An Integrated Multilevel Mental Health Support System for University Students: 4-Year Longitudinal Observational Study.

Approximately 29% of all university students used the mood reporting function of the mobile app over the 45-month test period.

• The University of Debrecen student population on October 15, 2024, was 29,045 students.
• The student population using the mobile app mood report was 8,673 students (8673/29,045).
• The model was launched in September 2020 and tested for 45 months.
• After an initial increase in use, usage stabilized at approximately 29% of all students.

The percentage of students reporting a bad mood varied between 8.9% and 12.2% across the test period, while 50% of reports indicated a good mood.

• Bad mood reports ranged from 8.9% (26,465/297,372) to 12.2% (36,280/297,372) of total reports.
• Good mood was reported in approximately 50% of submissions (151,548/297,372 reports).
• The mood report offered 3 categories: awful, acceptable, and good.
• Students could submit one mood report per day through the dedicated smartphone app.

Mood reporting usage followed a marked seasonal pattern tied to the academic calendar.

• Use of mood reporting increased markedly during fall and spring study periods.
• Usage prominently decreased during the examination period and summer recess.
• This pattern was observed across the 45-month testing period.

The integrated multilevel system consists of five levels combining digital and personal service modalities accessible via a smartphone app.

• The system has 2 levels of informal digital service and 3 levels of partly digital, partly personal service modalities.
• Students access the system through a dedicated smartphone app that also offers other university-related functions requiring personal login.
• Based on weekly mood report patterns, students may be directed to a second level for depression screening or peer group participation assessment.
• Depending on screening responses, students are referred to personal (face-to-face) services at the secondary level for intervention.
• Aggregated reporting for university leadership on use of functions is available at all levels.

The system was developed at the University of Debrecen in response to mental health challenges among university students that were aggravated by the COVID-19 pandemic.

• University students in emerging adulthood struggle with mental health problems mostly due to difficulties related to studies and social relations.
• Most students are aware of their problems, but health-seeking behavior tends to lag behind.
• The COVID-19 pandemic aggravated mental health problems among students.
• The system was designed for screening, prevention, and treatment of students' mental health problems.

The app-based mood reporting approach was identified as capable of identifying at-risk students without stigmatization.

• The 4-year trial period demonstrated that the mood report embedded in the mobile app can identify students with a potentially increased risk of mental health problems in need of support without stigmatization.
• The unique feature of the model is described as its app-based screening at the first level and its hierarchy integrating digital and personal services.
• The system provides an easy-to-follow path from digital to personal services.
• Time-specific data on student mental health is available for university leadership to facilitate development of new services.