Background The majority of university students with mental health problems are untreated. Only a small empirical literature exists on strategies to increase mental health service use. Aims To investigate the effects and moderators of a brief acceptance‐facilitating intervention on intention to use mental health services among university students. Method Within the German site of the World Health Organization's World Mental Health International College Student (WMH‐ICS) initiative, 1,374 university students were randomized to an intervention condition (IC; n = 664) or a control condition (CC; n = 710) that was implemented in the survey itself. Both conditions received the questions assessing mental disorders and suicidality that were included in other WMH‐ICS surveys. The IC group then additionally received: Internet‐based personalized feedback based on subject symptom severity in the domains of depression, anxiety, substance use, suicidal thoughts and behaviors, and nonsuicidal self‐injury; psychoeducation tailored to the personal symptom profile; and information about available university and community mental health services. The primary outcome was reported intention to use psychological interventions in the next semester, which was the last question in the survey. A broad range of potential moderating factors was explored. Results There was a significant main effect of the intervention with students randomized to IC, reporting significantly higher intentions to seek help in the next semester than students in the CC condition (d = 0.12, 95% CI: 0.02 to 0.23). Moderator analyses indicated that the intervention was more effective among students that fulfilled the criteria for lifetime (d = 0.34; 95% CI: −0.08 to 0.7) and 12‐month panic‐disorder (d = 0.32; 95% CI: −0.10 to 0.74) compared with those without lifetime (d = 0.11; 95% CI: 0.00 to 0.22) or 12‐month panic disorder (d = 0.11; 95% CI: 0.00 to 0.22), students with lower (d = 0.37; 95% CI: −0.77 to 1.51) than higher (d = −0.01; 95% CI: −0.36 to 0.34) self‐reported physical health, and students with nonheterosexual (d = 0.38; 95% CI: 0.08 to 0.67) compared with heterosexual (d = 0.06; 95% CI: −0.06 to 0.17) sexual orientation. The intervention had no effects among students who reported that they recognized that they had an emotional problem and “are already working actively to change it” (Stage 4 “stages of change”). Conclusions A simple acceptance‐facilitating intervention can increase intention to use mental health services, although effects, are on average, small. Future studies should investigate more personalized approaches with interventions tailored to barriers and clinical characteristics of students. In order to optimize intervention effects, the development and evaluation should be realized in designs that are powered to allow incremental value of different intervention components and tailoring strategies to be evaluated, such as in multiphase optimization designs.

The college years can be accompanied by mental distress. Internet- and mobile-based interventions (IMIs) have the potential to improve mental health but adherence is problematic. Psychological guidance might promote adherence but is resource intensive. In this three-armed randomized controlled trial, “guidance on demand” (GoD) and unguided (UG) adherence-promoting versions of the seven-module IMI StudiCare Mindfulness were compared with a waitlist control group and each other. The GoD participants could ask for guidance as needed. A total of 387 students with moderate/low mindfulness were recruited. Follow-up assessments took place after 1 (t1), 2 (t2), and 6 (t3) months. Post-intervention (t2), both versions significantly improved the primary outcome of mindfulness (d = 0.91–1.06, 95% CI 0.66–1.32) and most other mental health outcomes (d = 0.25–0.69, 95% CI 0.00–0.94) compared with WL, with effects generally persisting after 6 months. Exploratory comparisons between UG and GoD were mostly non-significant. Adherence was low but significantly higher in GoD (39%) vs. UG (28%) at the 6-month follow-up. Across versions, 15% of participants experienced negative effects, which were mostly mild. Both versions effectively promoted mental health in college students. Overall, GoD was not associated with substantial gains in effectiveness or adherence compared with UG. Future studies should investigate persuasive design to improve adherence.

