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Insomnia is common among university students and is associated with mental health problems. Students often have irregular day/night rhythms, which contribute to circadian rhythm disruptions. This open pilot study investigated the feasibility, acceptability, and preliminary effectiveness of a 5-week digital guided self-help intervention in university students with self-reported insomnia. The intervention is based on cognitive behavioural therapy for insomnia with specific emphasis on the biological clock ( ‘i-Sleep & BioClock’ ). We assessed feasibility and acceptability. Pre- to post-intervention (7-week) changes in insomnia, depression, anxiety, chronotype, and quality of life were evaluated. Of 101 included students, 81 accessed the platform, 41 initiated the intervention, and 13 completed the intervention. Post-test response was 39%. Students rated the intervention with good acceptability and the platform with excellent usability. Study completers ( n  = 39) showed large improvements in insomnia severity ( p  < 0.001, d  = 1.04), and moderate improvements in depression ( p  < 0.001, d  = 0.63), anxiety ( p  < 0.001, d  = 0.35), and functioning ( p  < 0.001, d  = 0.56). No significant changes were found in quality of life ( p  = 0.07, d  = 0.19). To summarize, the intervention had low uptake but moderate adherence and fairly good acceptability along with important improvements in sleep, mental health, and functioning. Trial registration: ClinicalTrials.gov: NCT05363995.

Evidence-based psychological interventions exist for individuals with obsessive-compulsive disorder (OCD), but many individuals with OCD are unable to access them because of barriers, such as geographical isolation, treatment cost, and stigma etc. Unguided self-help psychological intervention has emerged as a potential solution to this problem. However, there is limited research on its overall effectiveness. This study aimed to address this gap. Comprehensive searches from inception to 1st Jan 2023 were conducted in both international (PubMed, Embase, PsycINFO, International clinical trials registry platform of WHO) and Chinese (China National Knowledge Infrastructure, WeiPu, WanFang, Chinese Clinical Trial Registry) databases. The registered protocol is accessible at https://doi.org/10.17605/OSF.IO/FKB5W. We included randomized controlled trials (RCTs) comparing unguided self-help psychological interventions to control groups for individuals with OCD. The primary outcome was OCD symptom severity, with Hedges' g calculated post-intervention. Heterogeneity was deemed to be low, moderate, and high if the I2 value was quantified 25%, 50%, and 75% respectively. Relative Risks (RRs) was calculated for dropout rates post-intervention. Random-effects models were used for all analyses. 12 RCTs comparing unguided self-help psychological interventions to control groups were identified, with a total of 20 comparisons and 769 OCD patients. Overall, unguided self-help psychological interventions demonstrated a significant moderate effect on reducing OCD symptom severity (g = −0.42; 95% CI [−0.69; −0.14]) compared to control groups, with a moderate heterogeneity (I2 = 59%; 95% CI [22.73; 78.38]). This finding remained significant in sensitivity analyses for the self-rated Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; k = 7, g = −0.46; 95% CI [−0.71; −0.2]) and after removing an outlier (g = −0.37; 95% CI [−0.55; −0.19]), but not for the clinician-rated Y-BOCS (k = 4, g = −0.78; 95% CI [−2.75; 1.19]) and Obsessive Compulsive Inventory-Revised (k = 6, g = −0.26; 95% CI [−0.53; 0]). Subgroup analyses revealed a significant difference in effect size between studies conducting intention-to-treat and completers-only analyses (p = .01). The completers-only analyses demonstrated a moderate significant effect (g = −0.65; 95% CI [−1.08; −0.21]), whereas the effect of the intention-to-treat analyses was not significant (g = −0.18; 95% CI [−0.36; 0]). Participants in the unguided self-help groups exhibited a significantly higher dropout rate (RR = 2.08; 95% CI [1.53; 2.81]) compared to control groups. Furthermore, participants recruited from the community had a higher likelihood of dropping out compared to those recruited from clinical settings (p < .001). Additionally, participants who received cognitive-behavioural therapy intervention were more likely to drop out than those who received other types of intervention (p < .001). Most trials (92%) were rated at a high risk of bias. Unguided self-help psychological interventions demonstrate potential effectiveness in alleviating OCD symptom severity post-intervention. However, caution should be exercised when interpreting the results due to high risk of bias across trials and the relatively small sample size. And the considerable dropout rate might hinder treatment effects. Future studies with strict methodology should investigate the long-term effectiveness of unguided self-help psychological interventions for OCD, explore the reasons for high dropout rates, and improve intervention adherence. •Unguided self-help psychological interventions is a promising way to treat OCD.•The way to handle missing data significantly affects treatment effect.•Unguided self-interventions exhibited significantly higher dropout rates.•Intervention type and participant recruitment method affect dropout rates

