# Wellness4Students Program to Mitigate Stress, Anxiety, and Depression Among Makerere University Students in Uganda: Protocol for a Longitudinal Study

## TL;DR

This study tests a text messaging program to reduce stress, anxiety, and depression among university students in Uganda.

## Contribution

The Wellness4Students program offers a novel SMS-based mental health intervention to address unmet needs in a low-resource setting.

## Key findings

- The W4S program will provide insights into the prevalence of stress, anxiety, and depression among Makerere University students.
- The study will identify students most at risk of poor mental health outcomes through longitudinal data collection.
- Daily supportive messages will be delivered for six months to assess their impact on mental well-being.

## Abstract

Research indicates that university students experience higher levels of stress, anxiety, and depression (SAD) than the general population. In Uganda, existing psychological interventions for addressing SAD among students are primarily delivered face to face, which limits effective diagnosis and treatment due to stigma, a shortage of counselors, and long waiting times, which contribute to significant unmet mental health needs. Consequently, there is an urgent need for innovative approaches to improve access to mental health services.

This study aims to assess the feasibility and effectiveness of a supportive SMS text messaging program (Wellness4Students [W4S]) in reducing the prevalence of SAD among university students in Uganda.

This study has a quantitative longitudinal research design. We will target 4494 undergraduate students aged 18 to 24 years who will be recruited from Makerere University, Uganda. Through advertisements on social media platforms (WhatsApp and X [formerly known as Twitter]) and websites, students will receive a link to the W4S website with information about the intervention. Eligible students will voluntarily self-subscribe to the W4S program by providing their email addresses. The subscription will be an indicator of consent required for participation in receiving the intervention. Subscribers will receive daily supportive messages for 6 months. The data will be collected from subscribers at baseline (program initiation), 1 month, 3 months (midpoint), and 6 months (program completion) through web-based surveys. Students will complete questionnaires regarding SAD and well-being. We will conduct both descriptive and inferential statistical analyses using STATA version 17.

The results of this study are expected within 1 year after program initiation. The data will be collected from February 2026 through October 2026. The development of the W4S app and the survey instrument has been completed. The cocreation of mental health messages with 15 undergraduate students and 2 university psychologists has been completed as of March 23, 2026. The roll-out of the program is scheduled for March 24, 2026.

The W4S intervention is feasible. The W4S program will provide essential insight into the prevalence and correlates of SAD among Makerere University students. We will identify students who are most at risk of poor mental health outcomes.