Harnessing Mobile Technology to Reduce Mental Health Disorders in College Populations

项目概要/摘要 近几十年来，大学生心理健康问题的患病率稳步上升， 三分之一的大学生患有焦虑、抑郁或饮食失调症。然而，只有20-40% 有精神障碍的大学生接受治疗。精神卫生保健服务不足导致 长期患病，疾病进展，预后较差，复发的可能性更大，强调了 需要一种新的方法来检测心理健康问题，并让大学生参与服务。我们 开发了一个跨诊断、低成本的移动的健康定向预防和干预平台， 使用人口水平的筛选，让大学生参与量身定制的服务， 健康问题这种护理提供系统是一种理想的服务提供模式，因为它使用我们的 有前途的，以证据为基础的移动的程序，一种跨诊断的方法，解决共病的精神 健康问题，个性化筛查和干预，以增加服务的吸收，提高参与度， 并改善结果。此外，我们的服务交付模式利用了我们领导团队的专业知识， 行为科学，大学生心理健康，技术和健康经济学，并桥梁我们的团队的 过去25年来，在160多个国家成功实施了以人口为基础的筛查计划， 大学和展示基于互联网的有针对性的预防方案的有效性， 在40多所大学进行焦虑、抑郁和饮食失调的干预。我们建议测试 这个移动的心理健康服务平台在20所大学进行了大规模的试验。的学生 筛查阳性或临床焦虑、抑郁或进食障碍（不包括神经性厌食症， 需要加强医疗监测），这占了 大学校园的心理健康负担，以及目前没有从事心理健康服务的人 （N= 7，884;初始筛选的146，000例）将被随机分配至：1）通过移动的心理干预 健康平台;或2）转诊到常规护理（即，校园健康或咨询中心）。我们将测试 与常规护理相比，移动的心理健康平台与改善的吸收（即，个人 开始治疗）（目标1），减少临床病例和疾病特异性症状（目标2a，2b），以及 改善生活质量和功能（目标2c）。我们还将测试假定的目标/机制，其他 改善心理健康结果的中介者、预测者和调节者（目标3）以及利益相关者- 相关成果，包括成本效益和学习成绩（目标4）。我们全面 心理健康护理平台可以为学生带来临床效益，吸引大学利益相关者，最大限度地减少 在校园实施可持续发展的障碍，并产生投资的经济回报 与平时的护理相比。这种人口层面的服务参与方法有可能改善 心理健康的结果为20+万学生就读于美国学院和大学。

PROJECT SUMMARY/ABSTRACT The prevalence of mental health problems among college populations has risen steadily in recent decades, with one-third of college students struggling with anxiety, depression, or an eating disorder. Yet, only 20-40% of college students with mental disorders receive treatment. Inadequacies in mental health care delivery result in prolonged illness, disease progression, poorer prognosis, and greater likelihood of relapse, highlighting the need for a new approach for detecting mental health problems and engaging college students in services. We have developed a transdiagnostic, low-cost mobile health targeted prevention and intervention platform that uses population-level screening for engaging college students in tailored services that address common mental health problems. This care delivery system represents an ideal model for service delivery given its use of our promising, evidence-based mobile programs, a transdiagnostic approach that addresses comorbid mental health issues, and personalized screening and intervention to increase service uptake, enhance engagement, and improve outcomes. Further, our service delivery model harnesses the expertise of our team of leaders in behavioral science, college student mental health, technology, and health economics, and bridges our team's work over the past 25 years in successfully implementing a population-based screening program in over 160 colleges and demonstrating the effectiveness of Internet-based programs for targeted prevention and intervention for anxiety, depression, and eating disorders in over 40 colleges. We propose to test the impact of this mobile mental health platform for service delivery in a large-scale trial across 20 colleges. Students who screen positive or at high-risk for clinical anxiety, depression, or eating disorders (excluding anorexia nervosa, for which more intensive medical monitoring is warranted), which account for a substantial proportion of the mental health burden on college campuses, and who are not currently engaged in mental health services (N=7,884; of 146,000 initially screened) will be randomly assigned to: 1) intervention via the mobile mental health platform; or 2) referral to usual care (i.e., campus health or counseling center). We will test whether the mobile mental health platform, compared to usual care, is associated with improved uptake (i.e., individuals beginning treatment) (Aim 1), reduced clinical cases and disorder-specific symptoms (Aims 2a, 2b), and improved quality of life and functioning (Aim 2c). We will also test putative targets/mechanisms, other mediators, predictors, and moderators of improved mental health outcomes (Aim 3) as well as stakeholder- relevant outcomes, including cost-effectiveness and academic performance (Aim 4). Our comprehensive mental health care platform can yield clinical benefit to students, appeal to university stakeholders, minimize barriers to implementation sustainability on campuses, and produce an economic return on investment compared to usual care. This population-level approach to service engagement has the potential to improve mental health outcomes for the 20+ million students enrolled in U.S. colleges and universities.