Abstract
BACKGROUND: College students face rising anxiety, depression, and stress, with traditional mental health services unable to meet demand. iCBT offers an accessible, low-cost alternative, yet evidence remains inconsistent regarding its effectiveness. OBJECTIVE: This systematic review and meta-analysis synthesizes evidence from RCTs to evaluate iCBT's effects on anxiety, depression, and stress in college students. METHODS: We systematically searched eight databases and one trial registry for studies published up to October 2025. Two reviewers independently screened studies, extracted data, and assessed bias using the Cochrane RoB 2 tool. Inter-rater agreement was measured using Cohen's kappa coefficient. Meta-analysis and subgroup analyses were conducted using RevMan 5.4 and Stata 17.0. RESULTS: This systematic review included 30 RCTs involving 5,169 college students, 29 of which were included in the meta-analysis. The meta-analysis results showed that, compared to the control group, internet-based Cognitive Behavioral Therapy significantly alleviated anxiety symptoms (SMD = -0.24, 95% CI -0.31 to -0.18, p < 0.001), depressive symptoms (SMD = -0.42, 95% CI -0.54 to -0.30, p < 0.001), and stress levels (SMD = -0.37, 95% CI -0.47 to -0.27; p < 0.001) in college students. Subgroup analysis tentatively suggested that chatbot-based interventions may be promising for alleviating depression, while web platform-based interventions appeared more effective in improving anxiety. Furthermore, longer intervention durations (>4 weeks) yielded superior effects compared to shorter ones. Follow-up meta-analysis demonstrated that iCBT had a sustained impact on improving college students' mental health (Depression: SMD = -0.28, 95% CI -0.39 to -0.18, p < 0.001; Anxiety: SMD = -0.17, 95% CI -0.30 to -0.03, p = 0.01; Stress: SMD = -0.32, 95% CI -0.45 to -0.18, p < 0.001). CONCLUSION: Our study found that iCBT is an effective approach for improving anxiety, depression, and stress among college students, with relatively long-term effects. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD420251177558, identifier (CRD420251177558).