What works for mental health problems in youth? Survey of real‐world experiences of treatments and side effects

Abstract

Aim Despite youth being the most common age group for onset of mental disorders, there is less knowledge on the benefits and harms of treatments in young people. In addition, efficacy data from randomized controlled trials may not generalize to how treatment works outside of research settings. This study aimed to investigate young people's perceived effectiveness of different treatments for mental health problems, the professionals who delivered these, and the experience of negative effects. Methods We developed a consumer report website where young people who were ever diagnosed with a mental disorder provided ratings on the helpfulness or harmfulness of different types of professionals, mental health treatments (medical, psychological complementary/alternative) and self‐help strategies, and whether they had experienced particular negative effects. Results Here, 557 young people aged 12–25 years, who were recruited from English‐speaking, high‐income countries, provided 1258 ratings of treatments. All treatments showed varied perceptions of effectiveness. Medical and psychological treatments were rated moderately helpful on average with low rates of harmfulness. Self‐help strategies were rated as being as helpful as professional treatments. Side effects related to the head or mind (e.g., concentration difficulties, inability to feel emotions, depression and irritability) were the most common across all types of medicines. For psychological treatments, treatment being too expensive and feeling worse at the end of a session were the most commonly reported negative effects. Conclusions Study findings may be a useful guide to clinicians, researchers, young people and their families about what is likely to work in real‐world settings.

Self-management, self-care, and self-help in adolescents with emotional problems: a scoping review

“…The included articles showed wide geographic spread of high-income countries, primarily English-speaking, with participant representation spanning Australia [ 57 ], New Zealand [ 58 ], Canada [ 59 ], the UK [ 48 ], Ireland [ 60 ], the United States of America (US) [ 61 ], South Korea [ 62 ], and the Netherlands [ 63 ]. Articles included participants from both rural and urban areas, and several socially excluded or marginalized groups were featured — e.g., sexual minority youth [ 58 ], Latina adolescents [ 64 ], adolescents with visible physical differences [ 65 ], Mexican–American adolescents [ 66 ], individuals with autism spectrum disorder (ASD) [ 62 ], rural Australian young people [ 67 ], adolescent mothers [ 68 ], and LGBTQ + young people [ 69 ].…”

“…In contrast, self-help was associated with the largest number of strategies or techniques, ranging from personal, individual, or lifestyle-oriented strategies, e.g., “Eat a healthy, balanced diet” [ 60 ], “Work through on one’s own” [ 103 ], to strategies involving peers or family members, e.g., “Spending time with friends and family” [ 66 ], “Ask a trusted friend or relative to help you get out and about or do activities” [ 60 ]. A wealth of digital interventions and strategies were associated with self-help in the included literature.…”

“…There was significant overlap across the strategies and interventions associated with self-care, self-help, and self-management in this review. For example, the following strategies or interventions spanned all three terms: sleep or rest [ 60 , 64 , 77 , 103 ], talking to others such as peers, family, or a professional when needed [ 60 , 61 , 64 , 66 , 99 , 103 , 104 ], activities involving physical movement [ 64 , 66 , 77 ], and digital strategies [ 68 , 69 , 105 ].…”

“…This was highlighted in associated strategies in included articles for self-management, specifically in “Peer relationships or involving others in management” (e.g., friends, parents, or mainstream authorities) [ 61 , 64 , 104 ]. This was also the case for self-help, specifically in “Ask a trusted friend or relative to help you get out and about or do activities” [ 60 ], “Be with friends” [ 103 ], “Let family and friends know how you are feeling so that they are aware of what you are going through” [ 60 ], “Spending time with friends and family” [ 66 ], and “Talk problems or feelings over with someone who is supportive and caring” [ 60 ]. In general, the evidence base appears to be larger for self-help and self-management than it is for self-care as applied to adolescents with emotional problems, which may explain in part why self-help and self-management were predominately associated with clinical treatments or interventions.…”

“…Many of the interventions or strategies identified for self-help, self-management, and self-care in this review (see Table 3 ) overlapped with the “self or community approaches” for children and young people identified by Wolpert et al [ 13 ]. Some examples of overlap or similarity are: “Goal setting” [ 13 ] overlaps with “Reward yourself for reaching a small goal” [ 60 ], “Apps delivering self-help strategies” [ 13 ] overlaps with “Self-help ICBT programs” [ 57 ], “Sleep” [ 13 ] is identical to “Sleep” [ 60 , 103 ], and “Playing a therapeutic online or computer-based game” [ 13 ] overlaps with “Rainbow SPARX” [ 69 ]. Notably, there was overlap across self-management, self-help, and self-care, suggesting that strategies associated with these terms might be more meaningfully grouped under a label such as “self or community approaches”, and do not necessarily need to be separated by concept [ 13 ].…”