Computer-delivered and web-based interventions to improve depression, anxiety, and psychological well-being of university students: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students' mental health. The effectiveness of these intervention types requires investigation to identify whether these are viable prevention strategies for university students. OBJECTIVE: The intent of the study was to systematically review and analyze trials of Web-based and computer-delivered interventions to improve depression, anxiety, psychological distress, and stress in university students. METHODS: Several databases were searched using keywords relating to higher education students, mental health, and eHealth interventions. The eligibility criteria for studies included in the review were: (1) the study aimed to improve symptoms relating to depression, anxiety, psychological distress, and stress, (2) the study involved computer-delivered or Web-based interventions accessed via computer, laptop, or tablet, (3) the study was a randomized controlled trial, and (4) the study was trialed on higher education students. Trials were reviewed and outcome data analyzed through random effects meta-analyses for each outcome and each type of trial arm comparison. Cochrane Collaboration risk of bias tool was used to assess study quality. RESULTS: A total of 17 trials were identified, in which seven were the same three interventions on separate samples; 14 reported sufficient information for meta-analysis. The majority (n=13) were website-delivered and nine interventions were based on cognitive behavioral therapy (CBT). A total of 1795 participants were randomized and 1480 analyzed. Risk of bias was considered moderate, as many publications did not sufficiently report their methods and seven explicitly conducted completers' analyses. In comparison to the inactive control, sensitivity meta-analyses supported intervention in improving anxiety (pooled standardized mean difference [SMD] -0.56; 95% CI -0.77 to -0.35, P<.001), depression (pooled SMD -0.43; 95% CI -0.63 to -0.22, P<.001), and stress (pooled SMD -0.73; 95% CI -1.27 to -0.19, P=.008). In comparison to active controls, sensitivity analyses did not support either condition for anxiety (pooled SMD -0.18; 95% CI -0.98 to 0.62, P=.66) or depression (pooled SMD -0.28; 95% CI -0.75 to -0.20, P=.25). In contrast to a comparison intervention, neither condition was supported in sensitivity analyses for anxiety (pooled SMD -0.10; 95% CI -0.39 to 0.18, P=.48) or depression (pooled SMD -0.33; 95% CI -0.43 to 1.09, P=.40). CONCLUSIONS: The findings suggest Web-based and computer-delivered interventions can be effective in improving students' depression, anxiety, and stress outcomes when compared to inactive controls, but some caution is needed when compared to other trial arms and methodological issues were noticeable. Interventions need to be trialed on more heterogeneous student samples and would benefit from user evaluation. Future trials should address methodological considerations to improve reporting of trial quality and address post-intervention skewed data.
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Internet-delivered CBT has demonstrated effectiveness in addressing anxiety disorders and depression in college samples.
“Internet-delivered CBT has demonstrated effectiveness in addressing anxiety disorders and depression in both the general population [23–25] and in college samples [26, 27].”
From An internet-delivered acceptance and commitment therapy program for anxious affect, depression, and wellbeing: A randomized, parallel, two-group, waitlist-controlled trial in a Middle Eastern sample of college students (2024) · cites this paper as [27]
The Results section reports improved anxiety and depression outcomes in university students compared with inactive controls, and the Conclusions say the findings support self-guided Internet-delivered CBT. The review measures anxiety outcomes rather than establishing effectiveness for diagnosed anxiety disorders, and it cautions that the findings are methodologically limited and show no significant advantage over active controls. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe consistent improvements in the intervention group on both anxiety measures and wellbeing are in concurrence with preceding literature on internet-delivered ACT and mindfulness programs.
