Many students in South Africa, as in other parts of the world, experience high levels of stress and symptoms of depression and anxiety. A study of first-year students in 19 universities across eight countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain and the US) found that 18.5% of students suffered from major depressive disorder in the previous 12 months and 16.7% had a generalised anxiety disorder. Left untreated, these problems can severely impede students’ social and academic functioning, leading to problems such as failing and dropping out of university.
Perhaps it is unsurprising that students sometimes struggle with symptoms of depression and anxiety given the stress that is typically associated with being at university and the developmental challenges that young adults often face. These include moving away from home, financial pressures, academic demands, greater opportunities for substance use, and lower levels of parental supervision. While university can be a very stressful time for some students some of the time, most students do not experience mental health problems and show high levels of resilience. It would therefore be a mistake to think that it is normal for students to feel depressed and anxious all the time.
Students who have prolonged periods of worry and sadness need support and help to manage these feelings.
Unfortunately, most students with mental health problems do not receive the support and professional help that they need. A study in South Africa found that only 28.9% of first-year students with mental disorders received treatment. There are many reasons why students do not receive psychological support when they need it, including problems with access to services and the high costs associated with professional mental healthcare. But there are also other reasons why students are slow to access professional support, including perceptions about stigma, a reluctance to consult mental health professionals, a desire to deal with problems on their own or seek the support of friends, concerns about privacy, problems with scheduling and beliefs that psychotherapy is ineffective.
One of the biggest challenges facing higher education institutions is how to provide mental health services that are effective and affordable, while also being convenient, engaging and acceptable to students. One possibility might be to use digital technologies to expand student counselling services, not by replacing conventional face-to-face services, but as a way of augmenting traditional counselling and overcoming some of the barriers students face to accessing these services.
A new study was launched recently to discover if digital technologies could be used to promote the mental health of university students in the country. Students from Stellenbosch University, the University of the Western Cape, and the University of the Free State are being offered the opportunity to test a range of digital solutions to reduce symptoms of depression and anxiety. These interventions include apps that use the principles of cognitive behavioural therapy to help students learn strategies and skills to manage their mental health.
Online group therapy, facilitated by a psychologist via video conferencing is also being tested. Small groups of students from different campuses meet virtually with a psychologist to learn skills to reduce stress, regulate their emotions and strengthen their relationships. These online groups were developed in South Africa in consultation with a group of student advisers and the initial testing of this intervention has shown some promising results.
The new study to test these digital interventions is being run by researchers from the South African Medical Research Council and the Institute for Life Course Health Research at Stellenbosch University and is the first time that universities in South Africa are collaborating with each other to test scalable digital interventions across multiple campuses. It is hoped that other universities, including the University of Cape Town, the University of the Witwatersrands and Rhodes University will also be added to the trial soon.
In recent years, there has been an explosion in the development of digital mental health solutions, including the development of apps to treat the most common mental disorders and chatbots that deliver real-time mental health coaching and emotional support. These technologies have the potential to make mental healthcare more accessible and affordable, giving users greater control over when and how they access psychological help.
Aside from being more affordable than conventional talking therapies, digital mental health solutions could also help to overcome the stigma that is sometimes associated with accessing treatment for mental disorders by allowing users to access help anonymously and in the privacy of their own homes. But digital interventions, like most forms of therapy, do not work for everyone all the time, making it important to better understand who can benefit from these technologies.
While there has been an explosion in the range and number of digital mental health solutions available, researchers have been slower to test the effectiveness and acceptability of digital interventions to promote mental health, especially among adolescents and young adults. The limited amount of data that is available suggests that digital technologies could be very helpful for some people, but more research is needed to help understand who will benefit from digital interventions and how to make them appealing and engaging for users.
The newly launched study promises not only to provide much-needed data about the potential effectiveness of digital interventions for young people, but also to demonstrate how universities can share scarce resources and collaborate to introduce novel approaches to promoting student mental health. This will help put South Africa at the forefront of implementing digital mental health solutions into routine clinical practice.
Professor Jason Bantjes is a chief specialist scientist in the alcohol, tobacco and other drug research unit at the South African Medical Research Council. He also holds an extraordinary appointment as an associate professor at the Institute for Life Course Health Research at Stellenbosch University.
Dr Xanthe Hunt is a senior researcher at the Institute for Life Course Health Research.