{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T14:50:59Z","timestamp":1785855059142,"version":"3.56.0"},"reference-count":51,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>University students, in the life stage of emerging adulthood, struggle with a number of mental health problems around the world, mostly due to difficulties related to their studies and social relations. Though most students are aware of their problems, health-seeking behavior tends to lag behind. The COVID-19 pandemic aggravated mental health problems among students. In response, the University of Debrecen developed an integrated, multilevel model system aimed at the screening, prevention, and treatment of students\u2019 mental health problems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This paper describes the testing of the integrated, multilevel model system aimed at the screening, prevention, and treatment of students\u2019 mental health problems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The new system consists of data collection and intervention or service functions with 2 levels of informal digital, and 3 with partly digital, partly personal service modalities. Students access the system through a dedicated smartphone app that offers other university-related functions requiring personal login. One function of the app involves a mood report with 3 categories (awful, acceptable, and good), of which one per day can be submitted by students. Based on this report, further services are offered. According to the weekly patterns of the mood report, responding students may be directed to the second level, at which screening for depression or willingness to participate in peer groups is assessed. Depending on the responses, students are referred to personal (face-to-face) services at the secondary level for intervention. Aggregated reporting for leadership on the use of functions is available at all levels, which can be used to make decisions regarding the expansion of services or creating new ones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The model was launched in September 2020 and was tested for 45 months. After an initial increase in use, approximately 29% (8673\/29,045) of all students provided mood reports (the University of Debrecen student population on October 15, 2024, was 29,045 students; the student population using the mobile app mood report was 8673 students). The percentage of students reporting a bad mood varied between 8.9% (26,465\/297,372) and 12.2% (36,280\/297,372) in the test period, while 50% (151,548\/297,372 reports) of students reported being in a good mood. There was a marked pattern of increased use of mood reporting during the fall and spring study periods, while usage prominently decreased during the examination period and summer recess.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The 4-year trial period demonstrated that the mood report embedded in the mobile app can identify students with a potentially increased risk of mental health problems in need of support without stigmatization. The unique feature of our model seems to be its app-based screening at the first level and its hierarchy integrating digital and personal services. The system provides an easy-to-follow path from digital to personal services, along with time-specific data on the mental health of students for university leadership to facilitate the development of new services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/67089","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T16:35:06Z","timestamp":1769445306000},"page":"e67089","source":"Crossref","is-referenced-by-count":1,"title":["An Integrated Multilevel Mental Health Support System for University Students: 4-Year Longitudinal Observational Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2130-9878","authenticated-orcid":false,"given":"Szilvia","family":"Vincze","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1052-6290","authenticated-orcid":false,"given":"Antal","family":"Bug\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7867-2403","authenticated-orcid":false,"given":"Karolina","family":"K\u00f3sa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0612-658X","authenticated-orcid":false,"given":"Zolt\u00e1n","family":"B\u00e1cs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref1","year":"2022","journal-title":"Education at a glance 2022: OECD indicators"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.65.12.1429"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0b013e31827ab077"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s40596-014-0205-9"},{"key":"ref5","unstructured":"GrezBMMental health of international students: prevalence and predictors for mental disorders and symptom severity PhD thesis [dissertation]University of T\u00fcbingen20122025-01-12https:\/\/tinyurl.com\/mvkkd9tm"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.55.5.469"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1671923"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1037\/abn0000362"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.1782"},{"key":"ref10","unstructured":"BaradaVDoolanKBuricIKroloKTonkovicZStudent