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New review published: We need to talk about self-care in youth mental health

There is a glaring lack of inclusion of young people’s experiences in mental health research according to a new paper published by EBPU today.

The review in The Lancet Psychiatry by our close partners at the Evidence Based Practice Unit (EBPU), found that only 7 self-care approaches have been evaluated for children and young people with depression and anxiety since the turn of the century. Of these, only 3 had enough information to even draw tentative conclusions.

Of the 5000 studies published since January 2000 that consider self-care approaches that do not involve a mental health professional, over 100 different approaches were identified. These were as varied as social interaction, use of humour, contact with pets, spending time in nature and listening to music.

Of these, only 7 self-help approaches had been evaluated: training (online and using books) based on cognitive-behavioural principles, physical activity, light therapy, food supplements, massage, online peer support and contact with a dog. 

The evaluated studies showed:

1. consistent evidence of light therapy helping with seasonal depression (but not general depression)
2. mixed evidence of online CBT helping with depression and anxiety
3. mixed evidence of physical exercise helping with depression (most studies found these helped but some found they didn’t help)
4. most of the studies were of low certainty and there was not enough evidence to draw even tentative conclusions in relation food supplements, contact with pets, massage or online peer support.

Only approaches that explicitly did not involve a professional were searched for. Lead author and EBPU & CORC Director, Professor Miranda Wolpert, said:

"Our research found out of 5000 articles, only 38 studies evaluated self-care approaches unsupported by a mental health professional for children and young people with anxiety or depression. Our research highlights the lack of reliable evidence on what works for whom beyond the clinic and into the community. We are aware of and support the growing trend to consider a wider range of ways of helping the large numbers of young people who experience anxiety and/or depression. But research to date has focused primarily on two options: therapy or meds. There is an urgent need to research a far wider range of self and community approaches. For too long, the research agenda has been based on help led by a professional. It is crucial that this expanded research agenda draws on the views and priorities of young people themselves. Young people’s natural strategies deserve the same rigorous attention as therapy and professionally developed support. Of course, specialist mental health support is vital and can be life-saving, and deserves more funding. But our research highlights the need to expand our vision beyond the clinic to the community. Professionals’ contribution to supporting young people’s mental health can only benefit from a body of research that listens to young people, takes their views seriously and analyses it rigorously.”

The Anna Freud National Centre for Children and Families are building on this research by leading a survey of young people to help understand more about what they find works for them in relation to anxiety and depression. Co-produced with young people, they have also created webpages containing information on 85 self-care strategies drawn from the 100+ strategies identified by the review. Anxiety and depression are the most frequently reported difficulties among young people seeking help from specialist services (WHO, 2017). To date, focus has been on researching what treatments most help people in specialist mental health services.

There is increasing interest in the possibility of self-care but we lack evidence to guide this.

Key contextual information:

• 4 in 5 people experience a mental health problem before they are 40 (Schaefer et al., 2017). 
• 1 in 8 children and young people have a mental health issue (NHS Digital, 2018). 
• 1 in 4 children and young people with a mental health difficulty ever get to see a specialist (NHS Digital, 2018). 
• 1 in 2 of those who do see a specialist still have ongoing problems even having seen services implementing best practice (Edbrooke-Childs et al., 2018).
• 1 in 4 GPs have introduced social prescribing. They urgently need evidence-based information to help them decide what to suggest for young people’s mental health (Cook, 2018).

Key links:

• Full paper: Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness
• Anna Freud National Centre for Children and Families self-care survey
• Anna Freud National Centre for Children and Families self-care information pages

References:

1. Cook, J. (2018, July 17). One in four GPs regularly use social prescribing, survey shows. GPOnline. Retrieved from https://www.gponline.com/one-four-gps-regularly-use-social-prescribing-survey-shows/article/1487838.
2. Edbrooke-Childs, J., Wolpert, M., Zamperoni, V., Napoleone, E., Bear,  H. (2018). Evaluation of reliable improvement rates in depression and anxiety at the end of treatment in adolescents. BJPsych Open, 4, 250-255.
3. NHS Digital (1990). Mental Health of Children and Young People in England, 2017. London: NHS Digital.
4. Schaefer, J.D., Caspi, A., Belsky, D.W., Harrington, H., Houts, R., Horwood L.J.,…Moffit, T.E. (2017). Enduring mental health: Prevalence and prediction. Journal of Abnormal Pyschology, 126(2): 212-224.
5. WHO. Depression and other common mental disorders: global health estimates. Geneva: World Health Organization; 2017.