Abstract
Background: Mental disorders are highly prevalent among university students. Distance-learning students are particularly burdened and have limited access to conventional university health services. Interventions for stress are sought after in distance learners and may help increase treatment coverage. Internet-based interventions have been shown to be effective in preventing and treating depression, but it remains unclear if interventions directed at academic stress also have this potential. Aim: The trial presented here investigates the effectiveness of an Internet- and App-based stress intervention in distance-learning students with elevated levels of depression. Methods: A sample of N = 200 students of a large German distance university with elevated levels of depression [Center for Epidemiological Studies’ Depression Scale (CES-D) ≥ 16] will be randomly assigned to either an Internet- and App-based stress management intervention group (IG) or a control group (CG) receiving an Internet-based psychoeducational program for academic stress. The IG consists of eight Internet-based sessions promoting stress management skills using cognitive–behavioral and problem-solving techniques. A mobile App will be employed to facilitate training transfer. Self-report data will be assessed at baseline (T0), post-treatment (T1; 7 weeks), and 3-month follow-up (T2). Potential moderators will be assessed at baseline. The primary outcome is depression (CES-D) post-treatment. Secondary outcomes include mental health outcomes, modifiable risk and protective factors, and academic outcomes. Data will be analyzed on an intention-to-treat principle along with sensitivity analyses to assess the robustness of findings. Additional health economic analyses will be conducted. Discussion: Results will provide the basis to assess the acceptance and effectiveness of Internet-delivered stress interventions in distance-learning students with symptoms of depression. Ethics and dissemination: The study has been reviewed and approved by the University of Erlangen-Nuremberg ethics committee (Erlangen, Germany; 33_17 Bc). Results of the study will be disseminated through peer-reviewed publications. Trial Registration: German Clinical Trial Registration (DRKS), identifier DRKS00011800
Highlights
Psychoeducation, information about stress and preview of subsequent sessions Problem-solvingStress management strategies, systematic problem-solving using a 6-step problem solving heuristicMuscle and breath relaxation Information on basic principles of muscle and breath relaxation, audio exercises for daily usage MindfulnessCoping with self-criticism, mindfulness exercisesAcceptance and toleranceDealing with unsolvable problems, psychoeducation on and exercises for acceptance and tolerance of unpleasant emotions Self-compassionSelf-criticism in precarious situations, defusion of self-worth and performance, exercises for positive self-support, overcoming dysfunctional perfectionistic thought-action patterns My master plan
The goal of the present study is to i) evaluate the effects of an Internet- and App-based stress intervention in distance-learning students with heightened levels of depression on mental health outcomes, modifiable risk and protective factors for mental health disorders, and functioning outcomes when compared to an active control group (CG) receiving an Internet-based psychoeducation program on stress management; ii) to investigate the moderators of potential treatment effects; iii) to assess the help-seeking intentions of study participants; and iv) to assess the interventions’ health economic benefits when implemented into routine care
We hypothesize the intervention to be more effective in reducing symptoms of depression and improving other mental health-related outcomes when compared to a CG receiving Internet-based psychoeducation
Summary
Psychoeducation, information about stress and preview of subsequent sessions Problem-solvingStress management strategies, systematic problem-solving using a 6-step problem solving heuristicMuscle and breath relaxation Information on basic principles of muscle and breath relaxation, audio exercises for daily usage MindfulnessCoping with self-criticism, mindfulness exercisesAcceptance and toleranceDealing with unsolvable problems, psychoeducation on and exercises for acceptance and tolerance of unpleasant emotions Self-compassionSelf-criticism in precarious situations, defusion of self-worth and performance, exercises for positive self-support, overcoming dysfunctional perfectionistic thought-action patterns My master plan. Suicidality is strongly associated with mental health disorders [13] and highly prevalent among university students [14,15,16], making it the second largest cause of mortality in this population [17]. Compared to the general university student population, distance learners may be at risk for suffering from a mental disorder. Distance-learning services are frequently used by individuals over 30, by employees attaining qualifications in addition to holding a job, or by parents [18, 19] This may result in a more complicated educational environment for affected individuals [19, 20]. Resulting mental health problems have been associated with worse academic attainment in distance learners [21]
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