Development of a Creative Arts Therapies Center for People With Developmental Disabilities
J Adolesc Health. 2016 October; 59(4 Suppl): S49–S60.
Interventions for Adolescent Mental Health: An Overview of Systematic Reviews
Jai Thousand. Das
aDivision of Women and Child Health, Aga Khan University, Karachi, Pakistan
Rehana A. Salam
aPartition of Women and Child Health, Aga Khan Academy, Karachi, Islamic republic of pakistan
Zohra Due south. Lassi
bRobinson Research Institute, University of Adelaide, Adelaide, Australia
Marium Naveed Khan
aPartition of Women and Child Wellness, Aga Khan University, Karachi, Pakistan
Wajeeha Mahmood
cZiauddin Academy, Karachi, Pakistan
Vikram Patel
dLondon School of Hygiene & Tropical Medicine, London, United Kingdom
ePublic Health Foundation of India, New Delhi, India
fSangath, Goa, India
Zulfiqar A. Bhutta
mCentre for Global Child Wellness, The Hospital for Ill Children, Toronto, Canada
hCenter of Excellence in Women and Child Wellness, The Aga Khan University, Karachi, Islamic republic of pakistan
Received 2016 Jan 25; Accepted 2016 Jul 1.
Abstract
Many mental health disorders emerge in late childhood and early adolescence and contribute to the burden of these disorders amid young people and later in life. We systematically reviewed literature published up to December 2015 to identify systematic reviews on mental health interventions in adolescent population. A total of 38 systematic reviews were included. Nosotros classified the included reviews into the following categories for reporting the findings: schoolhouse-based interventions (n = 12); community-based interventions (northward = 6); digital platforms (n = 8); and private-/family unit-based interventions (n = 12). Evidence from school-based interventions suggests that targeted group-based interventions and cognitive behavioral therapy are effective in reducing depressive symptoms (standard mean difference [SMD]: −.sixteen; 95% conviction interval [CI]: −.26 to −.05) and feet (SMD: −.33; 95% CI: −.59 to −.06). Schoolhouse-based suicide prevention programs suggest that classroom-based didactic and experiential programs increase short-term knowledge of suicide (SMD: i.51; 95% CI: .57–2.45) and knowledge of suicide prevention (SMD: .72; 95% CI: .36–one.07) with no evidence of an consequence on suicide-related attitudes or behaviors. Customs-based creative activities take some positive effect on behavioral changes, cocky-confidence, self-esteem, levels of cognition, and physical activity. Testify from digital platforms supports Cyberspace-based prevention and treatment programs for anxiety and depression; however, more extensive and rigorous enquiry is warranted to farther establish the weather condition. Among individual- and family-based interventions, interventions focusing on eating attitudes and behaviors evidence no bear on on torso mass alphabetize (SMD: −.x; 95% CI: −.45 to .25); Eating Mental attitude Exam (SMD: .01; 95% CI: −.xiii to .15); and bulimia (SMD: −.03; 95% CI: −.xvi to .10). Exercise is found to be effective in improving self-esteem (SMD: .49; 95% CI: .xvi–.81) and reducing depression score (SMD: −.66; 95% CI: −one.25 to −.08) with no impact on anxiety scores. Cerebral behavioral therapy compared to waitlist is effective in reducing remission (odds ratio: 7.85; 95% CI: 5.31–11.6). Psychological therapy when compared to antidepressants have comparable effect on remission, dropouts, and depression symptoms. The studies evaluating mental wellness interventions among adolescents were reported to exist very heterogeneous, statistically, in their populations, interventions, and outcomes; hence, meta-assay could non exist conducted in most of the included reviews. Time to come trials should likewise focus on standardized interventions and outcomes for synthesizing the exiting body of knowledge. There is a demand to study differential furnishings for gender, age groups, socioeconomic status, and geographic settings since the touch on of mental health interventions might vary according to various contextual factors.
Keywords: Adolescent wellness, Mental health, Suicide, Low, Anxiety, Eating disorders
Adolescence is a menses for the onset of behaviors and weather that not only affect health at that time but also lead to adulthood disorders. Unhealthy behaviors such as smoking, drinking, and illicit drug apply oft begin during adolescence and are closely related to increased morbidity and mortality and represent major public wellness challenges [1]. Many mental wellness disorders emerge in mid- to tardily adolescence and contribute to the existing burden of disease among young people and in later life [2]. More than 50% of developed mental disorders have their onset before the age of 18 years [3], [4]. Poor mental health has been associated with teenage pregnancy, HIV/AIDS, other sexually transmitted diseases, domestic violence, child abuse, motor vehicle crashes, physical fights, crime, homicide, and suicide [ii]. Globally, neuropsychiatric disorders are the leading crusade of years lost because of disability amid 10- to 24-year-olds, accounting for 45% of years lost considering of disabilities [v]. The overall prevalence of depression in adolescents is around vi% and that for children (younger than 13 years) is three% [6]. Major depressive disorder (MDD) is i of the leading causes of disability, morbidity, and mortality and is a major risk factor for suicide [7]. MDD also puts adolescents and young adults at a greater adventure for suicide every bit they are seven times more likely to consummate suicide than those without MDD [8]. Suicide itself accounts for nine.1% of deaths in fifteen- to 19-year age grouping and ranks as the third major crusade of mortality in this age group, preceded merely by accidents and assault [9].
Given the prevailing burden and impact of mental wellness disorders in children and adolescents, information technology is essential that effective interventions are identified and implemented. This commodity is function of a serial of reviews conducted to evaluate the effectiveness of potential interventions for adolescent wellness and well-being. Detailed framework, methodology, and other potential interventions take been discussed in separate articles [10], [11], [12], [thirteen], [xiv], [15], [16]. Our conceptual framework depicts the private and general risk factors through the life cycle perspective that tin can have implications at any stage of the life bike [10]. Nosotros besides acknowledge the fact that mental health interventions take a life course perspective and that interventions earlier in life can have impacts in adolescence; however, the focus of our review is to evaluate potential mental health interventions targeted toward adolescents and youth only. With this focus, we aimed to systematically review the effectiveness of interventions to foreclose and manage mental health disorders amongst adolescents and youth.
