VCOM Carolinas Research Day 2023

Educational Reports

Mental Health App Usage: Comparing Undergraduate Students and Medical Students During the COVID-19 Pandemic Natalie Fadel, PsyD; Alexis M. Stoner, Ph.D., MPH; Lindsey Ridgeway, Ph.D.; Robyn Hussa-Farrell MFAl, MFA, E RYT, Tim Farrell; Angela Wilson, MBA, CSSGB, CSSBB; Krisdaniel Berreta, OMS-IV; Cynthia Nguyen OMS-IV Edward Via College of Osteopathic Medicine, Psychiatry and Neuro-Behavioral Sciences, Spartanburg, SC.

Abstract # EDUC-3


Abstract Context : The prevalence of burnout and depression amongst students is higher compared to the normal population. The onset of the COVID-19 pandemic in 2020 prompted a sudden transition to a virtual learning environment and an increase in accessible mental health resources for students. Understanding how students utilized a mental health app during the COVID-19 pandemic may serve to address the mental health crisis. Objective : To compare mental health app utilization between college and graduate students during the COVID-19 pandemic. Methods: Data was derived from six apps including: a medical student mental health app and five similar applications customized for various undergraduate campuses. Medical and undergraduate students from the Appalachian region ranged from ages 18 to 26 years old, used these mental health apps from 2019-2022. Protective factors were used to create categories from modules used in the app to analyze and quantify usage amongst the participants with Google Analytics. Four primary categories include: mental health literacy (MHL), social-emotional learning (SEL), mindfulness-based stress reduction (MBSR), and suicide prevention (SP). Each category was then divided into subcategories based on the breakdown of individual modules that allowed for further investigation and analysis of each primary category (i.e., anxiety and financial literacy). T- tests, ANOVA, and Fisher’s Exact t -test were performed to compare the utilization and interests of the two student populations. Results : The number of respondents for this project was 270 medical students and 1,116 undergraduate students. The top three categories viewed for both student populations were MHL, MBSR, and self-help. The categories viewed overall between college students and medical student (COM) populations were significantly different, p = < 0.0001. There was no significant difference between individual subcategories. There was no significant difference between the average time spent on a page between COM (46.2 ± 103.9) and colleges (44.7 ± 113.6). The percentage exit mean was significantly different between COM (6.4% ± 0.2) and colleges (8.0% ± 0.2) where the exit percentage was higher for undergraduate students than medical students, p= .03. Conclusion: Medical students and undergraduate students appear to have an interest in topics that improve protective factors for mental well-being including MHL, mindfulness, and SEL. This study offers insight for further investigation into the dissemination and implementation of mental health technology solutions that can help address the prevalent mental health crisis that students are facing. About the App: The Sharpen system is built through a socio-ecological framework that addresses shared protective factors for mental disorders, suicide ideation, and trauma. The library of psychoeducational content has been created with over 200 researchers in the field of neuroscience to decrease stigma, improve resiliency, and mental health literacy, and increase engagement with mental health treatment. A library of psychoeducational modules is grouped into four primary categories that relate directly to the shared protective factors: mental health literacy (MHL), social-emotional learning (SEL), mindfulness-based stress reduction (MBSR), and suicide prevention (SP). Subcategories were developed based on these protective factors and module topics. Study Population: The subject population included registered users of five different versions of the Sharpen service customized for specific colleges located in the Appalachian region as well as version of the service customized for medical students attending an osteopathic medical college. Resiliency Technologies (RT) has partnered with multiple higher education institutions in the southeastern region of the United States to deploy its Sharpen technology to support college student resilience. The medical students for this project had a mean age of 24-26 years and reign from the Appalachian region, primarily from North Carolina and South Carolina. Data analysis: Based on the categories and subcategories, t-test, Fisher's Exact test, and the ANOVA test were performed to compare and determine if there were significant differences between the medical school and the undergraduate colleges. Page views, unique page views, and exit percentages were observed via Google Analytics. A single page view is defined as the number of times someone visits a specific module. Unique page views are a number of page views from the same person within one session. The average time on a page is defined as the average time a user spends on a module unit until leaving. An exit is determined by how often visitors exit a page after visiting any number of pages on the site and then the percentage is calculated as the number of exits/number of pageviews. Methods

Table 1. Categories and Subcategories

References From our study, it is evident that medical students and undergraduate students appear to have an interest in topics that improve protective factors for mental well-being including mental health literacy, mindfulness, and social-emotional learning; however, they appear to prefer different categories of modules. Subcategories to determine specific topics students sought out more during the COVID-19 pandemic were indeterminate. However, a larger sample size for future studies can help mental health app providers better disseminate targeted content to various student populations. Our study identified MHL, MBSR, and SEL as areas of interest for students during the onset of the COVID-19 pandemic – a highly stressful time. This study offers insight for further investigation into the dissemination and implementation of mental health technology solutions that can help address the ongoing and prevalent mental health crisis facing students. • There was a significant difference in page assessed per subcategory (p=<0.0001) viewed by COM and colleges however when compared amongst individuals there was no significant difference. There were no significant differences in average time spent on each page by subcategory for COM (p=0.6) and colleges (p=0.2). Table 3 . Comparison of the subcategories visited between COM and colleges. Conclusion 1. Auerbach RP, Alonso J, Axinn WG, et al. Mental disorders among college students in the World Health Organization World Mental Health Surveys [published correction appears in Psychol Med. 2017 Nov;47(15):2737]. Psychol Med . 2016;46(14):2955-2970. doi:10.1017/S0033291716001665 2. Dost S, Hossain A, Shehab M, et al. Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students. BMJ Open 2020;10:e042378. doi:10.1136/ bmjopen-2020-042378 3. Suruliraj B, Bessenyei K, Bagnell A et al. Mobile Sensing Apps and Self-management of Mental Health During the COVID-19 Pandemic: Web-Based Survey. JMIR Form Res . 2021;5(4):e24180. doi:10.2196/24180 4. Elmer T, Mepham K, Stadtfeld C. Students under lockdown: Comparisons of students’ social networks and mental health before and during the COVID-19 crisis in Switzerland. PLOS ONE . 2020;15(7). doi:10.1371/journal.pone.0236337 5. Kaparounaki, Chrysi K, et al. “University Students' Mental Health Amidst the Covid -19 Quarantine in Greece.” Psychiatry Research , vol. 290, 2020, pp. 113111 – 113111., doi:10.1016/j.psychres.2020.113111. 6. Giner-Murillo M, Atienza-Carbonell B, Cervera-Martínez J, et al. Lifestyle in Undergraduate Students and Demographically Matched Controls during the COVID-19 Pandemic in Spain. Int J Environ Res Public Health . 2021;18(15):8133. Published 2021 Jul 31. doi:10.3390/ijerph18158133 7. Page, Lesley, and Mike Cherry. “Comparing Trends in Graduate Assessment: Face ‐ to ‐ Face vs. Online Learning.” Assessment Update , vol. 30, no. 5, Sept. 2018, pp. 3 – 15. EBSCOhost , doi:10.1002/au.30144. 8. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214 – 2236. doi:10.1001/jama.2016.17324

Table 2 . Comparison of module categories visited between the COM and colleges. • The study includes a total of 1,386 participants: 270 were medical students and 1,116 were undergraduate students. The top three categories viewed for both populations were: MHL, MBSR, and self-help. There was a significant difference in number of students who accessed these categories between the two groups, p=<0.0001. • There was no statistically significant difference in mean time spent on page by category between COM (p=0.6) and colleges (p=0.6).


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