Mental health problems among college students have increased significantly and barriers to care contribute to a substantial treatment gap. Digital mental health interventions (DMHIs) show promise for overcoming barriers, but engagement with DMHIs is challenging, underscoring the need for low-burden strategies. This pilot trial evaluated the feasibility and acceptability of a six-week, low-burden, preventative DMHI that delivered supportive text messages and personalized feedback (PF) to first-semester college students. Students (N=120, 64% women, 55% non-Hispanic White) who had mild-to-moderate depressive symptoms (PHQ-9 scores between 5 and 14) and were not engaged in formal mental health care were randomized to intervention (n=90) or assessment-only (n=30) conditions. Those in the intervention condition received a weekly PF report and/or supportive text messages at random intervals as part of an embedded micro-randomized trial (MRT). Primary outcomes were feasibility and acceptability of the intervention components. Exploratory analyses examined 1) clinical outcomes after six weeks for the intervention and assessment-only conditions, and 2) weekly clinical outcomes within the intervention group based on the MRT. The trial demonstrated high feasibility (95% enrollment; 87% retention) and strong intervention acceptability, especially for PF and assessment components. Exploratory analyses did not reveal consistent patterns in between- and within-group comparisons. Low-burden strategies for assessment and intervention are feasible and acceptable to first-year college students at risk for depression. There is significant potential for integrating these lower-intensity strategies into a full-scale trial that adaptively delivers higher-intensity DMHIs and/or integrate human-delivered components in response to needs over time.

Digital mental health interventions (DMHIs) can be effective for adolescents and young people experiencing depression and anxiety. However, maintaining engagement remains a persistent challenge. While internal factors such as interface design, interactivity and personalisation have been widely examined, less is known about how young people themselves perceive barriers and facilitators to engaging with these tools. This scoping review explores adolescents' and young people's perceived experiences of engagement with DMHIs. A systematic search in PubMed, Scopus and PsycInfo identified 37 studies that met the inclusion criteria. Analysis revealed a broad range of perceived facilitators, including accessibility, perceived usefulness, opportunities for social connection and supportive human involvement. Commonly reported barriers included stigma, privacy concerns, low motivation, lack of personalisation, technical difficulties and limited trust in the interventions. Notably, most studies reported these perceptions qualitatively, with limited systematic assessment of their impact on engagement. This highlights a gap in the evidence base and underscores the need for future research to quantify how perceived barriers and facilitators shape engagement and adherence. Addressing barriers while building on facilitators may enhance sustained engagement and improve the real-world effectiveness of DMHIs for adolescent mental health.

Excessive worry is common among treatment-seeking individuals in primary care and has a negative impact on daily functioning, which may also lead to other mental health problems. The current study tested whether a worry-focused online intervention – provided in both a guided and an unguided format – was efficacious in reducing worry-related symptoms and if these effects were specifically linked to improvements in daily functioning. A total of 82 participants were randomized to intervention with therapist support (guided; n = 28), intervention without therapist support (unguided; n = 27) or to waiting list (n = 27). Results showed that the online intervention was more effective than waiting list in reducing worry at week 5 (between-group d = 0.96). The intervention was effective against waiting list irrespective of whether it was provided in a guided (between-group d = 0.90) or unguided format (between-group d = 1.07) with sustained results at the 7-week follow-up. Reduction in worry mediated improvement in daily functioning (between-group d = 0.58; indirect effect estimate = −1.06 [95 % CI: −1.76 to −0.51], 66 % mediated effect). The mediation effects were fairly robust to mediator-outcome confounding, with residual correlation values set to r = 0.3 in a sensitivity analysis. The results provide further evidence that it is beneficial to provide a low-threshold, easy access intervention to patients with excessive worry, irrespective of primary diagnosis. Clinical implications are discussed.