Coronavirus Might Worsen The College Mental Health Crisis: Can Apps Help?

Despite what many public health experts might advise, some colleges are set to open in person soon and with that comes a new round of mental health needs in an already taxed student population. Prior to the pandemic, college students had high and increasing rates of depression and suicidal ideation, and a nearly two-thirds increase in diagnosed mental health conditions (22% to 36%) from 2007 to 2017. According to Dr. Victor Schwartz, Chief Medical Officer at The Jed Foundation and Clinical Associate Professor of Psychiatry at NYU School of Medicine, there are many reasons for these increases. He says, “Some of this reflects societal and economic stresses and more openness of many college admission processes, along with a reduction in stigma and progress in efforts to get teens and young adults to be more open to asking for mental health care and support.”  

Whatever the reasons, Dr. Schwartz explains that “services and staffing in many centers have grown, but are not keeping up with demand.”  In fact, between 2009 and 2015, counseling center utilization increased on average by 30-40% per school, while school enrollment increased by only 5%. This has led to waitlists, even though, as Dr. Ellen Fitzsimmons-Craft, Assistant Professor of Psychiatry at Washington University School of Medicine and Psychologist notes, “intervening in a timely manner is crucial [given that] three quarters of lifetime mental disorders emerge by age 24, with lasting effects on students’ health, social, educational, and economic outcomes.” To put it simply, college mental health was in crisis long before the pandemic and it is hard to imagine college health centers can handle what is to come when they open their doors in just a few short weeks. If the recent Centers for Disease Control and Prevention (CDC) data suggesting a significant increase in suicidal ideation over Covid-19 in this population (25.5% contemplating suicide in the last month) is an indicator of need, they likely can’t. Jessica Dyer, LCSW and Director of WashU Cares at Washington University in St. Louis adds that while colleges are uncertain how Covid-19 will exactly impact student’s mental health, with the added stressors of financial hardship, potential lost loved ones to Covid-19, and social isolation, among others, they are “bracing for the tidal wave of the impact.” 

Students waiting for help are likely to be directed off-campus for care and also to the campus website for mobile apps to help with their stress, anxiety, and depression in the interim. The issue is, however, that most of their app recommendations are not good ones. That is at least according to a new study in the journal Psychiatric Services by Jennifer Melcher and Dr. John Torous from the Division of Digital Psychiatry at the Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School. In their research, they looked at the top 30 schools according to the US News and World Report’s 2020 rankings for “National Liberal Arts Colleges” and “Best National Universities,” and, for each of the 60 schools, they visited the counseling center’s website looking for any reference to apps as resources for students. They then coded each app for whether it was available, had been updated, had privacy policies, had efficacy studies, and whether it was paid or free.

According to their results, 43% or 26 of the schools included app suggestions on their website, with up to 218 unique apps suggested. However, 60 of the apps were discontinued (no longer available in the App Store or Google Play Store) and only 44% had been updated in the past 6 months. Additionally, 39% had no privacy policy, and of those with privacy policies, 88% collected user’s data and 49% shared that data with third parties. Finally, actual peer-reviewed efficacy studies had been published for only 16% of the listed apps. In other words, though colleges are suggesting apps on their websites, there are too many, they are outdated or not available, they are not private, and they are not evidence-based. 

This means that while they wait, students must become app experts on their own. Here are 5 things they should keep in mind when choosing a mental health app:

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2) The technology matters:

It is really important that apps work and are updated. Just like you would want research to stay up-to-date and to be the highest quality, apps should be held to the same standard. A study showed they decline in quality after 6 months without an update. Dr. Sherry Pagoto, Clinical Psychologist and Director of the UConn Center for mHealth and Social Media, explains that it is actually a danger of the app if it does not work. She emphasizes, “That might not seem like a big risk, but if someone decides to download an ineffective app instead of seeking care, this is a lost opportunity to make progress on whatever the issue is as well as risk the problem worsens without effective care. The even worse danger is that an untested app has unintended consequences that make the problem worse.” Drew Perkoski, a Junior at Washington University in St. Louis, adds “When I look at an app my concerns are mainly who made it and who is using it. I would not want to beta test something that is supposed to help me manage my mental health.” 

Functionality is also really important and whether it is easy to use will affect whether a student finds it useful. Dr. Fitzsimmons-Craft explains students have high expectations of their technology from daily use of apps like twitter, and while mental health apps might not be as “flashy,” they “have to work well and be easy for the student to use.” She feels that if they do not, “that evidence-based content is just not going to get through.”

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