This systematic review and meta-analysis aimed to examine the effects of stress management interventions in reducing stress, depression, and anxiety among college students. Two separate meta-analyses of randomized controlled trials were conducted using the random-effects model, for students with highstress levels (n = 8) and for the unselected college student population (n = 46). Overall, main results showed moderate intervention effects for stress, depression, and anxiety in both groups. Subgroup analyses yielded significant differences related to the theoretical background, the type of control condition, and the length of the intervention in trials targeting students with high-stress levels. However, these subgroup differences, except for the theoretical background, were not observed in trials including unselected samples. Our results suggest that stress management interventions may be effective in reducing distress among college students. Public Health Significance StatementSymptoms of stress are common among college students. Stress management programs are provided to help students in reducing stress. The present study showed that stress management programs have the potential to decrease stress and prevent mental health problems in higher education.

BackgroundThere is an increasing prevalence of mental health problems among university student populations. In Indonesia, treatment rates are low among university students because of the high cost of treatment, stigma and the limited availability of mental care services. Internet-based interventions have been found to be effective in treating anxiety and depression in Western countries. However, little is known about the effectiveness of Internet-based interventions in low- and middle-income countries (LMICs) such as Indonesia. In this paper, we describe how we culturally adapted an Internet-based intervention to meet the needs of Indonesian students with depression and anxiety based on the theoretical framework of Barrera et al. (2013).MethodWe culturally adapted a Western Internet-based student intervention for depression and anxiety. This intervention consists of 8 guided online sessions. 50 students from Universitas Gadjah Mada Yogyakarta who have mild to moderate depression or anxiety as assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), will participate in a feasibility study in which we will test participants' satisfaction, system usability and uptake. Secondary outcomes include assessment of participants' depression, anxiety and quality of life. Outcomes will be measured pre and post intervention.DiscussionThe present paper presents the protocol of a pilot study aimed at assessing the feasibility and acceptability of a culturally adapted intervention for Indonesian university students with depression and anxiety. The results from the feasibility study will further guide the development of the intervention and may inform the protocol of a future randomized controlled trial (RCT) examining the effectiveness of the Internet-based intervention.

Background University students with depression and anxiety do not easily receive or seek treatment; therefore, internet-based interventions have been suggested to be a promising way to improve treatment accessibility and availability. However, it has not been examined whether a guided, culturally adapted, transdiagnostic, internet-based intervention is effective for treating symptoms of depression, anxiety, or both among university students in Indonesia. Objective This study aims to investigate the feasibility (acceptability and satisfaction, usability, and uptake) of a guided, culturally adapted, transdiagnostic, internet-based intervention among university students with symptoms of depression, anxiety, or both in Indonesia. Methods Students from Universitas Gadjah Mada, Yogyakarta, Indonesia, were screened for symptoms of depression, anxiety, or both, and filled online informed consent, demographic questionnaires, and a quality of life measure at pretreatment assessment (T0). Subsequently, the participants started the intervention. Seven weeks after T0, the primary outcomes of this feasibility study were analyzed at posttreatment assessment (T1) using the 8-item Client Satisfaction Questionnaire (CSQ-8) and the System Usability Scale (SUS). Mean and SDs for the CSQ-8 and SUS were calculated to examine feasibility. Within-group secondary outcomes (depression, anxiety, and quality of life) were inspected for outliers and normal distribution. Paired-sample t tests were used to investigate differences between time points of secondary outcomes. A mixed-method approach of quantitative and qualitative analyses was adopted. Both the primary and secondary outcomes were additionally explored with an individual semistructured interview and synthesized descriptively. Results A total of 50 participants completed the intervention. We found a moderate to high level of satisfaction and acceptability, a slightly below-average level of desirable usability (≥70), and an adherence rate of 52% which was higher than expected given the novelty of the intervention. Results for the secondary outcomes indicated a decrease in depression and anxiety. For depression, the overall mean difference between the 2 time points for depression was 3.92 (95% CI 2.75-5.1; Hedges g 1.15; P<.001). For anxiety, the overall mean difference between the 2 time points was 3.34 (95% CI 2.06-4.61; Hedges g 1.02; P<.001). Further, a moderate effect in improving quality of life was found (g=0.50). Overall, participants were positive about the online intervention and ECoaches (online guidance), and they found the intervention to be culturally appropriate. Conclusions A culturally adapted, transdiagnostic, internet-based intervention appears to be acceptable and feasible for reducing symptoms of depression, anxiety, or both, and increasing quality of life in university students in Indonesia. Future studies should include a randomized controlled trial to assess the effectiveness of such interventions as they may supplement existing counseling services in universities, reduce the treatment costs, and maximize treatment accessibility in low-resourced settings. International Registered Report Identifier (IRRID) RR2-10.1016/j.invent.2018.11.002

