Amid a rising tide of young people living with anxiety and depression worldwide, a new report highlights the need for research that improves understanding of which mental health interventions work, for whom and why.
Commissioned by Wellcome Trust, the report Understanding how interventions for youth depression and anxiety work: Recommendations for mechanistic research is authored by an international expert team including CEI Director in the UK, Dr Katherine (Katie) Young. The authors note that despite decades of progress, “the field still lacks a clear understanding of how and why interventions work, or which components [or ‘active ingredients’] are most effective.”
Anxiety and depression are among the leading causes of disability in young people globally, with prevalence steadily rising in recent decades. One in three children will experience the onset of a mental health condition by age 14, rising to nearly one in two by age 18.
“There are now many interventions with evidence of effectiveness in reducing mental health distress in young people, including psychological therapies, pharmacological treatments and digital programs,” Katie notes. “However, the underlying mechanisms of these evidence-based interventions – exactly how and why they work – remain poorly understood.”
“We also know that at least one in three children and adolescents with anxiety and depression will gain no meaningful symptom relief from intervention, and relapse is common. So, even with many quality treatment options available, we see limited effectiveness.”
The report identifies four overarching challenges in youth mental health research – from an analysis of the existing knowledge base, as well as input from expert consultations and panels of young people in Brazil, Ghana, the UK and Zimbabwe with lived experience.
The research challenges are:
- Weak mechanistic evidence (how and why interventions work, their components and pathways), as well as gaps between theory and practice
- A lack of primary prevention research targeting underlying risk factors
- A narrow evidence-base concentrated in high-income countries (HICs), with limited adaptation and evaluation in low- and middle-income countries (LMICs) and culturally diverse settings
- Limited integration of lived experience, resulting in a mismatch between what studies measure and what youth find meaningful and relevant to their real-world needs
The report makes 32 recommendations to advance mechanistic understanding of interventions, summarised into five priorities for future research:
- Studies specifically designed to test mechanistic hypotheses
- Prevention research to identify how interventions reduce risk and promote resilience
- Studies investigating the role of lifestyle interventions (e.g. physical activity, sleep and diet) in prevention, symptom alleviation, recovery and long-term wellbeing
- Studies that assess social and interpersonal interventions through the lens of cultural adaptation (e.g. in LMICs) and the lived experience of young people
- Mechanistic testing of how creative and spiritual interventions can support young people (an under-explored but promising area)
“Our findings emphasise the need for more precise and theory-driven studies, more culturally diverse research, and embedding the perspectives of young people with lived experience to strengthen the scientific and practical value of research findings,” says Katie.
“Mechanistic approaches provide a stronger rationale for investment and implementation by clarifying active ingredients, examining subgroup and contextual differences, and integrating youth perspectives into models for change.”
More about the report
Wellcome commissioned this expert report to identify the most promising areas for intervention, to pinpoint opportunities and gaps in the existing knowledge base, and to determine where further mechanistic research is most urgently needed.
The research objectives were to synthesise evidence, identify gaps and opportunities, and incorporate insights from young people with lived experience and international academia.
The research team mapped current evidence on the mechanisms of action through which interventions reduce symptoms of anxiety and depression in children and young people under 18. They analysed 201 publications, and conducted consultations with young people with lived experience of anxiety and depression, as well as academic experts in the field.
The findings and recommendations will guide future Wellcome funding calls, with a particular focus on investing in mechanistically informed, contextually relevant, and youth-centred research.
The report Understanding how interventions for youth depression and anxiety work: Recommendations for mechanistic research, was authored by Tarisai Bere (University of Zimbabwe), Dr Christian Kieling (Universidade Federal do Rio Grande do Sul, Brazil), Dr Katherine (Katie) Young from CEI, and Dr Anna McLaughlin (Sci-translate, UK).
Download the full report HERE