Methods
We systematically reviewed literature published up to December 2015, to identify systematic reviews on interventions to prevent and manage mental health disorders in boyish population. For the purpose of this review, the boyish population was divers as anile xi–19 years; however, since many studies targeted youth (aged xv–24 years) along with adolescents, exceptions were made to include reviews targeting adolescents and youth. We did non apply whatever limitations on the start search engagement or geographical settings. We considered all available published systematic reviews on the interventions to foreclose and treat adolescent mental health disorders. A broad search strategy was used that included a combination of advisable keywords, medical subject heading, and gratuitous text terms; the search was conducted in the Cochrane Library, and PubMed. The abstracts (and the full sources where abstracts are not available) were screened by ii abstractors to identify systematic reviews adhering to our objectives. Whatsoever disagreements on choice of reviews between these two principal abstractors were resolved by the third reviewer. Afterward retrieval of the full texts of all the reviews that met the inclusion/exclusion criteria, data from each review were extracted independently into a standardized form. Information was extracted on (ane) the characteristics of included studies; (2) description of methods, participants, interventions, outcomes; (3) measurement of handling effects; (4) methodological issues; and (five) risk of bias tool. Nosotros extracted pooled effect size for outcomes reported by the review authors with 95% confidence intervals (CIs). We assessed and reported the quality of included reviews using the 11-point assessment of the methodological quality of systematic reviews criteria (AMSTAR) [17]. We excluded nonsystematic reviews, systematic reviews focusing on preventive and therapeutic mental health interventions targeting population other than adolescents and youth, and reviews not reporting outcomes related to mental health (Table 1).
Table 1
Inclusion/exclusion criteria
| Inclusion criteria | Exclusion criteria |
|---|---|
| Systematic review and/or meta-analysis of interventions for prevention and treatment of mental health targeting adolescents (11–19 years) or youth (15–24 years): Eating disorders Anxiety Low Suicidal behaviors eHealth interventions focusing on adolescent/youth mental health | Nonsystematic reviews Systematic reviews focusing on preventive and therapeutic mental health interventions targeting population other than adolescents and youth Reviews not reporting outcomes related to mental health |
Effigy i describes the search flow. Our search identified 107 potentially relevant review titles. Farther evaluation of the abstracts and full texts resulted in the inclusion of 38 eligible reviews. We classified the included reviews into the following categories for reporting the findings:
- • Schoolhouse-based interventions (n = 12)
- • Customs-based interventions (due north = 6)
- • Digital platforms (n = 8)
- • Individual-/family-based interventions (north = 12)
Search flow diagram. MeSH = Medical Subject field Heading.
Tabular array ii describes the characteristics of the included reviews while Tabular array 3 provides the summary estimates for all the interventions.
Table 2
Characteristics of the included reviews
| Intervention | Review | Intervention details | Setting; HICs/LMICs | Number of included studies | AMSTAR rating | Outcomes reported |
|---|---|---|---|---|---|---|
| School-based interventions | O'Mara and Lind [eighteen] | Social and emotional health and well-existence, positive youth evolution, wellness promotion, mental health promotion, primary prevention | Mostly HICs | xv reviews | — | Subclinical internalizing and externalizing issues, academic achievement, mood disorders, feet, depressive symptoms, self-concept, cocky-esteem, coping skills, interpersonal skills, quality of peer and adult relationships, self-control, problem-solving, self-efficacy, school misbehavior, ambitious beliefs and violence, interpersonal sensitivity, conflict resolution, schoolhouse attendance, social operation |
| Mason-Jones et al. [19] | School-based wellness care including comprehensive services based at schools, dedicated adolescent health services, school-linked services based at local health centers, and servicing a number of schools and other outreach | HICs | 27 (RCTs and observational studies) | seven | Utilization of mental health services, ever considered suicide, attempted suicide | |
| Cheney et al. [20] | Nurture group (NG) intervention delivered in primary and secondary school settings. NG sessions typically include circle time meet and greet. A directed activity, aiming to develop cooperation, listening, teamwork, turn-taking, trouble-solving, and self-esteem. Snack fourth dimension. Free time to cull an action from the range offered. Maxim good-byes | HICs | xvi (RCTs and pre–post) | eight | Social and emotional well-existence | |
| Kim and Franklin [21] | Solution-focused brief therapy on behavioral problems in schools | HICs | 7 (RCT, quasi, and case report) | half dozen | Changes in scores from Hare Self-Esteem Calibration; Conners' Teacher Rating Scale; Conners' Parent Rating Scale; Feelings, Attitudes and Behaviors Scale for Children; Substance Abuse Subtle Screening Inventory Boyish-2; and Child Behavior Checklist-Youth. | |
| Fothergill et al. [22] | Screening tools existence used by school nurses for the identification of emotional, psychological, and behavioral problems among adolescents in schools. | HICs | None | 6 | Existing screening tools existence applied past school nurses to detect mental ill health | |
| Calear and Christensen [23] | School-based prevention and early intervention programs for depression. Mostly including cerebral behavioral therapy (CBT) delivered by a mental health professional or graduate student over viii–12 sessions. Other common therapeutic approaches employed included psychoeducation and interpersonal therapy | HICs | 42 RCTs | 7 | Depression | |
