Assessing the Effectiveness, Adherence and Attrition of Smartphone‐Based Mental Health Interventions in University Students: A Systematic Review and Meta‐Analysis

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BACKGROUND: Mental health challenges are prevalent among university students, many of whom face barriers to accessing traditional psychological services. Smartphone-delivered mental health applications offer a scalable intervention option, but evidence regarding their effectiveness and engagement remains limited. This systematic review and multilevel meta-analysis examined clinical and engagement outcomes of app-based mental health interventions in university students. METHOD: Medline, PsycINFO, CINAHL, ProQuest Dissertations & Theses Global and Scopus were searched from inception to 27 October 2025 (initial search: 2 April 2025). Randomised controlled trials were synthesised using multilevel meta-analysis and non-randomised designs were narratively synthesised. Risk of bias was assessed using the Cochrane Risk of Bias tool. Outcomes included depression, anxiety, stress, well-being, disordered eating and body image, alongside attrition and adherence. RESULTS: A total of k = 122 studies were included. Interventions produced significant effects across all outcomes: anxiety (d = 0.22, 95% CI [0.14, 0.30]), depression (d = 0.25, 95% CI [0.16, 0.33]), stress (d = 0.28, 95% CI [0.19, 0.38]), well-being (d = 0.47, 95% CI [0.16, 0.78]), disordered eating (d = 0.29, 95% CI [0.06, 0.52]) and body image (d = 0.27, 95% CI [0.06, 0.48]). Substantial heterogeneity was observed for most outcomes. Attrition was moderate (17.0%, 95% CI [13.5, 21.2]) and adherence varied (70.0%, 95% CI [54.0, 82.0]). Personalization significantly moderated depression outcomes. CONCLUSIONS: App-based interventions demonstrate small-to-moderate benefits for university student mental health, though heterogeneity and engagement challenges limit impact. Future research should prioritise personalised, transdiagnostic approaches and standardised engagement reporting, with greater focus on eating- and appearance-related outcomes.

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