Increasing intentions to use mental health services among university students. Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student Initiative.

Abstract

The majority of university students with mental health problems are untreated. Only a small empirical literature exists on strategies to increase mental health service use. To investigate the effects and moderators of a brief acceptance-facilitating intervention on intention to use mental health services among university students. Within the German site of the World Health Organization's World Mental Health International College Student (WMH-ICS) initiative, 1,374 university students were randomized to an intervention condition (IC; n=664) or a control condition (CC; n=710) that was implemented in the survey itself. Both conditions received the questions assessing mental disorders and suicidality that were included in other WMH-ICS surveys. The IC group then additionally received: Internet-based personalized feedback based on subject symptom severity in the domains of depression, anxiety, substance use, suicidal thoughts and behaviors, and nonsuicidal self-injury; psychoeducation tailored to the personal symptom profile; and information about available university and community mental health services. The primary outcome was reported intention to use psychological interventions in the next semester, which was the last question in the survey. A broad range of potential moderating factors was explored. There was a significant main effect of the intervention with students randomized to IC, reporting significantly higher intentions to seek help in the next semester than students in the CC condition (d=0.12, 95% CI: 0.02 to 0.23). Moderator analyses indicated that the intervention was more effective among students that fulfilled the criteria for lifetime (d=0.34; 95% CI: -0.08 to 0.7) and 12-month panic-disorder (d=0.32; 95% CI: -0.10 to 0.74) compared with those without lifetime (d=0.11; 95% CI: 0.00 to 0.22) or 12-month panic disorder (d=0.11; 95% CI: 0.00 to 0.22), students with lower (d=0.37; 95% CI: -0.77 to 1.51) than higher (d=-0.01; 95% CI: -0.36 to 0.34) self-reported physical health, and students with nonheterosexual (d=0.38; 95% CI: 0.08 to 0.67) compared with heterosexual (d=0.06; 95% CI: -0.06 to 0.17) sexual orientation. The intervention had no effects among students who reported that they recognized that they had an emotional problem and "are already working actively to change it" (Stage 4 "stages of change"). A simple acceptance-facilitating intervention can increase intention to use mental health services, although effects, are on average, small. Future studies should investigate more personalized approaches with interventions tailored to barriers and clinical characteristics of students. In order to optimize intervention effects, the development and evaluation should be realized in designs that are powered to allow incremental value of different intervention components and tailoring strategies to be evaluated, such as in multiphase optimization designs.