| Kavanagh et al. [24] | Cognitive behavioral therapy | HICs | 17 RCTs | viii | Outcome related to low, anxiety, and suicidality (bodily or attempted suicide and suicidal ideation) | |
| Farahmand et al. [25] | Mean solar day therapy programs: a multidisciplinary community-based approach to the treatment of mental wellness bug | HICs | 29 programs | 7 | Academic outcomes, behavioral outcomes, comport problems, depression, substance employ, internalizing symptoms | |
| Katz et al. [26] | School-based suicide prevention programs: awareness/instruction curriculum, gatekeeper training, peer leadership training, screening, skills training, reconnecting youth, practiced behavior game | HICs | 16 programs | v | Students' and school staffs' knowledge and attitudes toward suicide, suicide attempts | |
| De Silva et al. [27] | Psychological interventions for suicide and cocky-harm prevention | HICs | 38 controlled studies and 6 systematic reviews | half dozen | Mapping of existing literature | |
| Harrod et al. [28] | Any intervention that (1) targeted students without known suicidal risk (i.e., master prevention); (2) had the prevention of suicide every bit one of its primary purposes; and (three) was delivered in the postsecondary educational setting in any country | HICs | eight RCTs | 11 | Completed suicide, suicide try, suicidal ideation, changes in knowledge, attitudes and behaviors | |
| Harlow and Clough [29] | Suicide prevention programs that have been evaluated for ethnic youth | HICs | 11 programs | 6 | Suicide ideation, knowledge, attitude | |
| Community-based interventions | Bungay and Vella-Burrows [xxx] | Music, dance, singing, drama and visual arts, taking place in community settings or as extracurricular activities | More often than not HIC except one in Tanzania | xx (RCTs and observational) | v | Behavioral changes, self-conviction, cocky-esteem, levels of noesis, and physical activity |
| Waddell et al. [31] | Parent training or kid social skills training and universal cognitive behavioral therapy (CBT) | HICs | xv RCTs | 6 | Conduct disorder, anxiety, and depression | |
| Durlak and Wells [32] | Principal prevention intervention designed specifically to reduce the future incidence of adjustment problems in currently normal populations, including efforts directed at the promotion of mental health | HICs | 144 programs | v | Competencies, performance, successful transitions | |
| Farahmand et al. [33] | Customs-based mental health and behavioral programs | HICs | 33 (RCTs and observational) | 4 | Psychological, behavior, achievement, school connectedness, antisocial beliefs, interpersonal, social skills customs or prosocial activities, physical health | |
| Bower et al. [34] | Effectiveness of interventions for kid and adolescent mental health issues in master care, and interventions designed to improve the skills of primary care staff | HICs | RCTs and pre–post studies | 7 | Clinical outcomes, social, educational, satisfaction with handling, costs, attitudes, knowledge, diagnostic and treatment behavior, costs | |
| Digital platforms | Cloudless et al. [35] | It was a mass media intervention, defined as an intervention that uses a aqueduct of communication intended to achieve large numbers, and is not dependent on person-to-person contact, for example, newspapers, billboards, pamphlets, DVDs, television, radio, cinema, some Web- and mobile telephone–based media, street art, and ambience media | HICs | 22 RCTs | 11 | Discrimination or prejudice result measures |
| Musiat and Tarrier [36] | Computerized cognitive behavioral therapy (cCBT) interventions | HICs | 101 (observational studies) | 4 | Cost-effectiveness, geographic flexibility, fourth dimension flexibility, waiting time for treatment, stigma, therapist time, effects on assistance-seeking and treatment satisfaction | |
| Montgomery et al. [27] | Media-based cognitive behavioral therapies | HICs | 11 RCTs | 11 | Behavioral disorders, therapist fourth dimension | |
| Clarke et al. [38] | Online mental health promotion and prevention interventions | HICs | 28 observational studies | half-dozen | Feet, low | |
| Calear and Christensen 2010 [39] | Brave for Children—ONLINE and BRAVE for Teenagers—ONLINE: based on cerebral behavioral therapy (CBT), these programs consist of 10 weekly sessions for children and adolescents; two booster sessions presented 1 and 3 months afterward the intervention, and five or six parent sessions. The programs present information on managing anxiety, recognizing the physiological symptoms of feet, graded exposure, and problem-solving techniques. Project CATCH-Information technology is a complimentary, Internet-based training program based on behavioral activation, CBT, and interpersonal psychotherapy. MoodGYM is a free, interactive, Internet-based programme designed to prevent and decrease symptoms of depression in young people. Grip op je dip online is a complimentary, Dutch language, CBT-based programme aimed at 16- to 25-yr-olds. Based on the confront-to-face Grip op je dip course, the online program consists of six moderated chat sessions attended by six to eight participants. | HICs | 4 programs | 9 | Anxiety and depression | |
| Kauer et al. [40] | Online services in facilitating mental health help-seeking | HICs | xviii (RCTs and observational studies) | 9 | Aid-seeking, mental health | |
| Martin et al. [41] | Networked communication: e-mail and/or Web-based electronic diary; videoconference; and virtual reality. | HICs | 12 (RCTs and observational studies) | 9 | Clinical outcomes (e.grand., symptom alleviation), patient-level impacts (eastward.one thousand., improved health behaviors), patient and health care professional satisfaction and costs | |