Although psychological treatments have been found to be effective for depression in adults, many individuals with depression do not actively seek help. It is currently unclear whether psychological treatments are effective among those not actively seeking help. Besides, little is known about the proportion of patients who completed a screening questionnaire who end up in a clinical trial. Therefore, we conducted a meta-analysis of 52 randomized trials comparing psychotherapies for adults with a diagnosis or elevated symptoms of depression against control conditions (care-as-usual, waiting list, and other inactive treatment). Only studies recruiting participants who do not actively seek help (participants who have been recruited through screening instead of advertisements and clinical referrals) were included. To obtain an overall effect estimate of psychotherapy, we pooled all post-test differences with a random-effects model. We found that psychological treatments had a moderate to high effect on reducing depressive symptoms compared to control groups [g = 0.55; 95% confidence interval (CI) 0.41–0.69]. Heterogeneity was high (I2 = 75%; 95% CI 68–80). At 12 months' follow-up, the effects were small but significant (6–8 months: g = 0.33; 95% CI 0.14–0.52; 9–12 months: g = 0.24; 95% CI 0.11–0.37). As a secondary outcome, we found that 13% of patients who completed a screening questionnaire met the inclusion criteria for depression and agreed to be randomized in the trial. Based on the current evidence, psychological treatments for depression might be effective for depressed patients who are not actively seeking help.

Although numerous studies have examined the effects of psychological treatments for obsessive-compulsive disorder (OCD), their overall effectiveness remains unclear. We aimed to estimate their overall effect by combining all available randomized controlled trials (RCTs) comparing psychological treatments to control groups for OCD. We conducted a meta-analysis of 48 RCTs with 55 comparisons published between 1992 and 1 January 2023. The primary outcome was OCD symptom severity, with Hedges' g calculated at post-treatment and follow-up. Random-effects models were employed for all analyses, and the risk of bias was assessed. In general, psychological treatments demonstrated a significantly large effect ( = -1.14; 95% CI [-1.31 to -0.97]; = 72.23%) on reducing OCD symptom severity post-treatment, this finding remained consistent across measures and after excluding outliers, but lost significance in the sensitivity analysis for only studies with low risk of bias. Type of treatment, control group and treatment format were associated with treatment effects. Moreover, more severe baseline OCD symptom severity predicted higher degree of treatment efficacy. No significant differences were observed in dropout rates between the treatment and control groups. Treatment effects lost significance at 3-6 and 6-12 month follow-ups. 87% of RCTs were rated at high risk of bias. Psychological treatments are effective in reducing OCD symptom severity. However, caution should be exercised when interpreting these results due to the high heterogeneity and risk of bias across RCTs. Future studies with more rigorous methodology are required, as well as studies examining their long-term effectiveness.

Online mental health self-help services are of societal importance and increasingly popular. Therefore, we have developed an online platform offering free self-help to the Turkish public with modules based on Cognitive Behavioral Therapy (CBT) targeting depression, anxiety, and stress respectively. The main purpose of this study is to describe the user profile of this platform. A pre-intervention self-report assessment including general demographic information and the Brief Symptom Inventory questionnaire during October 2020 until September 2022. 8331 participants completed the assessment and created an account out of the 11.228 users who registered during a two-year period, of which 8.331 (74%) completed the assessment and created an account. The majority of these users were female (76.17%), highly educated (82%), single (68%) and actively studying or working (84%). Slightly more than half (57%) of the platform user had not received psychological assistance before, while those who did receive previous assistance indicate to have benefitted from that (74%). The psychological symptoms of users are widely distributed, encompassing a broad range of user profiles. Approximately half of all users actively used the platform, while the other half did not complete any module. Among active users, the course “coping with depressive mood” was the most popular (41.45%), followed by “coping with anxiety” (37.25%) and “coping with stress” (21.30%). Offering a free online CBT self-help platform to the Turkish public seems feasible, with strong uptake among both man and woman struggling with a variety of psychological symptoms. Further research is needed to assess user satisfaction and change in symptoms over time during platform use by means of a feasibility trial.

Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time-order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults. We used survey data from = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time-order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1-5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in relation to mood, anxiety, and externalizing disorders. We estimated a lifetime NSSI rate of 24.5%, with approximately half reporting sporadic NSSI and half repetitive NSSI. The time-order associations between onset of NSSI and mental disorders were bidirectional, but mental disorders were stronger predictors of the onset of NSSI (median RR = 1.94) than vice versa (median RR = 1.58). These associations were stronger among individuals engaging in repetitive rather than sporadic NSSI. While associations between NSSI and mental disorders generally did not differ by sex, repetitive NSSI was a stronger predictor for the onset of subsequent substance use disorders among females compared to males. Most mental disorders marginally increased the risk for persistent repetitive NSSI (median RR = 1.23). Our findings offer unique insights into the temporal order between NSSI and mental disorders. Further work exploring the mechanism underlying these associations will pave the way for early identification and intervention of both NSSI and mental disorders.