Investigating the impact of eQuoo (a mental health support app) on college students in England

Plain English Summary

Background and study aims:
Almost half of people will at some point in their lives experience a mental health disorder but only about a third will access effective care. The majority of mental disorders (over two thirds) first develop in childhood and adolescence and commonly persist into adulthood. It is therefore important that we develop interventions which are accessible to the large numbers of people who would benefit from this support. There are a number of psychological, physical, social and genetic factors which increase the likelihood of developing a mental disorder and how severe and long-lasting it is. Effective psychological interventions exist but as noted above access is limited. Digital interventions, particularly for less severe disorders, are recommended by NICE and have the potential to increase access to care.
We know relatively little about the effectiveness of interventions developed for adolescents. We do know though that younger individuals tend to drop out of treatment more often than individuals who are older. This suggests we need to develop interventions which are more accessible for young people and are more likely to help them continue with the intervention. Digital interventions have shown promise in decreasing depression and anxiety (equivalent to face-to-face therapy). However, smartphone interventions (via apps) have high attrition rates (43%-99%). One way to address this is ‘gamification’ where the therapeutic features of an intervention are delivered in a game format, which has been shown to increase engagement, especially in younger people. The intervention to be tested is eQuoo, based on well-validated theory and practice which uses interventions originally designed to be delivered face-to-face in game format. It has received thousands of downloads and has been tested in a University College London (UCL)-led study with a university population and shown to be effective at improving mental health and resilience. It attained a top score by ORCHA, a leading health app assessment platform working with the NHS library, and has been determined to be safe and attractive enough to appeal to the student population. It has been used in commercial settings by companies to support their staff (e.g., Bosch and Inmarsat) who have a large employee body under the age of 30 with universally positive feedback. The general study aim is: To what extent does the use of a gamified mental health app (eQuoo) improve mental health and wellbeing in a college-aged sample over time?

Who can participate?
Students aged 16 years or older who are enrolled in one of the 14 colleges managed by Activate Learning and NCG. Participants must be 'Gillick competent'.

What does the study involve?
Participants complete a brief online survey to understand more about their mental health and wellbeing and are invited to download the eQuoo app on a phone from either the App or Play store (depending on the device). About an hour's usage is encouraged after installation, and then a minimum of 1 hour per week over the following 6 weeks. Although participants can use eQuoo as much or as little as they like, the app is restricted to learning three skills per 24-hour period (there is a notification about this within the app). This is to encourage a paced approach to engaging with the skills. Participants are free to continue using eQuoo after the initial 6-week period. After 2, 4, and 6 weeks after commencing the project, participants will be requested to complete the online survey again. This will also take place at 3 and 6 months, and 1 year after starting participation. There are different forms of data sharing that participation involves: (1) self-reported data about mental health and wellbeing that will be provided as a result of completing the online surveys; (2) grades and attendance data shared with the research team at the end of the year by the college; and (3) gender and progress within the eQuoo app (i.e., the number of skills completed and when they were completed), which are automatically stored on the app servers which the research team will have access to. Please note that all data will be stored confidentially.

What are the possible benefits and risks of participating?
Participation will help us to understand more about levels of mental health and wellbeing over the academic year and how the use of mental health games like eQuoo can impact levels of mental health and wellbeing, as well as other student outcomes, like grades and attendance. Furthermore, because eQuoo is designed to support mental health and wellbeing, participants may experience an improvement in how they feel as a result of their participation. For instance, a reduction in feelings of worry or low mood. eQuoo is a widely used app and we do not anticipate any disadvantages or risks from using it. However, in the survey, participants may find some questions prompt discomfort or distress. For instance, we ask about the possible presence of depression symptoms over the past 2 weeks, and reflecting on how an individual may have felt during this time it may make them feel uncomfortable or remind them of bad experiences. The researchers have provided contact details at the start and end of the questionnaire (and within the app) about who a participant can reach out to, should they feel uncomfortable and wish to speak with someone.

Where is the study run from?
One of the 14 colleges managed by Activate Learning and NCG.

When is the study starting and how long is it expected to run for?
July 2023 to February 2025

Who is funding the study?
1. PsycApps (owners of eQuoo) (UK)
2. Activate Learning (UK)
3. NCG (UK)

Who is the main contact?
Philip Jefferies, philip@psycapps.com

Contact information

Dr Philip Jefferies
Principal Investigator

PsycApps Ltd
London
SE1 7LL
United Kingdom

ORCID ID	0000-0003-4477-9012
Phone	+44 (0)7442 838394
Email	philip@psycapps.com

Ms Silja Litvin
Public, Scientific

PsycApps Ltd
London
SE1 7LL
United Kingdom

ORCID ID	0000-0003-1987-7403
Phone	+44 (0)7442 838394
Email	silja@psycapps.com

Study information

Eligibility

Locations

Countries of recruitment

• England
• United Kingdom

Study participating centres

Sponsor information

Funders

Funder type

Industry

Results and Publications

Editorial Notes

03/03/2025: The study was stopped.
13/02/2025: This study has been suspended indefinitely.
02/02/2024: Study's existence confirmed by the Activate Learning Research Ethics Committee.