| Farrer et al. [42] | A range of broad applied science types including the Cyberspace, audio, virtual reality, video, stand-alone estimator programs, and/or a combination of these | HICs | 27 RCTs | 9 | Low, anxiety | |
| Individual-/family-based interventions | Pratt and Woolfenden [43] | Eating disorder sensation, promotion of healthy eating attitudes and behaviors, as well as eating disorder awareness and coping with general adolescent issues, training in media literacy and advocacy skills | HIC | 12 RCTs | 8 | BMI, Eating Attitude Exam, Eating Disorder Inventory, Sociocultural Attitudes Towards Advent Questionnaire, social perception profile, torso image assessment |
| Ekelend et al. [44] | Gross motor, energetic activity, for example, running, swimming, ball games and outdoor play of moderate to high intensity, or forcefulness grooming, in contrast to "ordinary" physical activity (due east.g., routine physical education (PE) classes, walking to school, or playtime activities of low intensity) for at least a duration of 4 weeks | By and large HIC except one in Nigeria | 23 RCTs | 8 | Self-esteem | |
| Lubans et al. [45] | Three types of concrete activeness programs (i.due east., outdoor run a risk, sport and skill-based and physical fettle programs) | HICs | 15 (RCTs, quasi, and pre–post) | 9 | Social and emotional well-being | |
| Cooney et al. [46] | Exercise was defined every bit "planned, structured and repetitive bodily movement done to improve or maintain 1 or more components of physical fitness" | Generally HICs except one in Thailand, one in Brazil | 39 RCTs | 11 | Depression, acceptability of handling, number of participants completing the interventions; quality of life; toll; agin events | |
| Larun et al. [47] | Interventions that included vigorous physical activity of clearly specified quality with a minimum duration of iv weeks | HICs | 16 RCTs | eleven | Anxiety or low symptoms postal service-treatment | |
| James et al. [48] | (i) The relative efficacy of CBT versus non-CBT agile treatments; (2) the relative efficacy of CBT versus medication and the combination of CBT and medication versus placebo; and (3) the long-term effects of CBT | HICs | 41 RCTs | xi | Remission, reduction in anxiety symptom, acceptability | |
| Cox et al. [49] | Whatever psychological therapy with any antidepressant medication; a combination of interventions (psychological therapy plus antidepressant medication) with either psychological therapies or antidepressant medication alone; a combination of interventions (psychological therapy plus antidepressant medication) compared with either intervention (psychological therapy or antidepressants) plus a placebo; and a combination of interventions (psychological therapy plus antidepressant medication) with a placebo or treatment as usual | HICs | 11 RCTs | Remission from depressive disorder, acceptability, suicide-related serious adverse events, dropouts | ||
| Cox et al. [l] | Any blazon of pharmacotherapy or psychological therapy | HICs | 9 RCTs | 11 | Prevention of a 2d or next episode, readmissions, time to relapse, functioning, depressive symptoms, dropouts, secondary morbidity | |
| Shinohara et al. [51] | Behavioral therapy, behavioral activation, social skills training assertiveness training, relaxation therapies, other psychological therapies | HICs | 25 RCTs | 11 | Treatment efficacy, treatment acceptability, remittance, improvement in depressive symptoms, improvement in other symptoms | |
| Weisz et al. [52] | Evidence-based psychotherapies | HICs | 52 RCTs | 8 | Measures of symptoms and functioning | |
| Shepperd et al. [53] | Mental health services providing specialist intendance, across the chapters of generic outpatient provision, which provide an alternative to inpatient mental health care | HICs | seven RCTs | 11 | Illness-specific symptoms, general psychological operation, acceptability, and price | |
| Deenadayalan et al. [54] | HICs | 8 RCTs and observational studies | six | Symptoms, noesis, attitude |
Table 3
Summary estimates for adolescent mental health interventions
| Interventions (number of reviews) | Comparing | Outcomes and estimates |
|---|---|---|
| Schoolhouse-based interventions (n = 12) | Schoolhouse-based CBT | Symptoms of depression: effect size range: .21 to 1.40 |
| CBT in secondary schools | Depression (SMD: −.16; 95% CI: −.26 to −.05) | |
| Anxiety (SMD: −.33; 95% CI: −.59 to −.06) | ||
| Classroom instructions | Knowledge of suicide (SMD: 1.51; 95% CI: .57 to 2.45) | |
| Knowledge of suicide prevention (SMD: .72; 95% CI: .36 to 1.07) | ||
| Community-based interventions (n = vi) | Person-centered programs | Social credence at 3-calendar month follow-up (SMD: −.03; 95% CI: −.x to .04) |
| Melancholia educational activity (SMD: .33; 95% CI: .eighteen to .48) | ||
| Aggregate of positive mental health outcome (SMD: .03; 95% CI: −.xix to .25) | ||
| Person plus surround interventions | Aggregate of positive mental wellness outcome (SMD: .27; 95% CI: .sixteen to .37) | |
| Environment-only interventions | Amass of positive mental health outcome (SMD: .38; 95% CI: .15 to .lx) | |
| Digital platforms (n = 8) | Mass media | Discrimination: event size range: SMD −.85 to −.17 |
| Prejudice: event size range: SMD −2.94 to ii.40 | ||
| Private-/family unit-based interventions (n = 12) | Media literacy and advocacy approach | Internalization or acceptance of societal ideals relating to appearance at a 3- to 6-calendar month follow-up (SMD: −.28; 95% CI: −.51 to −.05) |
| Eating attitudes and behaviors and adolescent issues | BMI at 12- to xiv-month follow-up (SMD: −.x; 95% CI: −.45 to .25) | |
| Eating Attitude Test at half dozen- to 12-month follow-up (SMD: .01; 95% CI: −.13 to .fifteen) | ||
| Eating Disorder Inventory "bulimia" at 12- to 14-calendar month follow-upward (SMD: −.03; 95% CI: −.16 to .10) | ||
| Self-esteem approach | Close friendship at 3-month follow-up (SMD: −.01; 95% CI: −.09 to .06) | |
| Exercise lonely | Cocky-esteem (SMD: .49; 95% CI: .16 to .81) | |
| Exercise as a role of a comprehensive intervention | Self-esteem (SMD: .51; 95% CI: .15 to .88) | |