Background Procrastination, defined as irrational and voluntary delaying of necessary tasks, is widespread and clinically relevant. Its high prevalence among college students comes with serious consequences for mental health and well-being of those affected. Research for proper treatment is still relatively scarce and treatment of choice seems to be cognitive behavior therapy (CBT). The aim of this study is to evaluate the effectiveness and acceptability of an internet- and mobile-based intervention (IMI) for procrastination based on CBT for college students. Methods A two-armed randomized controlled trial with a calculated sample size of N = 120 participants with problematic procrastination behavior will be conducted. Students will be recruited in Germany, Austria and Switzerland via circular emails at 15+ cooperating universities in the framework of StudiCare, a well-established project that provides IMIs to college students for different health related issues. The intervention group will receive the e-coach guided 5-week IMI StudiCare Procrastination. A waitlist-control group will get access to the unguided IMI 12 weeks after randomization. Assessments will take place before as well as 6 and 12 weeks after randomization. Primary outcome is procrastination, measured by the Irrational Procrastination Scale (IPS). Secondary outcomes include susceptibility to temptation, depression, anxiety, wellbeing and self-efficacy as well as acceptability aspects such as intervention satisfaction, adherence and potential side effects. Additionally, several potential moderators as well as the potential mediators self-efficacy and susceptibility to temptation will be examined exploratorily. Data-analysis will be performed on intention-to-treat basis. Discussion This study will contribute to the evidence concerning effectiveness and acceptability of an intervention for procrastination delivered via the internet. If it shows to be effective, StudiCare Procrastination could provide a low-threshold, cost-efficient way to help the multitude of students suffering from problems caused by procrastination. Trial registration : The trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (DRKS): DRKS00014321 (date of registration: 06.04.2018). In case of important protocol modifications, trial registration will be updated. Trial status : This is protocol version number 1, 11th December 2019. Recruitment started 9th of April 2018 and was completed 30th of November 2018. Assessment and intervention are still ongoing and will be completed by April 2019.

Objectives College is an exhilarating but stressful time often associated with mental distress. The StudiCare project offers Internet- and mobile-based interventions (IMI) for college student mental health promotion. Within this framework, we evaluated the IMI StudiCare Mindfulness, and examined potential moderators and mediators of effectiveness. Methods In this randomized controlled trial, 150 college students with low to moderate mindfulness were randomly assigned to StudiCare Mindfulness or a waitlist control group (WL). StudiCare Mindfulness comprises 5 weekly online modules based on Acceptance Commitment Therapy and stress management. Assessments took place before (t0) and 6 weeks after (t1) randomization. Primary outcome was mindfulness. Secondary outcomes were stress, depression, anxiety, quality of life, intervention satisfaction, and adherence. Sociodemographic variables, pre-intervention symptomatology, personality traits, and attitudes towards IMI were examined as potential moderators. Results Intention-to-treat analyses (N = 149) showed a large effect of StudiCare Mindfulness on mindfulness (d = 1.37; 95% CI: 1.01–1.73) compared to WL at t1 (β = 1.18; 95% CI: 0.96–1.40). Effects on secondary outcomes were significant in favor of the intervention group except for physical quality of life. Mindfulness was found to mediate intervention effectiveness on depression, anxiety, and stress. Moderation analysis was non-significant except for baseline openness to experience, with lower openness associated with larger intervention effects on mindfulness. Conclusions This trial suggests that StudiCare Mindfulness may enhance mindfulness and reduce mental health problems. Its potential applicability as low-threshold prevention and treatment option on a population level should be subject to future trials. Trial Registration German Clinical Studies Trial Register TRN: DRKS00012559.

Background Physical inactivity is a major contributor to the development and persistence of chronic diseases. Mobile health apps that foster physical activity have the potential to assist in behavior change. However, the quality of the mobile health apps available in app stores is hard to assess for making informed decisions by end users and health care providers. Objective This study aimed at systematically reviewing and analyzing the content and quality of physical activity apps available in the 2 major app stores (Google Play and App Store) by using the German version of the Mobile App Rating Scale (MARS-G). Moreover, the privacy and security measures were assessed. Methods A web crawler was used to systematically search for apps promoting physical activity in the Google Play store and App Store. Two independent raters used the MARS-G to assess app quality. Further, app characteristics, content and functions, and privacy and security measures were assessed. The correlation between user star ratings and MARS was calculated. Exploratory regression analysis was conducted to determine relevant predictors for the overall quality of physical activity apps. Results Of the 2231 identified apps, 312 met the inclusion criteria. The results indicated that the overall quality was moderate (mean 3.60 [SD 0.59], range 1-4.75). The scores of the subscales, that is, information (mean 3.24 [SD 0.56], range 1.17-4.4), engagement (mean 3.19 [SD 0.82], range 1.2-5), aesthetics (mean 3.65 [SD 0.79], range 1-5), and functionality (mean 4.35 [SD 0.58], range 1.88-5) were obtained. An efficacy study could not be identified for any of the included apps. The features of data security and privacy were mainly not applied. Average user ratings showed significant small correlations with the MARS ratings (r=0.22, 95% CI 0.08-0.35; P<.001). The amount of content and number of functions were predictive of the overall quality of these physical activity apps, whereas app store and price were not. Conclusions Apps for physical activity showed a broad range of quality ratings, with moderate overall quality ratings. Given the present privacy, security, and evidence concerns inherent to most rated apps, their medical use is questionable. There is a need for open-source databases of expert quality ratings to foster informed health care decisions by users and health care providers.