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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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In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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)
The cited source says what the claim attributes to it.
In the citing paper
“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)
The cited source says what the claim attributes to it.
In the citing paper
“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)
The cited source says what the claim attributes to it.
In the citing paper
“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)
In the citing paper
“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]
In the citing paper
“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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Metadata
- 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
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