“The consistent improvements in the intervention group on both measures of anxiety, the generalized and social anxiety variants, as well as wellbeing are in concurrence with the preceding literature”
From An internet-delivered acceptance and commitment therapy program for anxious affect, depression, and wellbeing: A randomized, parallel, two-group, waitlist-controlled trial in a Middle Eastern sample of college students (2024) · cites this paper as [27]
In Results > Web-Based or Computer-Delivered Intervention Compared to Inactive Control (page unavailable), the review reports improved anxiety outcomes for web-based or computer-delivered interventions overall. Results > Intervention Characteristics and Participant Satisfaction/Evaluation (pages unavailable) identify a mindfulness intervention and report perceived personal benefit, but do not establish improvements in both generalized and social anxiety or well-being from internet-delivered ACT and mindfulness programs. (LLM, conf=0.84)
Experimental — accuracy not yet measuredComputer-based e-mental health programs with a CBT framework have been found effective for improving happiness and well-being.
“and improving happiness and well-being [21-23].”
From Apps with maps-anxiety and depression mobile apps with evidence-based frameworks: Systematic search of major app stores (2020) · cites this paper as [21]
The Results (Intervention Characteristics) include programs aimed at general psychological well-being, and the Discussion (Conclusions) cautiously supports the effectiveness of Internet-delivered CBT for university students’ mental-health outcomes. The paper does not report an improvement in happiness specifically, and its demonstrated benefits chiefly concern depression, anxiety, and stress rather than a measured overall well-being outcome. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe aforementioned meta-analyses showed positive results on depressive symptoms with effect sizes in a small range.
“Although the aforementioned meta-analyses showed positive results on depressive symptoms with effect sizes in a small range”
From Meta-analytic review of online guided self-help interventions for depressive symptoms among college students (2021) · cites this paper as Davies et al., 2014
The Results (Web-Based or Computer-Delivered Intervention Compared to Inactive Control; page unavailable) report a significant improvement in depressive symptoms in the sensitivity meta-analysis (SMD −0.43), consistent with a relatively small effect. But the non-skewed analysis found a larger effect (SMD −0.67), and the paper did not find a significant benefit against active controls. The claim omits those distinctions. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAll previous meta-analyses combined guided and unguided self-help interventions in their investigations and there was substantial variation in the degree of success for included programs.
“all authors combined guided and unguided self-help interventions in their investigations and there was substantial variation in the degree of success for included programs”
From Meta-analytic review of online guided self-help interventions for depressive symptoms among college students (2021) · cites this paper as Davies et al., 2014
The Results (Use of Human Support in Interventions; page unavailable) identify both self-administered and semi-guided trials, and the Discussion (Principal Findings; page unavailable) says the review did not compare their effects. The Discussion also reports moderate to high heterogeneity in two analyses, supporting variation in outcomes. The paper does not establish that all previous meta-analyses combined guided and unguided interventions. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Only one qualitative review and two meta-analytic reviews have examined the effectiveness of internet-based interventions for depression targeting college students.
“Only one qualitative review and two meta-analytic reviews have examined the effectiveness of internet-based interventions for depression targeting this population”
From Meta-analytic review of online guided self-help interventions for depressive symptoms among college students (2021) · cites this paper as Davies et al., 2014
The Introduction (page unavailable) identifies Farrer and colleagues’ narrative review of technology-based interventions in higher education students. The Methods and Discussion > Principal Findings (page unavailable) show that Davies et al. conducted a meta-analysis including depression outcomes in university students. The paper does not establish the claimed total of only one qualitative review and two meta-analytic reviews specifically examining internet-based interventions for depression in this population. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEmpirical studies on evidence-based digital interventions for mental health, including internet-based CBT, have shown that these interventions are effective, feasible, and acceptable to users.
“Empirical studies on evidence-based digital interventions for mental health, including internet-based cognitive behavioral therapy (CBT), have shown that these interventions are effective, feasible, and acceptable to users [12-14]”
From Engagement and effectiveness of a healthy-coping intervention via chatbot for university students during the COVID-19 pandemic: Mixed methods proof-of-concept study (2021) · cites this paper as [13]
The Conclusions describe self-guided Internet CBT as effective and online interventions as easily implemented, but caution that the findings are preliminary and concern university students. The Results (Participant Satisfaction/Evaluation With Intervention) report favorable user evaluations in eight studies. The citing sentence presents effectiveness, feasibility, and acceptability more broadly and definitively than this review supports. (LLM, conf=0.86)
Experimental — accuracy not yet measuredExisting systematic reviews on this topic combine digital programs with and without human support.
