# Low-burden preventative digital mental health interventions for first-year college students: A pilot feasibility microrandomized trial

## TL;DR

A low-burden digital mental health intervention for first-year college students was found to be feasible and acceptable, with personalized feedback and surveys being particularly valued.

## Contribution

This study introduces a low-burden preventative digital mental health intervention model for college students with mild-to-moderate depressive symptoms.

## Key findings

- High feasibility with 95% enrollment and 87% retention over six weeks.
- Personalized feedback reports were valued by 77% of participants.
- Supportive text messages were less effective, with only 46% finding them helpful.

## Abstract

Mental health problems among college students have increased significantly and barriers to care contribute to a substantial treatment gap. Digital mental health interventions (DMHIs) show promise for overcoming barriers, but engagement with DMHIs is challenging, underscoring the need for low-burden strategies.

This pilot trial evaluated the feasibility and acceptability of a six-week, low-burden, preventative DMHI that delivered supportive text messages and personalized feedback (PF) to first-semester college students.

Students (N = 120, 64% women, 55% non-Hispanic White) who had mild-to-moderate depressive symptoms (PHQ-9 scores between 5 and 14) and were not engaged in formal mental health care were randomized to intervention (n = 90) or assessment-only (n = 30) conditions. Those in the intervention condition received a weekly PF report and/or supportive text messages at random intervals as part of an embedded micro-randomized trial (MRT). Primary outcomes were feasibility and acceptability of the intervention components. Exploratory analyses examined 1) clinical outcomes after six weeks for the intervention and assessment-only conditions, and 2) weekly clinical outcomes within the intervention group based on the MRT.

The trial demonstrated high feasibility (95% enrollment; 87% retention) and strong intervention acceptability, especially for PF and assessment components. Exploratory analyses did not reveal consistent patterns in between- and within-group comparisons.

Low-burden strategies for assessment and intervention are feasible and acceptable to first-year college students at risk for depression. There is significant potential for integrating these lower-intensity strategies into a full-scale trial that adaptively delivers higher-intensity DMHIs and/or integrate human-delivered components in response to needs over time.

•95% of eligible participants enrolled in the trial; 87% retention over six weeks•77% agreed personalized feedback reports provided valuable mental health insights.•Over 90% agreed daily and weekly surveys helped to promote self-reflection.•Supportive text messages were seen as less useful; only 46% found them helpful.•Scalable DMHI model with potential for integration with higher-intensity supports

95% of eligible participants enrolled in the trial; 87% retention over six weeks

77% agreed personalized feedback reports provided valuable mental health insights.

Over 90% agreed daily and weekly surveys helped to promote self-reflection.

Supportive text messages were seen as less useful; only 46% found them helpful.

Scalable DMHI model with potential for integration with higher-intensity supports