Analysis Identifies Key Components in Adolescent Mental Health Care

A meta-analysis in Pediatrics has found that three components of adolescent mental health programs are consistently effective across multiple outcomes: those geared toward improving interpersonal skills, developing emotional regulation, and providing alcohol and drug education.

Sarah Skeen, Ph.D., a senior researcher at Stellenbosch University in South Africa, and colleagues analyzed data from 158 studies of psychosocial interventions administered to adolescents aged 10 to 19 years old. They found that components that focused on building interpersonal skills consistently delivered positive results across multiple outcomes, notably on overall mental health, depression and anxiety prevention, and substance use prevention.

“Developing skills to improve interpersonal relationships is highly relevant for improving adolescent mental health outcomes, and our findings indicate that including these skills in multi-outcome interventions designed to promote mental health and prevent mental disorders and risk behaviors is a valuable strategy,” the researchers wrote.

Components focused on teaching adolescents emotional regulation improved mental health and reduced symptoms of depression and anxiety. Alcohol and drug education had positive effects on mental health and aggression. However, this education was not associated with a positive effect on substance use, for reasons unknown to the researchers.

in South Africa, and colleagues analyzed data from 158 studies of psychosocial interventions administered to adolescents aged 10 to 19 years old. They found that components that focused on building interpersonal skills consistently delivered positive results across multiple outcomes, notably on overall mental health, depression and anxiety prevention, and substance use prevention.

“Developing skills to improve interpersonal relationships is highly relevant for improving adolescent mental health outcomes, and our findings indicate that including these skills in multi-outcome interventions designed to promote mental health and prevent mental disorders and risk behaviors is a valuable strategy,” the researchers wrote.

Components focused on teaching adolescents emotional regulation improved mental health and reduced symptoms of depression and anxiety. Alcohol and drug education had positive effects on mental health and aggression. However, this education was not associated with a positive effect on substance use, for reasons unknown to the researchers.

Molly McVoy, M.D., a training director and assistant professor of child and adolescent psychiatry at University Hospitals in northeast Ohio, noted the practical implications of the research. “Every psychiatrist who works with teenagers can put interpersonal relationship-building skills and emotional regulation at the top of the list [to achieve] for resilience,” said McVoy, who was not involved in the research.

The meta-analysis was conducted to aid the development of a universally delivered intervention as part of the Helping Adolescents Thrive initiative, which is sponsored by the World Health Organization and the United Nations Children’s Fund. To that end, the study authors noted an important caveat to their findings: Nearly all of the studies in the meta-analysis were conducted in high-income countries. Therefore, it will be essential to track implementation if and when these interventions are adapted for use in low- and middle-income countries to ensure that they are implemented in culturally appropriate ways, the researchers wrote.

McVoy suggested that the best way to ensure culturally appropriate implementation is for low- and middle-income countries to determine how to apply the components themselves. “More wealthy countries coming in and trying to insert their approach, even if it’s evidence based, is not sustainable and does not go well,” she said. In a commentary accompanying the study, Glenn Thomas, Ph.D., of the Department of Psychiatry and Behavioral Health at Nationwide Children’s Hospital in Columbus, Ohio, wrote that effective implementation and sustainability may require resources that are unavailable in low-income communities.

“This maintains disparity in access to mental health resources, with the unintended consequence being that economically marginalized families are even less likely to be exposed to high-quality interventions,” Thomas wrote. “If we are to close the gap in social determinants of health, a concerted effort to fund and implement prevention and evaluate effectiveness and transportability is imperative.”

This study was funded by the World Health Organization. ■

“Adolescent Mental Health Program Components and Behavior Risk Reduction: A Meta-Analysis” is posted here. “Universal Mental Health Prevention for Adolescents: Real-World Implications” is posted here.