@Article{info:doi/10.2196/jmir.9293,
author="Harrer, Mathias
and Adam, Sophia Helen
and Fleischmann, Rebecca Jessica
and Baumeister, Harald
and Auerbach, Randy
and Bruffaerts, Ronny
and Cuijpers, Pim
and Kessler, Ronald C
and Berking, Matthias
and Lehr, Dirk
and Ebert, David Daniel",
title="Effectiveness of an Internet- and App-Based Intervention for College Students With Elevated Stress: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="23",
volume="20",
number="4",
pages="e136",
keywords="randomized controlled trial; stress, psychological; depression; telemedicine; students; help-seeking behavior",
abstract="Background: Mental health problems are highly prevalent among college students. Most students with poor mental health, however, do not receive professional help. Internet-based self-help formats may increase the utilization of treatment. Objective: The aim of this randomized controlled trial was to evaluate the efficacy of an internet-based, app-supported stress management intervention for college students. Methods: College students (n=150) with elevated levels of stress (Perceived Stress Scale 4-item version, PSS-4 ≥8) were randomly assigned to either an internet- and mobile-based stress intervention group with feedback on demand or a waitlist control group. Self-report data were assessed at baseline, posttreatment (7 weeks), and 3-month follow-up. The primary outcome was perceived stress posttreatment (PSS-4). Secondary outcomes included mental health outcomes, modifiable risk and protective factors, and college-related outcomes. Subgroup analyses were conducted in students with clinically relevant symptoms of depression (Center for Epidemiological Studies' Depression Scale >17). Results: A total of 106 participants (76.8{\%}) indicated that they were first-time help-seekers, and 77.3{\%} (intervention group: 58/75; waitlist control group: 58/75) showed clinically relevant depressive symptoms at baseline. Findings indicated significant effects of the intervention compared with the waitlist control group for stress (d=0.69; 95{\%} CI 0.36-1.02), anxiety (d=0.76; 95{\%} CI 0.43-1.09), depression (d=0.63; 95{\%} CI 0.30-0.96), college-related productivity (d=0.33; 95{\%} CI 0.01-0.65), academic work impairment (d=0.34; 95{\%} CI 0.01-0.66), and other outcomes after 7 weeks (posttreatment). Response rates for stress symptoms were significantly higher for the intervention group (69{\%}, 52/75) compared with the waitlist control group (35{\%}, 26/75, P<.001; number needed to treat=2.89, 95{\%} CI 2.01-5.08) at posttest (7 weeks). Effects were sustained at 3-month follow-up, and similar findings emerged in students with symptoms of depression. Conclusions: Internet- and mobile-based interventions could be an effective and cost-effective approach to reduce consequences of college-related stress and might potentially attract students with clinically relevant depression who would not otherwise seek help. Trial Registration: German Clinical Trial Register DRKS00010212; http://www.drks.de/drks{\_}web/navigate.do? navigationId=trial.HTML{\&}TRIAL{\_}ID=DRKS00010212 (Archived by WebCite at http://www.webcitation.org/6w55Ewhjd) ",
issn="1438-8871",
doi="10.2196/jmir.9293",
url="http://www.jmir.org/2018/4/e136/",
url="https://doi.org/10.2196/jmir.9293",
url="http://www.ncbi.nlm.nih.gov/pubmed/29685870"
}