| Exercise compared to command | Depression (SMD: −.62; 95% CI: −.81 to −.42) | |
| Dropouts (RR: one.00; 95% CI: .97 to 1.04) | ||
| Practise compared to psychological therapies | Low (SMD: −.03; 95%CI −.32 to .26) | |
| Exercise compared to antidepressant | Low (SMD: −.eleven; 95% CI: −.34 to .12) | |
| Vigorous practice versus no intervention | Anxiety scores (SMD: −.48; 95% CI: −.97 to .01) | |
| Depression score (SMD: −.66; 95% CI: −i.25 to −.08) | ||
| Vigorous practice to low intensity practise | Anxiety scores (SMD: −.14; 95% CI: −.41 to .13) | |
| Depression scores (SMD: −.15; 95% CI: −.44 to .xiv) | ||
| Do with psychosocial interventions | Anxiety scores (SMD: −.13; 95% CI: −.43 to .17) | |
| Depression scores (SMD: .10; 95% CI: −.21 to .41) | ||
| Waitlist versus CBT for anxiety | Anxiety remission (OR: 7.85; 95% CI: 5.31 to 11.6) | |
| Participants lost to follow-upward: (OR: .93; 95% CI: .58 to 1.51) | ||
| Psychological therapy versus antidepressant medications for depression | Remission (OR: .62; 95% CI: .28 to 1.35) | |
| Dropouts (OR: .61; 95% CI: .11 to 3.28) | ||
| Suicidal ideation (SMD: −3.12; 95% CI: −five.91 to −.33) | ||
| Depression symptoms (SMD: .16; 95% CI: −.69 to ane.01) | ||
| Combination therapy versus antidepressant medication for depression | Remission (OR: one.l; 95% CI: .99 to two.27) | |
| Dropouts (OR: .84; 95% CI: .51 to ane.39) | ||
| Suicidal ideation (OR: .75; 95% CI: .26 to 2.sixteen) | ||
| Low symptoms (SMD: −.27; 95% CI: −four.95 to iv.41) | ||
| Functioning (SMD: .09; 95% CI: −.11 to .28) | ||
| Combination therapy versus psychological therapy | Remission (OR: 1.61; 95% CI: .38 to 6.90) | |
| Dropouts (OR: 1.23; 95% CI: .12 to 12.71) | ||
| Suicidal ideation (SMD: .threescore; 95% CI: −ii.25 to three.45) | ||
| Depression symptoms (SMD: −.28; 95% CI: −1.41 to .84) | ||
| Combination therapy versus psychological therapy plus placebo | Dropouts (OR: .98; 95% CI: .42 to 2.28) | |
| Remission (OR: 2.xv; 95% CI: 1.15 to 4.02) | ||
| Low symptoms (SMD: −.52; 95% CI: −.78 to −.26) | ||
| Antidepressants compared to placebo to relapse and recurrence | Number of relapsed recurred (OR: .34; 95% CI: .18 to .64) | |
| Suicide-related behaviors (OR: ane.02; 95% CI: .14 to seven.39) | ||
| Dropouts (OR: one.02; 95% CI: .38 to 2.79) | ||
| Behavioral therapy compared to all other psychological therapies | Response (RR: .97; 95% CI: .86 to 1.09) | |
| Remission (RR: .91; 95% CI: .8 to 1.04) | ||
| Response at follow-up (RR: .77; 95% CI: .59 to 1.01) | ||
| Depression severity (SMD: −.03; 95% CI: −.two to .xv) | ||
| Dropouts (RR: one.02; 95% CI: .65 to ane.61) | ||
| Evidence-based youth-focused psychotherapy versus usual clinical care | Effect size (SMD: .31; 95% CI: .16 to .44) | |
| Prove-based parent-/family unit-focused psychotherapy versus usual clinical care | Upshot size (SMD: .xvi; 95% CI: −.01 to .33) | |
| Multisystem approaches | Effect size (SMD: .35; 95% CI: .19 to .52) | |
| Combinations | Effect size (SMD: .29; 95% CI: .06 to .52) |
Results
Schoolhouse-based interventions
Nosotros found a total of 12 reviews reporting schoolhouse-based interventions for boyish mental wellness, of which ane review performed meta-analysis. AMSTAR rating ranged between v and eleven with a median score of vii.5. Five of the included reviews focused on school-based mental health promotion interventions; 3 reviews evaluated school-based programs for prevention and early intervention for existing mental health conditions while four reviews evaluated school-based programs for suicide prevention. A review on school mental health promotion programs based on the findings from xv studies suggests that an arroyo focusing on mental health promotion rather than on mental disease prevention is effective in promoting adolescent and youth mental health [18]. However, study populations were limited, and studies either lack clarity regarding who implemented interventions or lack theoretical foundations, process evaluations, or youth viewpoints [18]. Meta-analysis was not conducted due to variations in interventions and outcomes. Another review reported from 27 studies that school-based preventive health care is popular with immature people and provides important mental health services [nineteen]. However, meta-assay was not done due to report quality. Findings from a review based on 16 studies focusing on targeted group-based interventions delivered in schoolhouse settings suggest that nurture groups (short-term, focused intervention which addresses barriers to learning arising from social, emotional, or behavioral difficulties in an inclusive, supportive manner) have an immediate positive bear upon on the social and emotional well-being of young people [xx]. Due to heterogeneity of design, information technology was not possible to carry a meta-analysis, and the studies were examined for effectiveness qualitatively. A review evaluating solution-focused brief therapy in schools has suggested mixed results with some hope in working with students in school settings, specifically for reducing the intensity of students' negative feelings, managing behave problems, and externalizing behavioral problems [21]. These findings are based on seven studies while meta-analysis could not exist conducted. School-based mental health interventions specifically focusing on low- and middle-income countries (LMICs) suggest that the majority of the school-based life skills and resilience programs indicated positive effects on students' cocky-esteem, motivation, and self-efficacy. However, there were mixed results, including differential effects for gender and age groups [19], and issue estimates could non exist pooled. A systematic review on the effectiveness of school nurse implemented mental health screening for adolescents in schools did non observe any bear witness of existing screening tools to observe mental ill health amongst adolescents in schools [22].