BACKGROUND University students with depression and anxiety do not easily receive or seek treatment, therefore Internet-based interventions have been suggested to be a promising way to improve treatment accessibility and availability. However, it has not been examined whether a guided, culturally adapted, transdiagnostic, Internet-based intervention is effective for treating symptoms of depression and/or anxiety among university students in Indonesia. OBJECTIVE This study aims to investigate the feasibility (acceptability and satisfaction, usability, and uptake) of a guided, culturally adapted, transdiagnostic, Internet-based intervention among university students with symptoms of depression and/or anxiety in Indonesia. METHODS Students from Universitas Gadjah Mada, Yogyakarta, Indonesia were screened for symptoms of depression and/or anxiety, filled online informed consent, demographic questionnaires, and a quality of life measure at pre-treatment assessment (T0). Subsequently, the participants started the intervention. Seven weeks after T0, the primary outcomes of this feasibility study were analyzed at post-treatment assessment (T1) using the Client Satisfaction Questionnaire-8 (CSQ-8), and the System Usability Scale (SUS). Mean and standard deviations for the CSQ-8 and SUS were calculated to examine feasibility. Within-group secondary outcomes (depression, anxiety, and quality of life) were inspected for outliers and normal distribution. Paired-sample t-tests were used to investigate differences between time points of secondary outcomes. A mixed-method approach of quantitative and qualitative analyses was adopted. Both the primary and secondary outcomes were additionally explored with an individual semi-structured interview and synthesized descriptively. RESULTS A total of 50 participants completed the intervention. We found a moderate to high level of satisfaction and acceptability, a slightly below-average level of desirable usability (≥ 70), and an adherence rate of 52% which was higher than expected given the novelty of the intervention. Results for the secondary outcomes showed that the intervention had large effects in reducing depression, g = 1.15 (95% CI, 2.75 – 5.1) and anxiety, g = 1.02 (95% CI, 2.06 – 4.61). Further, a moderate effect in improving quality of life was found, g = .50. Overall, participants were positive about the online intervention and ECoaches (online guidance), and they found the intervention to be culturally appropriate. CONCLUSIONS A culturally adapted, transdiagnostic, Internet-based intervention appears to be acceptable and feasible for reducing symptoms of depression and/or anxiety, and increasing quality of life in university students in Indonesia. Future studies should include a randomized controlled trial to assess the effectiveness of such interventions as they may supplement existing counseling services in universities, reduce the treatment costs and maximize treatment accessibility in low resourced settings. INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1016/j.invent.2018.11.002

Purpose: This study explores the occurrence and different levels of anxiety and depression among male and female students who perform or do not perform mudik (homecoming). Investigate the primary source of COVID-19 related information among students. Methods: Online questionnaires consisting of the self-report level of anxiety and depression were delivered to study participants after completing the online informed consent. Quantitative analysis was conducted using the IBM SPSS version 20.0.Results: From a total of 2018 study participants, n=936 were students. Depression (M=8.68; SD= 5.45) was higher among students who did not perform mudik. Meanwhile, the prevalence rate of depression (M=7.18; SD=4.99) was also higher among students who performed mudik. A significant difference [sig (2-tailed) = 0.017; p <0.05)] regarding the level of anxiety was reported higher among female students (M=7.80; SD=4.6) than male students (M=7.03; SD=4.7) and no significant difference [sig (2-tailed) = 0.173; p> 0.05] was reported for the level of depression between male and female students. Instagram was reported as the primary source of COVID-19 related information. Conclusion: This current study supports the notion regarding the occurrence of common mental disorders among students as an impact of the COVID-19 pandemic, regardless of whether homecoming was performed or not. Different levels of anxiety and depression were reported between the male and female student population.