Unguided self-help to bridge waiting time for face-to-face therapy in a university student mental health service: interrupted time series analysis

Background: Marked increases in mental health services utilisation across university settings mean that students often spend long periods waiting for evaluation and treatment. Aims: To assess whether digital unguided self-help delivered while waiting for face-to-face therapy could reduce anxiety and depression and improve functioning in university students. Method: We retrospectively analysed routinely collected data from the student mental health service at the University of Padua, Italy. From June 2022, all students waiting for clinical evaluation and treatment received a self-help stress management booklet (The World Health Organization's Doing What Matters in Time of Stress (DWM)). The clinical evaluation included depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and functional impairment (Work and Social Adjustment Scale). Single-group interrupted time series (ITS) analyses compared outcomes in users contacting the service between October 2021 and 23 June 2022 (pre-intervention) and, respectively, between 24 June 2022 and 18 November 2023 (post-intervention). Results: Seven hundred and forty-nine Italian students (77% women, median age 23 years) were included; of these, 411 (55%) received the intervention and 338 (45%) did not. ITS indicated that the intervention introduction coincided with immediate and sharp decreases in depression (level change, β = -2.26, 95% CI -3.89, -0.64), anxiety (β = -1.50, 95% CI -3.89, -0.65) and impaired functioning (β = -2.66, 95% CI -4.64, -0.60), all largely maintained over time. Conclusions: In the absence of a control group, no causal inferences about intervention effects could be drawn. DWM should be studied as a promising candidate for bridging waiting time for face-to-face treatment.