A systematic review of 28 schoolhouse-based prevention and early intervention programs for depression has shown some support for the implementation of depression prevention and early intervention programs in schools [23]. Most of these programs were based on cognitive behavioral therapy (CBT) and delivered past a mental health professional person or graduate educatee over viii–12 sessions. Indicated programs, which targeted students exhibiting elevated levels of depression, were constitute to be the most effective in reducing depressive symptoms with effect sizes ranging from .21 to one.40. Meta-analysis was not conducted. It was found that CBT delivered to young people in secondary schools can reduce the symptoms of depression (standard mean divergence [SMD]: −.16; 95% CI: −.26 to −.05) and anxiety (SMD: −.33; 95% CI: −.59 to −.06) [24]. Schoolhouse-based therapeutic mental health programs specifically targeting adolescents with existing mental health disorders in LMICs suggested negative effects for programs that targeted externalizing problems and were delivered selectively to youth with existing problems. Distinctive characteristics of low-income, urban schools, and nonschool environments were emphasized every bit potential explanations for the findings [25].
School-based suicide prevention programs focused on awareness/education curricula, screening, gatekeeper, peer leadership, and skills training [26], [27]. Interventions for main prevention of suicide in university and other postsecondary educational settings propose that classroom-based didactic and experiential programs increased short-term knowledge of suicide (SMD: 1.51; 95% CI: .57–two.45) and knowledge of suicide prevention (SMD: .72; 95% CI: .36–1.07) with no evidence of an outcome on participant's suicide-related attitudes or behaviors; even so, these findings are limited by the overall depression quality [28]. Promising interventions that need further inquiry include school-based prevention programs with a skills training component, private CBT interventions, interpersonal psychotherapy, and attachment-based family therapy [26], [27]. A systematic review evaluating suicide prevention programs targeting indigenous youth (aboriginals) suggested that more than controlled report designs using planned evaluations and valid outcome measures are needed in enquiry on indigenous youth suicide prevention [29].
Community-based interventions
We report findings from half-dozen systematic reviews evaluating various community-based interventions targeting adolescents and youth; meta-assay was conducted in ii reviews. AMSTAR ratings ranged between 4 and seven with a median score of v. Bear witness from twenty studies evaluating community-based creative activities (including music, dance, singing, drama, and visual arts) suggests some positive event on behavioral changes, self-conviction, cocky-esteem, levels of knowledge, and concrete activity [30]. The interventions used in the studies were diverse, and the research was heterogeneous, and hence overall synthesis of the results was not attempted. Another review based on fifteen studies on community-based parent preparation and social skills training for preventing low suggested meaning reductions in symptom and/or diagnostic measures at follow-upwards [31]. However, meta-analysis was non conducted. Show from a review evaluating main prevention mental health programs for adolescents suggests that individually focused mental health promotion efforts and attempts to help negotiate stressful transitions yield significant mean effects on reducing problems and increasing competencies [32]. Show from community-based mental health delivery programs specifically targeting mental health promotion of young people in LMICs suggests positive impacts on mental health outcomes; even so, pooled analysis could non be conducted [19]. Another review evaluating community-based mental wellness and behavioral programs for low-income urban youth suggested that person-only interventions had a nonsignificant impact on improving mental health (measured by an aggregate outcome measure; SMD: .03; 95% CI: −.nineteen to .25) while person plus ecology interventions (SMD: .27; 95% CI: .sixteen–.37) and environs-only interventions had a significant positive impact (SMD: .38; 95% CI: .15–.threescore) [33]. I review reporting the impact of handling of adolescent mental health disorders in primary care settings suggests some preliminary evidence that treatments by specialist staff working in primary intendance were effective, although quality of included studies was variable. Meta-analysis could not be conducted. Some educational interventions showed potential for increasing skills and conviction of primary care staff, but controlled evaluations were rare, and few studies reported the actual modify in professional behavior or patient wellness outcomes [34].
Digital platforms for mental health interventions
Nosotros study findings from eight systematic reviews evaluating impact of digital platforms for mental health disorders. None of the included reviews conducted meta-assay. AMSTAR rating ranged between four and 11 with a median score of ix. A review evaluating the bear upon of mass media interventions from two studies suggests an impact ranging from SMD −.85 to −.17 on bigotry while the touch on prejudice ranged betwixt SMD −2.94 and 2.40. The studies were very heterogeneous, statistically, in their populations, interventions, and outcomes, and hence meta-analysis could not be conducted [35]. Evidence pertaining to mass media suggests that mass media–based behavioral treatments have a moderate effect while computerized CBT for mental health suggests that such interventions are cost-effective and often cheaper than usual care [36], [37]. Another review evaluating online youth mental wellness promotion and prevention interventions indicates that at that place is some testify that skills-based interventions presented in a module-based format can have a significant impact on adolescent mental wellness; however, an insufficient number of studies limit this finding. The results from online interventions indicate significant positive effect of computerized CBT on adolescents' and emerging adults' feet and depression symptoms [38]. These findings are based on 20 studies; still, meta-analysis could not exist conducted in this review due to heterogeneity in studies. Evidence from four Internet-based prevention and handling programs for anxiety and depression suggests early support for the effectiveness; however, more extensive and rigorous research is warranted to further establish the weather condition through which effectiveness is enhanced, also as to develop additional programs to address gaps in the field [39]. 3 reviews evaluating the acceptability and feasibility of mental health resources among youth suggested that young people regularly use and are by and large satisfied with online mental wellness resource [40], [41], [42].
