College student interest in teletherapy and self-guided mental health supports during the COVID-19 pandemic 大学生在 COVID-19 大流行期间对远程治疗和自我指导心理健康支持的兴趣
Isaac L. Ahuvia, Jenna Y. Sung, Mallory L. Dobias, Brady D. Nelson, Lauren L. Richmond, Bonita London & Jessica L. Schleider 艾萨克·L·阿胡维亚，詹娜·宋，马洛里·L·多比亚斯，布雷迪·D·尼尔森，劳伦·L·里士满，博尼塔·伦敦和杰西卡·L·施莱德
To cite this article: Isaac L. Ahuvia, Jenna Y. Sung, Mallory L. Dobias, Brady D. Nelson, Lauren L. Richmond, Bonita London & Jessica L. Schleider (2024) College student interest in teletherapy and self-guided mental health supports during the COVID-19 pandemic, Journal of American College Health, 72:3, 940-946, DOI: 10.1080/07448481.2022.2062245
College student interest in teletherapy and self-guided mental health supports during the COVID-19 pandemic
Isaac L. Ahuvia, BA (D), Jenna Y. Sung, BA, Mallory L. Dobias, BS, Brady D. Nelson, PhD (D), Lauren L. Richmond, PhD, Bonita London, PhD and Jessica L. Schleider, PhD (D) Department of Psychology, Stony Brook University, Stony Brook, New York, USA
Abstract
Objective The COVID-19 pandemic has worsened college students’ mental health while simultaneously creating new barriers to traditional in-person care. Teletherapy and online self-guided mental health supports are two potential avenues for addressing unmet mental health needs when face-to-face services are less accessible, but little is known about factors that shape interest in these supports. Participants: 1,224 U.S. undergraduate students (mean age =20.7;73%=20.7 ; 73 \% female; 40% White) participated. Methods: Students completed an online questionnaire assessing interest in teletherapy and self-guided supports. Predictors included age, sex, race/ethnicity, sexual minority status, and anxiety and depression symptomatology. Results: Interest rates were 20% and 25% for at-cost supports (teletherapy and online self-help, respectively) and 70%70 \% and 72%72 \% for free supports (teletherapy and online self-help, respectively). Patterns emerged by age, anxiety symptom severity, and race/ethnicity. Conclusions: Results may inform universities’ efforts to optimize students’ engagement with nontraditional, digital mental health supports, including teletherapy and self-guided programs. The SARS-CoV2 (COVID-19) pandemic has taken a severe toll on public health, with effects reaching far beyond unprecedented illness and mortality. Levels of mental health difficulties appear to be rising broadly as the pandemic has progressed, both in the general U.S. population and among college students specifically. ^(1,2){ }^{1,2} The COVID-19 pandemic and its repercussions may undermine college student mental health in myriad ways. ^(2){ }^{2} Concurrently, students now face the potential for serious illness, loss of loved ones, financial strain, social isolation, loss of on-campus resources, and sudden disruption of routines-creating a “perfect storm” for the emergence or exacerbation of psychological distress.
ARTICLE HISTORY
Received 25 April 2021
Revised 24 January 2022
Accepted 30 March 2022
KEYWORDS
College student; COVID-19; mental health; self-guided; teletherapy
Even before the pandemic, only approximately a third of college students with mental health problems received treatment. ^(3){ }^{3} Since March 2020, social distancing measures to mitigate illness spread, including nationwide campus closures, have further suppressed opportunities for students to access face-to-face psychological support. ^(4){ }^{4} Together with the complexities of treating students forced to move off-campus, often across state lines, many students were initially left without access to usual providers. Identifying means of delivering mental health care to college students that circumvent these barriers-and ensuring those supports are acceptable and likely to be used by students facing diverse access bar-riers-is key to supporting positive emotional and educational trajectories in students nationwide. Thus, we examined the acceptability of two potential means for providing mental health care that avoid these issues: teletherapy and self-guided mental health programs.
Teletherapy and self-guided mental health programs are two mental healthcare delivery modalities that may circumvent traditional barriers to treatment. Teletherapy (also known as telehealth, e-mental health, etc.) is standard one-on-one or group therapy provided online or over the
phone. Self-guided mental health programs (often Web- or app-based) are designed to improve mental health, but they do not involve talking directly with a therapist. They are often available as brief online programs or as apps. ^(5){ }^{5} Mental health apps vary widely in terms of focus areas, treatment approaches, and adherence to evidence-based treatment practices. ^(6){ }^{6} Both intervention delivery modalities remove barriers to seeking care frequently endorsed by college students, such as logistical difficulties, too-long waiting-times, high costs, and viewing treatment as too large a time commitment. ^(7){ }^{7}
As the promise of these virtual treatment delivery modalities has received more attention from consumers, researchers, and providers alike, consumers have increasingly sought them out in recent years. ^(8){ }^{8} Researchers’ attention to teletherapy and digital supports has accelerated dramatically because of the pandemic and social distancing practices. ^(9,10){ }^{9,10} In addition to teletherapy, there is an ever-increasing number of digital health apps available to college students, with some requiring a monthly fee and others offered at no cost to users. ^(11){ }^{11} Likewise, policymakers have taken note of the need for these supports during the pandemic, as many states have
taken action to make teletherapy more widely accessible. ^(12){ }^{12} Of particular note for the college student population are allowances made for teletherapy to be provided across state lines; this can be critical for college students who attend universities in different states than they reside. Together, these developments suggest a system-level embrace of this new approach to providing flexible support for college students.
