Harnessing Mobile Technology to Reduce Mental Health Disorders in College Populations

项目摘要/摘要 近几十年来，大学生心理健康问题的患病率稳步上升， 三分之一的大学生与焦虑、抑郁或饮食失调作斗争。然而，只有20%-40% 有精神障碍的大学生接受治疗。精神卫生服务提供结果的不足之处 在长期患病、疾病进展、预后较差和复发的可能性较大的情况下，突出 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 开发了跨诊断、低成本的移动健康针对性预防和干预平台 使用人群级别的筛查，让大学生参与针对常见心理问题的定制服务 健康问题。这种护理交付系统代表了一种理想的服务交付模式，因为它使用了我们的 前景看好的、基于证据的移动程序，一种解决共病心理问题的跨诊断方法 健康问题，以及个性化筛查和干预，以增加服务接受度，增强参与度， 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在 行为科学、大学生心理健康、技术和健康经济学，并在我们团队的 在过去的25年里，成功地在160多个国家实施了基于人口的筛查计划 并展示了基于互联网的有针对性的预防和预防方案的有效性 对40多所大学的焦虑、抑郁和饮食失调进行干预。我们建议测试一下 这一移动心理健康服务平台在20所高校进行了大规模试用。学生 筛查临床焦虑、抑郁或进食障碍阳性或高危人群(神经性厌食症除外， 因此需要更密集的医疗监测)，它们占到了 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；最初筛查的146,000人)将被随机分配到：1)通过移动心理干预 健康平台；或2)转诊至常规护理(即校园健康或咨询中心)。我们将测试是否 与通常的护理相比，移动心理健康平台与提高接受度(即个人 开始治疗)(目标1)、减少临床病例和特定于疾病的症状(目标2a、2b)； 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 心理健康结果改善的调解人、预测者和调解人(目标3)以及利益相关者- 相关成果，包括成本效益和学业成绩(目标4)。我们全面的 心理健康护理平台可以为学生带来临床益处，吸引大学利益相关者，最大限度地减少 阻碍校园实施的可持续性，并产生投资的经济回报 与平时的护理相比。这种人口级别的服务参与方法有改进的潜力 在美国高校注册的2000多万学生的心理健康状况。

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.