The Effectiveness of a Mobile App Intervention for Anxiety and Depression Symptoms in University Students: a Randomised Controlled Trial

Tayla McCloud, Rebecca Jones , Gemma Lewis, Vaughan Bell , Elias Tsakanikos

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Background: Depression and anxiety symptoms are common among university students, but many do not receive treatment. This is due to lack of availability, reluctance to seek help and many students not meeting the diagnostic criteria required to access services. Internet-based interventions such as smartphone applications can overcome these issues, but at present there are a large number publicly available and a dearth of evidence demonstrating their effectiveness.

Objective: To evaluate for the first time the effectiveness of a self-guided mobile app, “Feel Stress Free”, for the treatment of depression and anxiety symptoms in students.

Methods: A web-based randomised controlled trial (RCT) compared a cognitive behavioural therapy-based mobile app “Feel Stress Free” with a wait list control group. The app is fully automated and incorporates behavioural relaxation activities, mood tracking and thought challenging, and mini-games. University students experiencing symptoms of anxiety and/or depression were randomised to either the intervention group (n=84) or control group (n=84). Participants completed the Hospital Anxiety and Depression Scale (HADS) online at baseline and fortnightly for six weeks.

Results: At week 6, the primary endpoint, there was evidence that the “Feel Stress Free” app reduces depression symptoms (mean difference: -1.56; 95% CI: -2.67 to -0.44; P = .006), but not anxiety symptoms (mean difference: -1.36; 95% CI: -2.93 to 0.21; P = .09). At week 4, however, there was evidence to support the effectiveness of the intervention for both anxiety symptoms (mean difference: -1.94; 95% CI: -3.11 to -0.77; P = .001) and depression symptoms (mean difference: -1.08; 95% CI: -2.12 to -0.04; P = .04). At week 6, 83% of participants indicated that they were using the app weekly or more.

Conclusions: The “Feel Stress Free” application is a promising mobile intervention that overcomes many of the barriers to traditional CBT. It appears to be beneficial for treating symptoms of depression and anxiety in students, but further research is needed to establish its long-term effectiveness.
Trial Registration: NCT03032952

© 2020 The Author(s). This is an open-access article due to be published open access in the JOURNAL OF MEDICAL INTERNET RESEARCH.
Original languageEnglish
JournalJournal of Medical Internet Research
Publication statusAccepted/In press - 26 Apr 2020

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