Private-/family-based interventions
We included 12 systematic reviews focusing on individual- or family-based interventions, of which 10 reviews performed meta-assay. AMSTAR rating ranged between 6 and 11 with a median score of 11. One review focused on interventions for eating disorders; four reviews focused on physical activity and exercise interventions; six reviews focused on CBT, psychotherapy, behavioral, and pharmacological interventions for anxiety and depression; while two reviews focused on home-based multisystemic interventions.
A systematic review on the effectiveness of eating disorder programs for adolescents focused on eating disorder awareness, good for you eating attitudes and behaviors, media literacy and advocacy skills, and promoting self-esteem [43]. All included studies were conducted in high-income countries (HICs). Interventions focusing on eating attitudes and behaviors showed no impact on torso mass index at 12- to 14-calendar month follow-upwardly (SMD: −.x; 95% CI: −.45 to .25), Eating Mental attitude Test at vi- to 12-calendar month follow-upwardly (SMD: .01; 95% CI: −.13 to .15), and bulimia at 12- to 14-month follow-up (SMD: −.03; 95% CI: −.sixteen to .10). Combined data from two eating disorder prevention programs based on a media literacy and advocacy approach showed a significant reduction in the internalization or credence of societal ideals relating to advent at a iii- to six-month follow-up (SMD: −.28; 95% CI: −.51 to −.05). Two studies focusing on cocky-esteem approach showed no impact on shut friendships (SMD: −.01; 95% CI: −.09 to .06) and social credence (SMD: −.03; 95% CI: −.10, .04) at three-month follow-up. There is not enough prove to propose whatever harm from any of the prevention programs included in the review.
4 systematic reviews evaluated the impact of exercise and physical activity on mental wellness outcomes among adolescents and youth. Exercise lone was evaluated in eight studies showing significant touch on self-esteem (SMD: .49; 95% CI: .16–.81). Exercise equally a function of other comprehensive interventions was evaluated in four studies and showed a significant improvement in self-esteem (SMD: .51; 95% CI: .15–.88). However, these conclusions are based on several modest number of trials reporting poolable data with lack of long-term follow-up data [44]. Another review reporting the furnishings of physical action programs (including outdoor run a risk, sport and skill-based and concrete fitness program) included 15 studies. Due to small number of studies and large heterogeneity in terms of study length, sample size, assessment of outcomes, and participants, meta-analysis was non conducted. Some studies suggested positive impacts on social and emotional well-being; all the same, due to mixed findings and the high hazard of bias, the efficacy of physical activity programs could non be ended [45]. Bear witness on the utilize of exercise for depression compared to no treatment suggests significant impact in reducing low from 35 trials (SMD: −.62; 95% CI: −.81 to −.42) while at that place was no touch on dropouts (relative risk [RR]: 1.00; 95% CI: .97–i.04). Exercise when compared to psychological therapy and pharmacological handling constitute no significant difference on depression (SMD −.03; 95% CI: −.32 to .26 and SMD: −.11; 95% CI: −.34 to .12, respectively) [46]. Vigorous practise when compared to no intervention led to reduced depression score (SMD: −.66; 95% CI: −1.25, −.08) with no affect on feet scores (SMD: −.48; 95% CI: −.97, .01) while vigorous exercise when compared to depression intensity exercise and psychosocial interventions showed comparable results. Yet, the small number of studies and the clinical variety of participants, interventions, and methods of measurement limit the ability to draw conclusions [47].
Six systematic reviews reported findings on interventions for anxiety and low among adolescents and youth. A review on the effectiveness of CBT for feet disorders included 41 studies. CBT compared to waitlist was effective in reducing remission (odds ratio [OR]: seven.85; 95% CI: five.31–11.6). There was nonsignificant impact on participants lost to follow-up (OR: .93; 95% CI: .58–ane.51) [48]. A review evaluating the impact of psychological therapies and antidepressant medication, solitary and in combination, for the treatment of depressive disorder for adolescents included 11 studies. Findings suggest that psychological therapy when compared to antidepressants had comparable outcome on remission (OR: .62; 95% CI: .28–1.35), dropouts (OR: .61; 95% CI: .11–3.28), and depression symptoms (SMD: .16; 95% CI: −.69 to 1.01) while psychological therapy significantly reduced suicidal ideation (SMD: −3.12, 95% CI: −five.91 to −.33) when compared to antidepressant. Combination therapy was also found to be comparable to antidepressant medications for remission (OR: one.50; 95% CI: .99–2.27), dropouts (OR: .84; 95% CI: .51–i.39), suicidal ideation (OR: .75; 95% CI: .26–ii.sixteen), depression symptoms (SMD: −.27; 95% CI: −4.95 to four.41), and functioning (SMD: .09; 95% CI: −.11 to .28). Combination therapy was besides found to exist comparable to psychological therapy for remission (OR: 1.61; 95% CI: .38–6.90), dropouts (OR: 1.23; 95% CI: .12–12.71), suicidal ideation (SMD: .sixty; 95% CI: −two.25 to 3.45), and depression symptoms (SMD: −.28; 95% CI: −ane.41 to .84). Psychological therapy when compared to combination therapy was effective in reducing remission (OR: 2.15; 95% CI: one.15–4.02). Combination therapy significantly reduced depression symptoms (SMD: −.52; 95% CI: −.78 to −.26) compared to psychological therapy plus placebo [49]. Another review evaluating the impact of interventions for relapse and recurrence of depressive disorders included ix trials. Findings advise reduction in number of relapsed recurred (OR: .34; 95% CI: .18–.64) with no touch on on suicide-related behaviors (OR: 1.02; 95% CI: .14–7.39) and dropouts (1.02; 95% CI: .38–2.79) [fifty]. However, there is considerable diversity in the design of trials, making it difficult to compare outcomes across studies [50]. Behavioral therapy when compared to all other psychological therapies is reported to exist every bit constructive for depression response (RR: .97; 95% CI: .86–1.09); remission (RR: .91; 95% CI: .8–1.04); response at follow-up (RR: .77; 95% CI: .59–1.01); depression severity (SMD: −.03; 95% CI: −.2–.15); and dropout (RR: one.02; 95% CI: .65–1.61) [51]. Another review evaluating the performance of prove-based youth psychotherapies compared with usual clinical care suggests that psychotherapies outperform usual care (SMD: .31; 95% CI: .16–.44), but the reward is modest and chastened by youth, location, and assessment characteristics [52].
