Fifty consecutive respondents (36 female and 14 male) completed the baseline survey and received access to the MoodGYM program. Of the 50 students, 47 accessed the program, and 44 completed the post-intervention survey and formed the study sample (88.0% follow-up). Mean participant age was 20.7 years (SD=1.55; range 18−24) and the majority were female (72%) (Table 2). At baseline, there were no detectable differences in demographic characteristics or baseline GPA, depressive symptoms or number of attendance warnings between responders at follow-up (Intervention group, n=44) and non-responders at follow-up (n = 6) or between the intervention group responders at follow-up and the historic control group (n = 19) (all p=>0.05). However, non-responders were substantially and significantly more anxious at baseline than responders (M = 11.00, SD = 3.63, n = 6, vs. M = 7.61, SD = 2.57, n = 44 p = 0.006, d = 1.2). There was no difference in baseline anxiety between the Intervention group and historic control.
Table 2. Demographic characteristics of the sample and comparison groups at baseline.
Variables
|
Intervention group
(n=44)
|
Non-responders
(n=6)
|
Historic control group
(n=19)
|
Gender
|
|
|
|
Male
|
13 (29.5%)
|
1 (16.7%)
|
6 (31.6%)
|
Female
|
31 (70.5%)
|
5 (83.3%)
|
13 (68.4%)
|
Age
|
|
|
|
18−20
|
19 (43.2%)
|
4 (66.6%)
|
8 (42.1%)
|
21−24
|
23 (52.3%)
|
2 (33.3%)
|
11 (57.9%)
|
Mean age (SD)
|
20.7 (1.46)
|
20.4 (1.95)
|
20.00 (1.84)
|
Marital status
|
|
|
|
Married
|
4 (9.1%)
|
2 (33.3%)
|
2 (10.5%)
|
Single
|
40 (90.9%)
|
4 (66.6%)
|
17 (89.5%)
|
Year of study
|
|
|
|
2nd year
|
24 (54.5%)
|
4 (66.6%)
|
12 (63.2%)
|
3rd year
|
18 (40.9%)
|
2 (33.3%)
|
6 (31.6%)
|
4rd year
|
2 (4.5%)
|
0
|
1 (5.3%)
|
Department of study
|
|
|
|
Business
|
22 (50.0%)
|
2 (33.3%)
|
7 (36.9%)
|
Humanities & Social Sciences
|
2 (4.5%)
|
0
|
2 (10.5%)
|
Technological Innovation
|
6 (13.6%)
|
0
|
3 (15.8%)
|
Communication & Medical Sciences
|
8 (18.2%)
|
2 (33.3%)
|
4 (21.0%)
|
Natural Health Sciences
|
6 (13.6%)
|
2 (33.3%)
|
3 (15.8%)
|
Help seeking
Prior to using MoodGYM, nearly half of the students reported seeking help for their mental health from their friends (n= 19, 43.2%) and a quarter of them had sought help from internet sources (n=11, 25.0%), Two participants (4.5%) sought help from family, four (9.1%) had sought help from their university tutor and only three (6.8%) had sought help from university counselling services. Five students (11.4%) had not sought any help for their mental health.
Depression and anxiety before and after MoodGYM
A paired-samples t-test found a significant reduction in HADS-D scores post-intervention compared to baseline (t (43) = 3.07, p = 0.004, d=0.5), indicating a significant reduction in depressive symptoms (Table 3). The proportion of participants scoring above the cut-off for depression caseness from 77.2% to 27.3% (n=34 to n = 12; McNemar = p < 0.001). There was also a decrease in HADS-A scores post-intervention (t (43) = 5.67, p ≤ .001, d = 1.1), indicating a considerable reduction in anxiety symptoms. The proportion of students scoring above the cut-off for anxiety caseness fell from 50% to 11.4% (n= 22 to n = 5; McNemar = p < 0.001).
Table 3. Participants’ depression and anxiety levels before and after MoodGYM
|
Pre-intervention
(n=44)
|
Post-intervention
(n=44)
|
HADS-D Group
Normal
|
10 (22.7%)
|
32 (72.7%) ***
|
Borderline
|
30 (68.2%)
|
5 (11.4%)
|
Clinical
|
4 (9.1.%)
|
7 (15.9%)
|
HADS-D
Mean (SD)
|
8.32 (1.72)
|
6.64 (3.72)
|
HADS-A group
|
|
|
Normal
|
22 (50.0%)
|
39 (88.6%) ***
|
Borderline
|
18 (40.9%)
|
2 (4.6%)
|
Clinical
|
4 (9.1%)
|
3 (6.8%)
|
HADS-A
Mean (SD
|
7.61 (2.57
|
4.77 (2.67)
|
Note: *p ≤ 0.05, **p ≤ 0.01, *** p ≤0.001
Academic performance before and after MoodGYM
Student GPA at pre-intervention ranged from 0.33−1.90, with a mean of 1.55 (SD = 0.32). There was a significant increase in GPA at post-intervention (t (43) = -9.26, p ≤ 001 d = 1.3), reflecting substantial improvement in academic performance after using MoodGYM (Table 4). At pre-intervention, all students in the intervention group had a GPA below 2.0 indicating academic weakness. After using MoodGYM, 19 (43.2%) students had a GPA of 2.0 or above, thereby moving out of the academic warning zone.