However, the increase in supply for digitally administered supports has not led to a proportional increase in usage. ^(13-15){ }^{13-15} The adage “if we build it, they will come” may not always hold true in the context of wide-scale program implementation, particularly with respect to digital health tools. Many widely-available mental health apps, for example, suffer from low retention rates; one analysis found median 30-day retention rates in the range of 4%^(16)4 \%{ }^{16} Improvements to the accessibility of care do not necessarily mean that said care will be accessed.
Why, if there are digitally administered supports available to college students (and if college students demonstrate a need for additional mental health supports), do college students not engage with these supports? One answer may simply be that the array of services offered to college students are not adequately attractive as treatment options. Without adequate interest, even effective supports may remain underutilized. Creators of digital interventions have often failed to explore what people with mental health difficulties want from such interventions until after they are already developed. ^(17,18){ }^{17,18}
What factors drive college students’ interest in digitally-administered supports? A handful of studies have explored factors that may contribute to interest in teletherapy and self-guided mental health programs. Research on adults suggests that the personalization of digital supports to individuals’ situations (eg, providing the opportunity to engage at any time during the day), as well as individuals’ initial beliefs about digital interventions (eg, how effective individuals believe digital interventions are in general), are important predictors of uptake. ^(19){ }^{19} Additional factors such as the perceived quality of the service, ease of use, and esthetics inform whether or not individuals use digitally administered supports. ^(20,21){ }^{20,21}
Aside from characteristics of the service, person-level characteristics have been shown to predict interest in digitally administered mental health supports. Teletherapy is often deemed useful by students who face time- and travel-related barriers to face-to-face therapy. ^(22){ }^{22} In addition, those with past experience receiving in-person counseling may be more open to engaging in teletherapy than those without that experience. ^(23){ }^{23} Openness to using digitally administered supports may be higher among women and those who have received face-to-face mental health supports in the past. ^(24){ }^{24} Some findings indicate that students of color prefer digital mental health apps at a greater rate than white students, ^(4,24){ }^{4,24} potentially due to greater stigma toward traditional face-to-face treatments among communities of color. ^(25,26){ }^{25,26} To this point, one evaluation that made online self-guided supports freely available over the Internet attracted approximately 50%50 \% individuals of color. ^(27){ }^{27}
Importantly, college students experiencing more distress appear more likely to use digital mental health supports, while the opposite pattern holds true for traditional mental health supports. ^(28){ }^{28} However, the severity of symptoms is not always a significant predictor when studied. Lastly, qualitative work has indicated that cost is a central concern for those who may be interested in pursuing this care. ^(29){ }^{29} However, more research is needed to determine what factors influence uptake of digitally-administered mental health supports in college students, specifically. ^(30){ }^{30}
Present research questions
The pandemic has dramatically increased risks to college students’ mental health, ^(31,32){ }^{31,32} with studies finding majorities of students feeling increased stress and anxiety as a result of the pandemic. ^(2,33){ }^{2,33} Simultaneously, social distancing measures have undermined access to in-person counseling. Thus, we examined the following research questions. First, what is the extent of college students’ openness to various digital mental health supports, including teletherapy (synchronous virtual counseling with a clinician) and self-guided treatments (eg, apps or online programs), during the early months of the COVID-19 pandemic in the United States (March to April 2020)? Second, how does students’ interest in these interventions vary by treatment modality type (teletherapy vs. self-guided treatment), symptom severity (eg, higher vs. lower levels of depression and anxiety symptoms), presence versus absence of minoritized student identities (eg, racial/ethnic or sexual minority identity), and cost (no-cost vs. cost of a typical behavioral health copay)? Results may inform targeted dissemination of different digital mental health tools to the particular subgroups most receptive to using them.
Methods
Procedures
Researchers collected data from a campus-wide survey administered within the first two months of its initial, pandemic-related campus closure. Responses were collected between March 26, 2020, and May 2, 2020. Campus mental health providers began to offer teletherapy services in March 2020. Recruitment was conducted over email, with communications sent from deans to all colleges within the university. Surveys could be completed on any Internet-equipped device. Participants had a four-week window to complete the survey after being invited to participate. Students were not compensated directly for their participation. However, they were told that for each completed survey $1\$ 1 would be donated to the undergraduate COVID-19 student hardship fund. While the survey was open to all members of the campus community (eg, students, faculty, staff), our analysis is limited to only undergraduate students to optimize the specificity and interpretability of results. This study was deemed exempt from the university’s Institutional Review Board (IRB) review, as researchers did not collect any personally identifying data.
