Results from a meta-analysis published in Pediatrics demonstrated the efficacy of universally delivered interventions in improving adolescent mental health and reducing risk behavior. In addition, the following 3 treatment components emerged as consistently effective across outcomes: interpersonal skills, emotion regulation, and alcohol and drug education. The results informed the development of “Helping Adolescents Thrive,” a World Health Organization and United Nations Children’s Fund initiative aimed at developing a package of evidence-based psychological interventions for improved adolescent mental health.
Investigators conducted a systematic review of PubMed, Medline, PsycINFO, Scopus, Embase, and Applied Social Sciences Index Abstracts for studies assessing the effectiveness of certain psychosocial interventions for adolescents aged 10 to 19 years. Eligible studies were randomized controlled, cluster randomized controlled, factorial, and crossover trials published between 2000 and 2018. Extracted outcome measures included positive mental health, depressive and anxious symptomatology, violence perpetration and bullying, and substance use. Data analysis was conducted by 3 independent researchers who captured relevant study outcomes. Interventions were separated by modality for analysis, with face-to-face and digital interventions directly compared across outcome measures.
Among 14,600 identified records, 158 studies were included in the meta-analysis. The average intervention duration was 13.88 hours for face-to-face interventions and 6.05 hours for digital interventions. The mean number of components (defined as content-related features of programs) was 5.4 for face-to-face interventions and 5.9 for digital interventions.
The following 7 intervention components were associated with more successful programs: interpersonal skills, emotional regulation, alcohol and drug education, mindfulness, problem solving, assertiveness training, and stress management. Among these, interpersonal skills, emotional regulation, and alcohol and drug education predicted the largest effect sizes for positive improvements. Interpersonal skills intervention yielded improved effects for positive mental health, depression and anxiety prevention, and prevention of substance use. Emotional regulation was associated with improvements in positive mental health and depressive and anxious symptomatology. When administered face to face, alcohol and drug education predicted positive mental health; when administered through digital means, it yielded improvements in aggression.
Further work is necessary to develop interventions for adolescents in low- and middle-income countries, as the present study used only data from high-income settings.
Skeen S, Laurenzi CA, Gordon SL, et al. Adolescent mental health program components and behavior risk reduction: a meta-analysis [published online July 1, 2019]. Pediatrics. doi:10.1542/peds.2018-3488