interpersonal challenges, opportunities, and substantial stress. It is estimated that 30–50% of university students meet criteria for some mental disorder, especially depression, in any given year. The university has traditionally provided many channels to promote students’ mental health, but until now only a minority have sought such help, possibly owing to lack of time and/or to stigma related to mental illness. Smartphone-delivered cognitive behavioral therapy (CBT) shows promise for its accessibility and effectiveness. However, its most effective components and for whom it is more (or less) effective are not known.Methods/designBased on the multiphase optimization strategy framework, this study is a parallel-group, multicenter, open, fully factorial trial examining five smartphone-delivered CBT components (self-monitoring, cognitive restructuring, behavioral activation, assertion training, and problem solving) among university students with elevated distress, defined as scoring 5 or more on the Patient Health Questionnaire-9 (PHQ-9). The primary outcome is change in PHQ-9 scores from baseline to week 8. We will estimate specific efficacy of the five components and their interactions through the mixed-effects repeated-measures analysis and propose the most effective and efficacious combinations of components. Effect modification by selected baseline characteristics will be examined in exploratory analyses.DiscussionThe highly efficient experimental design will allow identification of the most effective components and the most efficient combinations thereof among the five components of smartphone CBT for university students. Pragmatically, the findings will help make the most efficacious CBT package accessible to a large number of distressed university students at reduced cost; theoretically, they will shed light on the underlying mechanisms of CBT and help further advance CBT for depression.Trial registrationUMIN, CTR-000031307. Registered on February 14, 2018.
Highlights
Youth in general and college life in particular are characterized by new educational, vocational, and interpersonal challenges, opportunities, and substantial stress
Given the breadth of new experiences, opportunities, and challenges faced by university students, it is not surprising that college life is characterized by substantial stress
We have demonstrated the efficacy of a smartphone cognitive behavioral therapy (CBT) package containing the SM, behavioral activation (BA), and cognitive restructuring (CR) components among patients with antidepressant-resistant depression in an Randomized controlled trial (RCT) [18]
Summary
Youth in general and college life in particular are characterized by new educational, vocational, and interpersonal challenges, opportunities, and substantial stress. It is estimated that 30–50% of university students meet criteria for some mental disorder, especially depression, in any given year. It is estimated that between 30% and 50% of university students meet criteria for at least one mental disorder in any given year [1, 2]. Mental disorders, when untreated, can have significant consequences: they have been shown to lead to lowered academic performance [3], increased dropout from university before completion [4, 5], and impairment in social relationships [6]. Short form of the Big Five scale (29 items) [37, 38] b. Behavioral activation: Behavioral Activation for Depression Scale-Short Form (eight items) [32, 33] d. Presenteeism scale from the HPQ [36]
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