“In addition, the systematic reviews that exist on this topic combine digital programs with and without human support (Davies et al., 2014; Heber et al., 2017; Lattie et al., 2019).”
From Effects of self-guided stress management interventions in college students: A systematic review and meta-analysis (2022) · cites this paper as Davies et al., 2014
Digital interventions have the potential to improve mental well-being among university students.
“Several systematic reviews and meta-analyses have attested that digital interventions have the potential to improve mental well-being among this population [14,15,27-29]”
From Optimization of a Transdiagnostic Mobile Emotion Regulation Intervention for University Students: Protocol for a Microrandomized Trial (2023) · cites this paper as [28]
Even if a staff member took only 5-10 minutes per session to provide assistance, this could impact user engagement.
“Even if a staff member took only 5 -10 minutes per session to provide assistance (Marks and Cavanagh, 2009), this could impact user engagement (Batterham et al ., 2018; Davies et al ., 2014).”
From A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland (2021) · cites this paper as Davies et al., 2014
Computer-delivered and web-based interventions are effective relative to inactive control for anxiety, depression and stress in university students.
“another meta-analysis25 of computer-delivered and web-based interventions (14 trials, n=1795 university students) reported that the interventions—relative to an inactive control—were effective for anxiety (SDM: −0.56; 95% CI −0.77 to −0.35, p<0.001), depression (SDM: −0.43; 95% CI −0.63 to −0.22, p<0.001) and stress (SDM: −0.73; 95% CI −1.27 to −0.19, p=0.008).”
From Novel ACT-based eHealth psychoeducational intervention for students with mental distress: A study protocol for a mixed-methodology pilot trial (2019) · cites this paper as [25]
Pooling of data of the two comparisons with active control conditions did not result in a significant difference between e-mental health interventions and controls.
“However, the pooling of data of the two comparisons (229 participants) with active control conditions, such as online psychoeducation material, did not result in a significant difference between e-mental health interventions and controls.”
From The effect of e-mental health interventions on academic performance in university and college students: A meta-analysis of randomized controlled trials (2020) · cites this paper as Davies et al. (2014)
Compared to inactive control conditions, e-mental health interventions had a moderate effect on symptoms of anxiety (d = 0.56; seven studies; 374 participants).
“The authors found that compared to inactive control conditions, e-mental-health interventions had a moderate effect on symptoms of depression (d = 0.43; nine studies; 712 participants), anxiety (d = 0.56; seven studies; 374 participants), and stress (d = 0.73; three studies; 217 participants).”
From The effect of e-mental health interventions on academic performance in university and college students: A meta-analysis of randomized controlled trials (2020) · cites this paper as Davies et al. (2014)
Compared to inactive control conditions, e-mental health interventions had a moderate effect on symptoms of stress (d = 0.73; three studies; 217 participants).
“The authors found that compared to inactive control conditions, e-mental-health interventions had a moderate effect on symptoms of depression (d = 0.43; nine studies; 712 participants), anxiety (d = 0.56; seven studies; 374 participants), and stress (d = 0.73; three studies; 217 participants).”
From The effect of e-mental health interventions on academic performance in university and college students: A meta-analysis of randomized controlled trials (2020) · cites this paper as Davies et al. (2014)
Compared to inactive control conditions, e-mental health interventions had a moderate effect on symptoms of depression (d = 0.43; nine studies; 712 participants).
“The authors found that compared to inactive control conditions, e-mental-health interventions had a moderate effect on symptoms of depression (d = 0.43; nine studies; 712 participants), anxiety (d = 0.56; seven studies; 374 participants), and stress (d = 0.73; three studies; 217 participants).”
From The effect of e-mental health interventions on academic performance in university and college students: A meta-analysis of randomized controlled trials (2020) · cites this paper as Davies et al. (2014)
Most DMH approaches were as effective as face-to-face CBT in noninferiority trials.
