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

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.