Population-based RCT of a digital cognitive-behavioural guided self-help intervention for anxiety, depression and eating disorders in college students.

Scalable approaches such as digital cognitive-behavioural therapy guided self-help (D-CBTgsh) may help close the treatment gap for college students with mental disorders. In a randomized clinical trial (ClinicalTrials.gov: NCT04162847) across 26 US colleges, populations were offered a mental health screen (39,194 assessed). Students with clinical levels or high risk for anxiety, depression and/or eating disorders (N = 6,205) were randomized to screening+D-CBTgsh or screening+referral-to-college-provided-care groups. Screening+D-CBTgsh reduced prevalence of any mental disorder (primary outcome) at 6 weeks (odds ratio (OR) = 0.80, 95% CI = 0.70-0.91), 6 months (OR = 0.77, 95% CI = 0.68-0.88) and 2 years (OR = 0.82, 95% CI = 0.72-0.93). Services uptake was greater in screening+D-CBTgsh (74.4%) versus screening+referral (30.2%) at 6 months (OR = 6.72, 95% CI = 6.01-7.52) and 2 years (OR = 1.83, 95% CI = 1.64-2.04), including for minoritized groups. Screening+D-CBTgsh (versus screening+referral to college-provided care) also improved dimensional outcomes of generalized anxiety, social anxiety, depression, eating disorder symptoms and mental health functioning. Findings supported transdiagnostic prevention and intervention benefits of screening+D-CBTgsh and its viability as a scalable, population-based approach.