“Noninferiority trials comparing DMH interventions to face-to-face CBT in order to determine whether a new intervention is therapeutically similar to an existing effective treatment [33] showed that most DMH approaches were as effective as face-to-face CBT [31,34-36].”
From Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint (2019) · cites this paper as [31]
Analyses comparing DMH interventions for both anxiety and depression with active nontherapeutic controls have generally failed to show superiority of DMH interventions.
“However, analyses comparing DMH interventions for both anxiety and depression with active nontherapeutic controls have generally failed to show superiority of DMH interventions [31,32].”
From Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint (2019) · cites this paper as [31]
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“Five trials compared intervention to inactive (ie, no treatment or waitlist control) and either an active control [53] or comparison intervention [28,47,50,52], five trialed the intervention to an active control [44,45,55-57], six trialed against inactive control [42,46,48,49,51,54], and one compared intervention to a…”
BackgroundInfluentialePREP: Computer Based Prevention of Relationship Dysfunction, Depression and Anxiety
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Attitudes towards computerized CBT for depression amongst a student population
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Web-based cognitive-behavioral therapy for perfectionism: A randomized controlled trial
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Computer-Based Intervention for Anxious and Depressive Symptoms in a Non-Clinical Population
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A randomised placebo-controlled trial of a self-help Internet-based intervention for test anxiety
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New Technologies to Manage Exam Anxiety
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Learning Lucid Dreaming and its Effect on Depression in Undergraduates
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A Review of Effective Youth Engagement Strategies for Mental Health and Substance Use Interventions
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“Empirical studies on evidence-based digital interventions for mental health, including internet-based cognitive behavioral therapy (CBT), have shown that these interventions are effective, feasible, and acceptable to users [12-14], although some limitations have been found, mainly regarding low engagement by users and…”
BackgroundWho benefits from psychotherapies for adult depression? A meta-analytic update of the evidence
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Mental Health-Related Digital Use by University Students: A Systematic Review
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“Over the last two decades, e-mental health programs with a CBT framework and designed for use on computers have been found to be effective for both adults and children in reducing anxiety and depression [19,20] and improving happiness and well-being [21-23].”
BackgroundDigital health for quality healthcare: A systematic mapping of review studies
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Recent Developments in Digital Mental Health Interventions for College and University Students
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Understanding Students’ Mental Well-Being Challenges on a University Campus: Interview Study
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Internetbasierte Interventionen in der Behandlung psychischer Störungen
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Business as usual? Psychological support at a distance.
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“Further meta-analyses have concluded that e-therapies are comparable to face-to-face therapies for young people in terms of their impact on symptoms of anxiety and depression (Davies et al., 2014; Hollis et al., 2017; Ye et al., 2014).”
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Digital Health Needs of Women With Postpartum Depression: Focus Group Study
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Recent advances in the prevention of mental disorders
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- Authors
- Davies, E. B., Morriss, R., & Glazebrook, C.
- Affiliations
- University of Nottingham (GB)
- Corresponding author
- Davies, E Bethan
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2014-05-16
- Volume
- 16
- Issue
- 5
- Pages
- e130
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4051748
- OpenAlex
- W2110842912
- Cited by
- 499
- References
- 80
- Citations by year
- 2026: 25 · 2025: 36 · 2024: 34 · 2023: 56 · 2022: 52 · 2021: 106 · 2020: 43 · 2019: 42 · 2018: 33 · 2017: 24 · 2016: 28 · 2015: 16 · 2014: 4
- FWCI
- 2.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by)
- Funders
- Mental Health Research UK
- National Institute for Health and Care Research
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
- Keywords
- depression, anxiety, psychological distress, stress, university students, digital health interventions, online intervention, computer-based intervention, cognitive behavioral therapy, student mental health, risk of bias assessment, attrition bias, publication bias, risk of bias in meta-analysis, risk of bias in individual studies
- MeSH terms
- Anxiety, Depression, Female, Humans, Male, Mental Health, Stress, Psychological, Students, Universities, Cognitive Behavioral Therapy, Telemedicine, Internet
About these checks
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