Feasibility, acceptance, user satisfaction, and differences between users and non-users of an online-based support service for University students

Abstract Mental health problems among university students have increased markedly in recent years. Despite their prevalence, help-seeking remains low, highlighting the need for accessible, low-threshold support. Digital interventions, including online counselling and app-based tools, may help bridge this treatment gap. This study aimed to evaluate the feasibility and acceptability of the digital mental health platform “enhance” as a low-threshold support service for university students, with a particular focus on characterizing counselling users and examining differences between users and non-users. A pragmatic, self-selected survey-based cohort study was conducted across six German universities. Students voluntarily registered and completed standardized assessments at baseline (T0) and post-intervention (T1). The platform included a mental health app and individual counselling via chat, video, or email. Overall, 447 students completed baseline assessments (mean age = 24.15 years; 76.5% female). Moderate anxiety and depression levels were reported. Of these, 343 downloaded the app, 117 engaged in at least one counselling session, with 41% choosing video counselling for their first contact. Satisfaction was high (ZUF-8: M = 20.14); 95.9% reported improved well-being after sessions, and 78.4% found the intervention helpful. Most sessions addressed mental health concerns and resulted in referral recommendations (80.9​%). Higher eating disorder symptoms and having a parent with a migration history were associated with lower counselling uptake. Findings suggest that “enhance” is a feasible and well-accepted low-threshold intervention, however, only 26% of the baseline sample engaged with at least one counselling session, warranting further research on long-term effectiveness and integration into university support systems.