life during the COVID-19 pandemic lockdown: Europe-wide insightsEuropean Students\u2019 Union (ESU)2025-12-18http:\/\/www.ehea.info\/Upload\/BFUG_DE_UK_73_11_6_students_Covid_19_survey_results.pdf"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2022.03.038"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2023.1166960"},{"key":"ref13","unstructured":"SandersMStudent mental health in 20232024-08-21https:\/\/www.kcl.ac.uk\/policy-institute\/assets\/student-mental-health-in-2023.pdf#:~:text=URL%3A%20https%3A%2F%2Fwww.kcl.ac.uk%2Fpolicy"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18030866"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2020.112934"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19020785"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2020.105866"},{"key":"ref18","unstructured":"B\u00edr\u00f3Studies on the mental health of students in higher education [PhD thesis]20142026-01-12https:\/\/dea.lib.unideb.hu\/server\/api\/core\/bitstreams\/cb61671a-ee5f-4e1a-b92d-96b78a29a715\/content"},{"key":"ref19","author":"Lisznyai, S","year":"2011","journal-title":"Ifj\u00fas\u00e1gkutat\u00e1s \u00e9s tan\u00e1csad\u00e1s. Budapest: FETA k\u00f6nyvek"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1556\/0016.2020.00014"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2022.e09185"},{"key":"ref22","unstructured":"KarnerOKissMOroszn\u00e9PMF\u00fclekiBFrancziaNT\u00f6r\u00f6kLMagyarorsz\u00e1gi fels\u0151oktat\u00e1sban tanul\u00f3 hallgat\u00f3k ment\u00e1lis j\u00f3ll\u00e9t\u00e9nek felm\u00e9r\u00e9se [Article in Hungarian]Fels\u0151oktat\u00e1si Tan\u00e1csad\u00e1s Egyes\u00fclet2025-12-18https:\/\/tinyurl.com\/4rb857dh"},{"key":"ref23","unstructured":"Kutat\u00e1si gyorsjelent\u00e9s - Orsz\u00e1gos hallgat\u00f3i ment\u00e1lis eg\u00e9szs\u00e9g felm\u00e9r\u00e9s - 2023FETA2025-12-18https:\/\/www.feta.hu\/kutatas\/kutatasi-gyorsjelentes-orszagos-hallgatoi-mentalis-egeszseg-felmeres-2023"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.831349"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1080\/10872981.2023.2242597"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-13943-x"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1186\/s13033-022-00569-0"},{"key":"ref28","unstructured":"\u00e9vi CCIV. t\u00f6rv\u00e9ny a nemzeti fels\u0151oktat\u00e1sr\u00f3l20112025-12-18https:\/\/net.jogtar.hu\/jogszabaly?docid=a1100204.tv"},{"key":"ref29","unstructured":"Decree 51\/2007 (III.26.) on grants available for higher education students and fees payable by themJogtar2025-12-18https:\/\/net.jogtar.hu\/jogszabaly?docid=a0700051.kor"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.2196\/12869"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.2196\/17458"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.2196\/44922"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.2196\/39128"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-093932"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.2196\/73180"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.2196\/53613"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.2196\/45905"},{"key":"ref38","unstructured":"Improving health systems and services for mental healthWorld Health Organization20092025-12-01https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/bbbdb581-edb2-4eea-a6f8-3f1524aa21ea\/content"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.171154"},{"key":"ref40","unstructured":"Act on Higher EducationHungary2025-12-18https:\/\/www.education.gov.in\/en\/acts-higher"},{"key":"ref41","unstructured":"CXIIAct on information autonomy and freedomHungary2025-12-18https:\/\/en.wikipedia.org\/wiki\/Right_to_Information_Act,_2005"},{"key":"ref42","unstructured":"World development indicatorsWorld Bank2025-12-18https:\/\/databank.worldbank.org\/"},{"key":"ref43","unstructured":"LaricchiaFSmartphone penetration worldwide as share of global population 2016-2023Statista2025-12-18https:\/\/www.statista.com\/statistics\/203734\/global-smartphone-penetration-per-capita-since-2005\/"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1186\/1475-925X-10-24"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.17265\/2160-6579\/2019.03.001"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2018.09.018"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.2196\/39686"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-013-0488-2"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.2196\/11467"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.2196\/58198"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.2196\/preprints.36864"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e67089","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:59:58Z","timestamp":1785851998000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e67089"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":51,"URL":"https:\/\/doi.org\/10.2196\/67089","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.67089","asserted-by":"object"}]},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]}}}