Co-Designed Mental Health Screening App (Here for You) for University Students: Pilot Feasibility Mixed Methods Study.

App-based DASS-21 depression scores showed strong correlation with clinician-administered Hamilton Depression Rating Scale scores.

• Pearson correlation coefficient r=0.819 (P<.001) between app-based DASS-21 depression subscale and HAM-D
• Sample consisted of 30 university students (mean age 21, SD 1.8 years; n=15, 50% female) diagnosed with depression, anxiety, or stress
• Wide confidence intervals were noted, reflecting the small sample size typical of pilot studies
• Participants completed DASS-21 via the app and underwent separate clinical assessments using HAM-D

App-based DASS-21 anxiety scores showed strong correlation with clinician-administered Hamilton Anxiety Rating Scale scores.

• Pearson correlation coefficient r=0.887 (P<.001) between app-based DASS-21 anxiety subscale and HAM-A
• This was the strongest correlation among the depression and anxiety measures
• Clinical assessments were conducted using the HAM-A as the comparator instrument
• Wide CIs reflected the small sample size typical of pilot studies

App-based DASS-21 stress scores showed very strong correlation with the Perceived Stress Scale.

• Pearson correlation coefficient r=0.972 (P<.001) between app-based DASS-21 stress subscale and PSS
• This was the highest correlation observed across all three subscale comparisons
• The PSS served as the clinician-administered comparator for stress
• Wide CIs reflected the small sample size typical of pilot studies

The Here for You app received high usability ratings exceeding published benchmarks for mental health apps in low-resource settings.

• Overall User Mobile App Rating Scale (UMAR) mean score was 4.4 on a 5-point scale
• Functionality subscale received the highest mean score of 4.7 (SD 0.3)
• Aesthetics subscale received a mean score of 4.5 (SD 0.4)
• Scores exceeded published benchmarks for mental health apps in low-resource settings

Qualitative feedback from participants identified key features contributing to app acceptability including privacy features, cultural resonance, and desire for integrated support.

• Thematic analysis was used to analyze qualitative feedback
• Participants highlighted usability and enhanced privacy due to features such as a quick exit function
• Cultural resonance was identified as a key theme in qualitative feedback
• Participants expressed desire for integrated support features within the app
• The co-design process led to implementation of features such as simplified language and crisis support links

The app was developed using a 4-phase user-centered co-design process involving students with lived mental health experience, clinicians, and developers.

• A purposive sample of 30 university students participated in pilot testing
• Students with lived mental health experience were included as co-designers alongside clinicians and developers
• The co-design process directly addressed student concerns identified during development
• The approach embodied the 'nothing about us without us' principle
• The study was conducted at a single site in India

Mental health disorders are a growing public health concern among university students globally and in India, exacerbated by stigma and limited access to care.

• Stigma and limited access to care were identified as key challenges in addressing student mental health
• mHealth apps were identified as a potential solution but user engagement and cultural relevance remain key challenges
• The study was situated in the context of Indian university students specifically
• The app was designed to provide accessible, nonstigmatizing support