Evidence suggests that abode-based multisystemic therapy resulted in improved externalizing symptoms, and they spent fewer days out-of-school and out-of-dwelling house placement. Intensive home-based crisis intervention using the "Homebuilders" model (components include human relationship building, reframing problems, anger management, advice, setting treatment goals, and CBT) did non bear witness any bear upon when compared to routine inpatient care [53]. Mean solar day therapy programs for adolescents with mental wellness disorders (including feet disorders, social phobia, and behavioral problems) suggest that it may be an effective intervention for adolescents with mental health disorders. A multimodal and multidisciplinary group-based treatment arroyo has shown to be most effective, and participants could benefit from the involvement of at least ane health professional from a psychology or psychiatric groundwork. Farther high-level, loftier-quality research using standardized event measures is required to back up these findings and determine fundamental parameters, such every bit an optimal frequency and duration for day therapy programs [54].
Discussion
We report findings from a full of 38 systematic reviews with an AMSTAR rating ranging between 7 and xi and a median score of 8. Show from schoolhouse-based interventions suggests that targeted grouping-based interventions and CBT were found to be effective in reducing depressive symptoms and anxiety. School-based suicide prevention programs suggest that classroom-based didactic and experiential programs increased short-term knowledge of suicide and knowledge of suicide prevention with no evidence of an effect on suicide-related attitudes or behaviors. Customs-based creative activities had some positive effect on behavioral changes, cocky-confidence, self-esteem, levels of knowledge, and physical action. Evidence from digital platforms supports Internet-based prevention and treatment programs for anxiety and depression; however, more than extensive and rigorous inquiry is warranted to farther establish the conditions. Among individual- and family unit-based interventions, interventions focusing on eating attitudes and behaviors showed no impact on trunk mass index, Eating Mental attitude Test, and bulimia. Exercise was plant to be effective in improving self-esteem and reduced low score with no touch on on feet scores. CBT compared to waitlist was effective in reducing remission. Psychological therapy when compared to antidepressants had comparable effect on remission, dropouts, and depression symptoms. Most of the bear witness is from HICs, limiting the generalizability of the findings for LMICs. Meta-analysis could not be conducted in many of the included reviews due to heterogeneity in their populations, interventions, and outcomes.
One of the limitations of our review was that the scope of our review was limited to interventions targeting adolescents and youth only; nonetheless, mental health interventions take a life course perspective. Mental health disorders are linked in different ways and levels, exerting a dimensional effect between environmental, genetic factors and other biological mechanisms [55], [56], [57]. Evidence from recent literature suggests interventions to back up parenting offer much scope for improving mental wellness among children and adolescents later in life [58], [59], [sixty], [61], [62]. Evidence suggests that early childhood development (ECD) interventions including stimulation in early babyhood, preschool level interventions, and ECD consultations have shown to be effective in improving wellness behaviors, conduct problems, and social skills and are too low-price interventions delivered in abode and at school [63], [64], [65], [66], [67]. Prove likewise suggests that ECD and parenting interventions can exist implemented finer in LMICs' schools and community settings; however, evidence for scaling-upwardly and sustainability of mental health promotion interventions in LMICs needs to be strengthened [68].
There are challenges pertaining to boyish mental health due to the associated stigma. Furthermore, at that place are gaps related to monitoring the health behavior of adolescents, even with multicountry surveys, for case, most of the data are gathered amidst older adolescents. More than widespread developmentally appropriate surveys of younger adolescents may help identify fundamental ages for implementing preventive mental wellness interventions. Well-nigh population-based boyish health surveys are conducted in schools. Nevertheless, even in HICs, in that location are adolescents who are not in school and who may face meaning wellness inequities. Furthermore, at that place is little consensus on which indicators and protective factors are the all-time survey measures. Findings from our review highlight that the existing show on mental health interventions for adolescents comes mainly from HICs. There is lack of standardized interventions and outcomes due to which meta-analysis could non be conducted in most of the included systematic reviews. Long-term follow-up data were non available since about of the studies reported outcomes at short-term follow-up, and hence the extent to which the furnishings of programs were maintained over longer periods of fourth dimension could not be evaluated. There is a dire need for rigorous, loftier-quality bear witness peculiarly from LMICs on effective interventions to prevent and manage mental health disorders among adolescents. Time to come trials should besides focus on standardized interventions and outcomes for synthesizing the exiting torso of knowledge. There is a demand to report differential effects for gender, age groups, socioeconomic condition, and geographic settings since the affect of mental health interventions might vary according to various contextual factors. Availability of such data would help investigate if sure strategies are more beneficial for ane group over the other and developing targeted strategies for various subgroups to optimize effectiveness of interventions.
Acknowledgments
All authors contributed to finalizing the manuscript.
Footnotes
Conflicts of interest: The authors do non accept any financial or nonfinancial competing interests for this review.
Disclaimer: Publication of this article was supported past the Beak and Melinda Gates Foundation. The opinions or views expressed in this supplement are those of the authors and do not necessarily correspond the official position of the funder.
Funding Sources
The preparation and publication of these papers was made possible through an unrestricted grant from the Bill & Melinda Gates Foundation (BMGF). V.P. is supported by a Wellcome Trust Principal Research Fellowship in Clinical Science.
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