Half the sample had received at least one attendance warning (n = 22, 50.0%) during the pre-intervention period; however, the number of participants who received attendance warnings decreased by nearly half after using MoodGYM (8 week intervention) (n = 11, 22.0%), with a significant reduction in the number of attendance warnings between pre- and post-intervention (Z = -2.66, p = 0.008, d = 0.6) (Table 4).
Table 4. Academic outcomes pre- and post-intervention and in historic control group.
Intervention group (n=44)
|
Historic control (n=19)
|
|
Baseline
|
Follow-up
|
Baseline
|
Follow-up
|
Mean GPA (SD)
|
1.54 (0.33)
|
1.99 (0.33) **
|
1.56 (0.39)
|
1.75 (0.51)
|
Mean number of attendance warnings (SD)
|
1.05 (0.75)
|
0.61 (0.78) **
|
1.17 (1.09)
|
1.21 (1.08)
|
Note: *p ≤ 0.05, **p ≤ 0.01
Academic performance outcomes compared to historic control
At baseline, the intervention group (n = 44) and the comparison group (n = 19) had similar GPAs and number of attendance warnings. A repeated-measures ANOVA with group (intervention/historic control) as the between-subjects factor and time found a significant time by group interaction (F = 5.96, df = 1.61, p = 0.018). At follow-up, the intervention group had significantly higher GPAs compared to historic control (t (61) = 2.22, p = 0.030 d = 0.6) and fewer attendance warnings (Z = -2.10, p = 0.036 d = 0.7) (Table 4).
Completed MoodGYM modules and outcome improvements
All students in the Intervention group reported completing at least two modules, with nearly half of them reporting completing all five modules (mean completed = 3.75, SD = 1.52, n = 44). Almost all participants completed the Feelings module (n = 42, 95.5%), followed by Thoughts (36, 81.8%), Unwrapping (34, 77.3%), De-stressing (29, 65.0%), and Relationships (24, 54.0%). There was a significant positive correlation between GPA improvement and the number of modules completed (rs = 0.388, n = 44, p = 0.009). Completing more modules was also associated with a greater reduction in anxiety scores (rs = 0.348, n = 44, p = 0.020); however, no relationship was found between changes in depression scores and number of completed modules.
Regression analysis (entry method) with the difference between pre and post-intervention GPAs as the dependent variable (higher scores indicating greater GPA improvement), and baseline anxiety scores, baseline depression scores, completed MoodGYM modules, and improved attendance as the independent variables, found that greater improvement in GPA was associated with a higher number of completed MoodGYM modules (β = .392, p = 0.005) and improved attendance (β = .388, p = 0.007; total adjusted r2 = 0.35) (Table 5).
Table 5. Regression analysis for depression, anxiety, completed MoodGYM modules, attendance, and GPA pre- and post-intervention
|
Post-intervention GPA
|
Predictors
|
B
|
SE B
|
Β
|
T
|
Depression scores (pre-intervention)
|
.024
|
.028
|
.125
|
.837
|
Anxiety scores (pre-intervention)
|
-.022
|
.018
|
-.171
|
-1.194
|
|
|
|
|
|
Total number of modules completed.
|
.083
|
.028
|
.392
|
2.985
|
Improved attendance
|
.126
|
.044
|
.388
|
2.857
|
Dependent Variable: Semester GPA (Post-intervention – Pre-intervention)
Note: *p = < 0.05, **p = < 0.01.
Evaluation of MoodGYM
The time period over which the participants used MoodGYM ranged from 2 weeks to 8 weeks; however, the highest proportion of students used the program for more than 4 weeks (n = 16, 36.4%) (Table 6).
Table 6. Number of weeks students spent completing MoodGYM modules
Number of weeks
|
Number of students (%)
|
Two weeks
|
4 (9.0%)
|
Three weeks
|
5 (11.4%)
|
Four weeks
|
9 (20.5%)
|
Five to eight weeks
|
16 (36.4%)
|
Not sure about time spent
|
10 (22.7%)
|
Participant ratings of MoodGYM were generally either overwhelmingly positive or neutral. Most students (n = 31, 70.5%) rated MoodGYM as good or very good, and 35 (79.6%) found it very or slightly helpful. More than half (n = 26, 59.1%) found MoodGYM easy or very easy to use, and 33 (75.0%) stated they would recommend it to a friend or family member.
Students were asked through an open-ended question to summarise how MoodGYM was helpful to them, and 70.5% (n=31) responded. Content analysis found that 20 (45.5%)
students reported that MoodGYM was helpful in reducing anxiety and depressive symptoms by teaching them different coping skills and strategies to address their negative thoughts. From the 20 students; four mentioned that the program helped them reflect on themselves more by completing different exercises and conducting self-assessments at the end of each module; five students stated that MoodGYM increased their knowledge about mental health; one student specifically suggested that it was a very good tool to deal with self-criticism and ten students mentioned that MoodGYM helped them acquire new self-help techniques and strategies to deal with their negative thoughts and change their daily routines by implementing some of the exercises. For example, one student stated ‘MoodGYM helped me to deal with my worrying thoughts and to understand why I get them very often’.
Eight (18.2%) students found MoodGYM helpful, but felt the modules were too long and time-consuming and two students (4.6%) felt that MoodGYM was unhelpful, due to its lack of clarity and complexity. For example, one student was not able to understand the purpose of some assessments, stating, ‘In all, I don't think it was clear enough’.