This pilot study provides preliminary evidence of good uptake and acceptability, and short-term improvement in knowledge, emotional self-awareness, and in health-promoting lifestyle behaviours observed in undergraduate students who completed this fully-digitalized MHL course co-created with students. These findings suggest that offering student mental health literacy as an online accredited course tailored for undergraduate university students may be an acceptable and effective way of promoting and supporting student mental health.
There is limited evidence about the effectiveness of teaching MHL to university students, as well as limited knowledge about the best method of delivery, what the important underlying mechanisms might be in supporting student mental health, and about the variation in engagement and benefit across diverse student groups. In response to these gaps and in partnership with students, we developed a comprehensive online MHL course tailored to undergraduate students. An optional research arm in conjunction with the U-Flourish Student Well-Being Survey Study will allow us to evaluate the impact of the course on indicators of student mental health and well-being, and potential mechanisms driving changes in these indicators. Preliminary results suggest this MHL course is an acceptable way to engage students. Course enrolment was rapid and student feedback positive in terms of the course being interesting and relevant, helpful in understanding the determinants of well-being and mental health and effective in supporting positive mental health and health-behaviours. Students learned how to identify the early warning signs of a mental health concern and were educated on appropriate help-seeking. We observed a significant increase in mental health knowledge and an improvement in emotional self-awareness in students who took the course. We also found preliminary evidence of an association between taking the MHL course and a reduction in substance use and sleep problems.
This study adds to the existing literature in that previous attempts to deliver MHL to post-secondary students have been limited to self-help resources, such as Transitions, a digital guide designed to provide incoming post-secondary students with a toolbox to support the transition to university [20] or one-off training sessions, such as The Inquiring Mind: Post-Secondary, a three-hour workshop intended to provide university students with practical knowledge about mental health [21]. Formal evaluations of these resources using small convenience samples did not show sustained long-term effects, and focused only on the limited outcomes of stigma, resiliency, and mental health knowledge [21, 22, 40]. Two curriculum-based efforts that we are aware of, The Science of Well-being [18], and the Science of Happiness [17], focus on psychoeducation and positive psychology. To our knowledge, no research has been conducted on the effects of the former curriculum-based approach. While an evaluation of the Science of Happiness demonstrated short-term improvements in overall well-being, sustained long-term effects were not observed, with scores regressing to baseline levels over time [17].
Strengths and limitations
Findings from this study are preliminary and derive from the first offering of the course to a small sample of predominantly female students, enrolled in a single program, who self-selected into the course. As a result, these students may be highly invested in their mental health, and their experiences may not reflect those of the broader undergraduate student population. In addition, this MHL course was launched during the COVID-19 pandemic; though developed as an online course, the sustained impact of this global event on student mental health and higher education is largely unknown. Furthermore, students enrolled in the first offering of this course were relatively healthy at baseline given their reported sleep, substance use, stigma and symptom scores, producing a ceiling effect and limiting room for improvement in some outcomes of interest. Finally, given that this was a pilot study, we did not evaluate the observed effects over the longer term nor did we have sufficient power to test the hypothesized underlying mechanisms, which is a priority moving forward. We also had limited power to detect main effects, particularly in the course group; the decrease in average anxiety symptom scores was greatest in course participants based on the effect size estimate, but only statistically significant in the control group.
The course is currently being expanded and offered to students across different learning programs and universities both in Canada and in the UK. Subsequent offerings will therefore result in much larger and more heterogeneous student samples, which will be more representative of the student population across programs and institutions. The resulting student samples will provide sufficient variability in demographics and program of study, as well as baseline health-related behaviors, mental health knowledge, stigma, well-being and symptoms to examine the effects in diverse student populations and test mechanisms of action over the short- and longer-term.
That said, our MHL course had several strengths over previous interventions and course offerings to post-secondary students. State-of-the-art online pedagogical techniques and a reverse mentorship approach to capture the student perspective were used to develop the course. The course was also designed to be more comprehensive, covering all domains of mental health literacy as discussed by Kutcher et al. [22], and took an interdisciplinary approach, making it suitable for students across diverse learning backgrounds. Furthermore, the course evaluation included validated pre- and post-course measures of well-being, mental health outcomes, and putative mechanisms, which we will prioritize analyzing moving forward as our sample size allows. Finally, we were able to compare outcomes to a parallel matched comparison group. Other researchers [17] have used a staggered approach, where they assigned half of a group of students to take the course in the first semester, and the remainder to a “waitlist” condition (these students would take the course the following semester), but this has its own inherent biases as we know from previous research that mental health status changes over the course of a semester [41]. Our parallel comparison group, drawn from the same base population (i.e., undergraduate students who studied at the same university, over the same time period), provided us with the ability to look at differences between students who did and did not take the mental health literacy course. We were also able to match the comparison and intervention group on age and gender.