A Mobile App to Identify Lifestyle Indicators Related to Undergraduate Mental Health (Smart Healthy Campus): Observational App-Based Ecological Momentary Assessment

Abstract

Background Undergraduate studies are challenging, and mental health issues can frequently occur in undergraduate students, straining campus resources that are already in demand for somatic problems. Cost-effective measures with ubiquitous devices, such as smartphones, offer the potential to deliver targeted interventions to monitor and affect lifestyle, which may result in improvements to student mental health. However, the avenues by which this can be done are not particularly well understood, especially in the Canadian context. Objective The aim of this study is to deploy an initial version of the Smart Healthy Campus app at Western University, Canada, and to analyze corresponding data for associations between psychosocial factors (measured by a questionnaire) and behaviors associated with lifestyle (measured by smartphone sensors). Methods This preliminary study was conducted as an observational app-based ecological momentary assessment. Undergraduate students were recruited over email, and sampling using a custom 7-item questionnaire occurred on a weekly basis. Results First, the 7-item Smart Healthy Campus questionnaire, derived from fully validated questionnaires—such as the Brief Resilience Scale; General Anxiety Disorder-7; and Depression, Anxiety, and Stress Scale–21—was shown to significantly correlate with the mental health domains of these validated questionnaires, illustrating that it is a viable tool for a momentary assessment of an overview of undergraduate mental health. Second, data collected through the app were analyzed. There were 312 weekly responses and 813 sensor samples from 139 participants from March 2019 to March 2020; data collection concluded when COVID-19 was declared a pandemic. Demographic information was not collected in this preliminary study because of technical limitations. Approximately 69.8% (97/139) of participants only completed one survey, possibly because of the absence of any incentive. Given the limited amount of data, analysis was not conducted with respect to time, so all data were analyzed as a single collection. On the basis of mean rank, students showing more positive mental health through higher questionnaire scores tended to spend more time completing questionnaires, showed more signs of physical activity based on pedometers, and had their devices running less and plugged in charging less when sampled. In addition, based on mean rank, students on campus tended to report more positive mental health through higher questionnaire scores compared with those who were sampled off campus. Some data from students found in or near residences were also briefly examined. Conclusions Given these limited data, participants tended to report a more positive overview of mental health when on campus and when showing signs of higher levels of physical activity. These early findings suggest that device sensors related to physical activity and location are useful for monitoring undergraduate students and designing interventions. However, much more sensor data are needed going forward, especially given the sweeping changes in undergraduate studies due to COVID-19.

An App-Based Ecological Momentary Assessment of Undergraduate Mental Health During the COVID-19 pandemic in Canada (Smart Healthy Campus Version 2.0): Longitudinal Study

“…The weekly variant is almost the same as our pilot SHC 1.0 study questionnaire (which was also distributed weekly) and this was shown in the pilot SHC 1.0 study to significantly correlate with mental health domains based on validated full-length questionnaires 13 . The first 7 questions are the same as the SHC 1.0 questionnaire.…”

“…The focus of the statistical analysis in this paper is on the relationship between phone digital measures and the SHC 2.0 questionnaire variants. The total score of the SHC 2.0 questionnaire variants are examined (some items were recoded to make them suitable for a total sum), along with scores from individual questions, which are representative of various mental health domains 13 (see Methods). SHC 2.0 required participants to answer all questions since the questionnaires were short.…”

“…Individual questions are examined here in addition to the total questionnaire score, as on their own, they were designed to capture various domains of mental health (e.g. depression, anxiety) 13 (discussed in Methods). The goal of the mixed linear model analysis is that by knowing the measurable behaviors/lifestyle associated with positive mental health, it should become easier to design traditional or computer-related interventions to direct participants to those associated behaviors/lifestyle.…”

“…Individual questions are examined here in addition to the total questionnaire score, as on their own, they were designed to capture various domains of mental health (e.g. depression, anxiety) 13…”

“…This ran on a research platform we called EMAX, which has been outlined in a previous paper 12 . SHC 2.0 is the successor to a limited, pilot SHC 1.0 study, also detailed in a previous paper 13 . The SHC 2.0 app asks a small number of mental health-related questions on a daily basis and collects data from phone hardware as questionnaires are submitted and also occasionally in the background.…”