Effectiveness of Digital Health Interventions on Stress, Anxiety, and Depression in University Students: A Systematic Review and Meta-Analysis

Summary

This systematic review and meta-analysis demonstrate that digital health interventions significantly improve student mental health. Web-based programs are superior to apps, with a 4-8 week duration being optimal, positioning them as a valuable, scalable resource.

Abstract

Stress, anxiety, and depression are among the most common mental health problems experienced by university students. The aim of this study was to systematically review and analyze the effectiveness of digital health interventions in reducing stress, anxiety, and depression in university students.

Several databases (the Cochrane Library, Ovid Embase, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection databases) were searched for randomized controlled trials (RCTs) of digital health interventions published by June 30, 2024. The trials were reviewed, and outcome data were analyzed using random effects meta-analyses for each outcome.

A total of 22 RCTs involving 3,655 participants (3,041 analyzed) were included. The meta-analysis revealed that digital health interventions significantly reduced stress, anxiety, and depression in university students (stress: WMD = -1.79; 95% CI: -2.51, -1.07; P<0.001; anxiety: WMD = -1.73; 95% CI: -2.20, -1.25; P<0.001; depression: WMD = -2.05; 95% CI: -2.91, -1.19; P<0.001). Intervention duration and technique were significant moderators of effect size across all outcomes (all P<0.001). Interventions lasting 4 to 8 weeks demonstrated the greatest reductions in symptoms (stress: WMD = -3.7, 95% CI: -5.02, -2.39; anxiety: WMD = -2.77, 95% CI: -3.46, -2.08; depression: WMD = -4.1, 95% CI: -5.31, -2.89). The effect sizes were significantly greater when the interventions were compared to the passive control groups (stress: WMD = -2.46, 95% CI: -3.56, -1.36; anxiety: WMD = -2.32, 95% CI: -2.89, -1.75; depression: WMD = -2.61, 95% CI: -3.92, -1.29). In contrast, comparisons with active control groups yielded smaller, although still significant, effects for stress and depression and a nonsignificant effect for anxiety.

The findings indicate that digital health interventions are effective at reducing stress, anxiety, and depression in university students. These findings underscore the necessity of digital health interventions for promoting university students' mental health in higher education settings.

Introduction

The mental health of young people has attracted increasing attention and is now recognized as a global public health challenge¹. University education aims to reinforce students' intellectual abilities and prepare them for productive and successful lives as adults². However, during this particular phase in life, students frequently encounter multiple stressors, such as moving away from home, becoming more independent, taking on new responsibilities, and managing academic workloads³. Such stressors can adversely affect both physical and emotional well-being, leading to diminished academic performanc....

Protocol

Study registration
This systematic review and meta-analysis protocol was registered on PROSPERO with a registration number of CRD 42024610457. This study was designed and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines¹⁹.

Search strategy
A comprehensive literature review was conducted by two authors (XXZ and JZ), who searched the Cochrane Library, Ovid Embase, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection databases. Their search encompassed all relevant records from the start of eac....

Results

A total of 20,975 potentially relevant studies were initially identified from the six databases. After 7,374 duplicate records were removed, 13,601 studies underwent screening. Of these, 13,548 were excluded based on their titles and abstracts. The remaining 53 studies underwent full-text review for eligibility. Following this assessment, 31 studies were excluded for the following reasons: (1) use of non-validated or inappropriate measurement scales (n = 7), (2) intervention not meeting the inclusion criteria (n = 5), (3.......

Discussion

The present meta-analysis identified 22 RCTs with 3,655 participants to examine the effectiveness of digital health interventions in reducing stress, anxiety, and depression among university students. As a scalable, low-cost, and readily accessible form of psychological support, digital health interventions have demonstrated strong implementation potential in the college population. Our systematic review and meta-analysis demonstrate that digital health interventions lead to significant reductions in students' stress.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
EndNote	Clarivate	X21	Software used for literature management and screening
Review Manager (RevMan)	The Cochrane Collaboration	5.3	Software used for meta-analysis
stata	StataCorp LLC	18	Software used for statistical analysis and data management