Challenges in Recruiting University Students for Web-Based Indicated Prevention of Depression and Anxiety: Results From a Randomized Controlled Trial (ICare Prevent)
Open accessAbstract
Background: Depression and anxiety are common mental health conditions in college and university student populations. Offering transdiagnostic, web-based prevention programs such as ICare Prevent to those with subclinical complaints has the potential to reduce some barriers to receiving help (eg, availability of services, privacy considerations, and students’ desire for autonomy). However, uptake of these interventions is often low, and accounts of recruitment challenges are needed to complement available effectiveness research in student populations. Objective: The aims of this study were to describe recruitment challenges together with effective recruitment strategies for ICare Prevent and provide basic information on the intervention’s effectiveness. Methods: A 3-arm randomized controlled trial was conducted in a student sample with subclinical symptoms of depression and anxiety on the effectiveness of an individually guided (human support and feedback on exercises provided after each session, tailored to each participant) and automatically guided (computer-generated messages provided after each session, geared toward motivation) version of ICare Prevent, a web-based intervention with transdiagnostic components for the indicated prevention of depression and anxiety. The intervention was compared with care as usual. Descriptive statistics were used to outline recruitment challenges and effective web-based and offline strategies as well as students’ use of the intervention. A basic analysis of intervention effects was conducted using a Bayesian linear mixed model, with Bayes factors reported as the effect size. Results: Direct recruitment through students’ email addresses via the central student administration was the most effective strategy. Data from 35 participants were analyzed (individually guided: n=14, 40%; automatically guided: n=8, 23%; care as usual: n=13, 37%). Use of the intervention was low, with an average of 3 out of 7 sessions (SD 2.9) completed. The analyses did not suggest any intervention effects other than anecdotal evidence (all Bayes factors10≤2.7). Conclusions: This report adds to the existing literature on recruitment challenges specific to the student population. Testing the feasibility of recruitment measures and the greater involvement of the target population in their design, as well as shifting from direct to indirect prevention, can potentially help future studies in the field. In addition, this report demonstrates an alternative basic analytical strategy for underpowered randomized controlled trials. Trial Registration: International Clinical Trials Registry Platform NTR6562; https://tinyurl.com/4rbexzrk International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2477-y
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Adolescents access and use mental health services less frequently than any other age group.
“adolescents access and use mental health services less frequently than any other age group due to under-detection, a lack of available psychotherapeutic services, and poor help-seeking [24, 33]”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [33]
The Introduction > Background discusses low help-seeking and limited service capacity among university students, not adolescents’ service use compared with other age groups. Searches for adolescent service use and age-group comparisons found no passage establishing the claimed ranking. (LLM, conf=0.74)
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Self-citationComparison of Site-Based Versus Central Ratings in a Study of Generalized Anxiety Disorder
Williams, J. B. W., Kobak, K. A., Giller, E. L., et al. (2015) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000422 · Cited by 9 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [49]American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th edition 1994 Washington, DC, USA American Psychiatric Association
- [90]Wickham H ggplot2: Elegant Graphics for Data Analysis 2016 Cham, Switzerland Springer
Cited by
Sorted by citations
Zarski, A.-C., Weisel, K. K., Berger, T., Krieger, T., Schaub, M. P., Berking, M., Görlich, D., Jacobi, C., & Ebert, D. D. (2024) · Psychotherapy and Psychosomatics · doi:10.1159/000536149 · Cited by 13 · see citing works
Self-citationHirsig, A., Häfeli, X. A., & Schmidt, S. J. (2024) · Trials · doi:10.1186/s13063-024-08241-3 · Cited by 2 · see citing works
“However, less consistent results have been found for such interventions in samples of younger adults, for example university students, often due to difficulties with recruitment [33].”
Test anxiety unplugged: Evaluating a brief web-based intervention for college students.
Karatas, Z., & Sensoy Briddick, H. (2026) · Journal of American College Health · doi:10.1080/07448481.2025.2608833
- Authors
- Bolinski, F., Kleiboer, A., Neijenhuijs, K., Karyotaki, E., Wiers, R., de Koning, L., Jacobi, C., Zarski, A.-C., Weisel, K. K., Cuijpers, P., & Riper, H.
- Affiliations
- Trimbos Institute (NL)
- Amsterdam Public Health (NL)
- HumanTotalCare (Netherlands) (NL)
- University of Amsterdam (NL)
- Technische Universität Dresden (DE)
- Technical University of Munich (DE)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Babeș-Bolyai University (RO)
- Corresponding author
- Bolinski, Felix
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2022-12-14
- Volume
- 24
- Issue
- 12
- Pages
- e40892
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC9798269
- OpenAlex
- W4296015378
- Cited by
- 24
- References
- 82
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 11 · 2023: 3
- FWCI
- 4.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- other-oa
- Locations
- Journal of Medical Internet Research (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- UvA-DARE (University of Amsterdam) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- European Commission (634757, HORIZON2020)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- recruitment difficulties, university students, depression prevention, anxiety prevention, online intervention, transdiagnostic prevention, subclinical symptoms, intervention uptake, human support, Bayesian linear mixed models, underpowered trials, student mental health
- MeSH terms
- Internet-Based Intervention, Anxiety, Bayes Theorem, Depression, Humans, Students, Universities
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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