Assessing the Effectiveness, Adherence and Attrition of Smartphone-Based Mental Health Interventions in University Students: A Systematic Review and Meta-Analysis
Abstract
Background: Mental health challenges are prevalent among university students, many of whom face barriers to accessing traditional psychological services. Smartphone-delivered mental health applications offer a scalable intervention option, but evidence regarding their effectiveness and engagement remains limited. This systematic review and multilevel meta-analysis examined clinical and engagement outcomes of app-based mental health interventions in university students.
Method: Medline, PsycINFO, CINAHL, ProQuest Dissertations & Theses Global and Scopus were searched from inception to 27 October 2025 (initial search: 2 April 2025). Randomised controlled trials were synthesised using multilevel meta-analysis and non-randomised designs were narratively synthesised. Risk of bias was assessed using the Cochrane Risk of Bias tool. Outcomes included depression, anxiety, stress, well-being, disordered eating and body image, alongside attrition and adherence.
Results: A total of k = 122 studies were included. Interventions produced significant effects across all outcomes: anxiety (d = 0.22, 95% CI [0.14, 0.30]), depression (d = 0.25, 95% CI [0.16, 0.33]), stress (d = 0.28, 95% CI [0.19, 0.38]), well-being (d = 0.47, 95% CI [0.16, 0.78]), disordered eating (d = 0.29, 95% CI [0.06, 0.52]) and body image (d = 0.27, 95% CI [0.06, 0.48]). Substantial heterogeneity was observed for most outcomes. Attrition was moderate (17.0%, 95% CI [13.5, 21.2]) and adherence varied (70.0%, 95% CI [54.0,…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Regulation of nucleolus assembly by non-coding RNA polymerase II transcripts
- For a Healthy Histone Code, a Little SUMO in the Tail Keeps the Acetyl Away
- Discovering a binary CTCF code with a little help from BORIS
- Article Commentary: Stabilizing the Code–-Methods to Preserve RNA Prove Their Worth
- Foreword to the Special Issue for the RINTC (The Implicit Seismic Risk of Code-Conforming Structures) Project
- Commentary: Promoting Health and Well-being in Pediatric Primary Care Settings: Using Health and Behavior Codes at Routine Well-child Visits
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.