# An Integrated Multilevel Mental Health Support System for University Students: 4-Year Longitudinal Observational Study

## TL;DR

This study presents a 4-year mental health support system for university students using a mobile app to track moods and provide timely interventions.

## Contribution

The novel contribution is an integrated multilevel system combining digital screening with personal services to support student mental health.

## Key findings

- Approximately 29% of students used the mood report feature of the app over 45 months.
- The system identified students at risk of mental health issues without stigmatization, with increased use during academic periods.
- The model offers a scalable path from digital to in-person services and provides data for leadership to improve mental health support.

## Abstract

University students, in the life stage of emerging adulthood, struggle with a number of mental health problems around the world, mostly due to difficulties related to their studies and social relations. Though most students are aware of their problems, health-seeking behavior tends to lag behind. The COVID-19 pandemic aggravated mental health problems among students. In response, the University of Debrecen developed an integrated, multilevel model system aimed at the screening, prevention, and treatment of students’ mental health problems.

This paper describes the testing of the integrated, multilevel model system aimed at the screening, prevention, and treatment of students’ mental health problems.

The new system consists of data collection and intervention or service functions with 2 levels of informal digital, and 3 with partly digital, partly personal service modalities. Students access the system through a dedicated smartphone app that offers other university-related functions requiring personal login. One function of the app involves a mood report with 3 categories (awful, acceptable, and good), of which one per day can be submitted by students. Based on this report, further services are offered. According to the weekly patterns of the mood report, responding students may be directed to the second level, at which screening for depression or willingness to participate in peer groups is assessed. Depending on the responses, students are referred to personal (face-to-face) services at the secondary level for intervention. Aggregated reporting for leadership on the use of functions is available at all levels, which can be used to make decisions regarding the expansion of services or creating new ones.

The model was launched in September 2020 and was tested for 45 months. After an initial increase in use, approximately 29% (8673/29,045) of all students provided mood reports (the University of Debrecen student population on October 15, 2024, was 29,045 students; the student population using the mobile app mood report was 8673 students). The percentage of students reporting a bad mood varied between 8.9% (26,465/297,372) and 12.2% (36,280/297,372) in the test period, while 50% (151,548/297,372 reports) of students reported being in a good mood. There was a marked pattern of increased use of mood reporting during the fall and spring study periods, while usage prominently decreased during the examination period and summer recess.

The 4-year trial period demonstrated that the mood report embedded in the mobile app can identify students with a potentially increased risk of mental health problems in need of support without stigmatization. The unique feature of our model seems to be its app-based screening at the first level and its hierarchy integrating digital and personal services. The system provides an easy-to-follow path from digital to personal services, along with time-specific data on the mental health of students for university leadership to facilitate the development of new services.