Picking Mental Health Apps for College Students

This post was co-written with by college mental health lead Jennifer Melcher of the BIDMC Division of Digital Psychiatry at BIDMC.

Between being given 24-hours’ notice to pack their rooms and say their goodbyes to attending classes from their childhood bedrooms, the COVID-19 pandemic has been especially unkind to college students. Recent CDC data suggests that college-aged Americans have experienced more negative mental health effects of the pandemic than any other age group with 62.9 percent meeting the criteria for an anxiety or a depressive disorder, and 25.5 percent reporting they had seriously considered suicide in the past month.

However, the increasing number of mental health challenges in college students is not new. Even before the pandemic, colleges saw a rise in mental health needs strain their counseling center resources and lead to long waitlists for appointments and burn-out among counselors. Today’s college students grew up in a world where almost every service they needed could be found on-demand. The average wait time for an intake appointment at a college counseling center of 6.1 business days may seem like an eternity to someone who is accustomed to having food delivered at their door within the hour and having their Amazon order arrive the next day.

Some college counseling centers now direct students who visit their website to mental health apps to provide some immediate resources and reduce the burden on their own staff. College students appear particularly well suited to mental health apps as this age group grew up utilizing digital resources and 96 percent of individuals in this age group own a smartphone of some kind.

Still, checking the app marketplaces for a suitable, safe, and effective resource can be a daunting task for students and counselors alike. Over 10,000 apps are marketed as mental health-related and the FDA has not heavily regulated this market. This means that there are no restrictions on mental health apps within the app store. Some apps advertised as mental health resources may share users’ personal data with third parties. Others may have outdated information or no evidence base for their interventions. Without any regulations, choosing between potentially harmful and potentially helpful apps is done with only star-ratings and reviews as guides.

Our research suggests that when students are looking for an app, there are four core themes to consider: data privacy, user interface, credibility, and customization. However, these themes alone cannot guide app selection as each is subject to personalized needs to a student and the mental health issue at hand. There are several approaches, and research suggests that offering people the information to make the best choice possible is a practical path forward. Towards that approach, we have begun to utilize an app database in guiding students towards the right app for them. The goal is to allow users to make informed decisions about the apps they download by objectively categorizing apps according to their accessibility, privacy protections, evidence-based, engagement style, and therapeutic goal.

In practice, we have found that the best way to use the database in care settings is to

1. Begin a conversation around what an app could be useful for and how it will help towards recovery
2. Consider what aspects of an app are critical for the student (e.g., must have mindfulness) and which negotiable
3. Search the database to see what apps meet the criteria.

After selecting an app, data shows that clinician engagement and follow-up around the use of that app is likely to boost the effect size, meaning apps should be seen as more than self-help tools. While there are definite numbers, one review estimates therapist involvement could double the effect size, highlighting how important active engagement is.

Finding the right app for college students and offering active support may seem daunting, but starting with a conversation about preferences and framing use within the therapeutic treatment plan are the important steps anyone can take today.