Effective adolescent mental health programs incorporate interpersonal skills, emotional regulation, and drug education

1. Of 25 psychosocial intervention components studied in adolescents, only interpersonal skills, emotional regulation, and alcohol and drug education predicted positive effects across multiple outcomes in mental health, prevention of mental disorders, and reduction of risk behaviors.

2. Mindfulness, problem solving, assertiveness training, and stress management predicted positive effects in a single outcome. The remaining components, including cognitive restructuring, behavioral activation, and social skills, were not found to be predictive in either direction.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Adolescence is a formative time that offers opportunities for promotion of mental health and prevention of mental disorders and risk behaviors throughout life. Previous studies have examined the effectiveness of psychosocial interventions in improving adolescent mental health, but most of these have focused on single-issue interventions and outcomes. In this systematic review and meta-analysis, researchers identified 158 randomized controlled trials studying the effects of psychosocial interventions with adolescents on mental health, prevention of mental disorders, and reduction of risk behaviors. Of the 25 intervention components included across the studies, interpersonal skills, emotional regulation, and alcohol and drug education predicted positive effects across multiple outcomes. Mindfulness, problem solving, assertiveness training, and stress management predicted positive effects in a single outcome. The remaining components, including cognitive restructuring, behavioral activation, and social skills, were not found to be predictive in either direction.

The researchers note that most of the included studies were completed in high-income countries, which may limit generalizability, and that only 2 trials reported on suicide and self-harm outcomes. Furthermore, researchers were not able to quantify the weight of each component present. Nonetheless, the study is strengthened by its analysis of a large number of randomized controlled trials across multiple outcomes. For physicians, these findings highlight program components that may serve the basis for developing future psychosocial intervention programs for adolescent mental health.

Click to read the study, published today in Pediatrics

Click to read an accompanying editorial in Pediatrics 

Relevant reading: Our future: a Lancet commission on adolescent health and wellbeing

In-Depth [meta-analysis]: Researchers used publication databases to identify 14 600 records published between 2000 and 2018 and included 158 randomized controlled trials of psychosocial interventions with adolescent participants between the ages of 10 to 19. The included studies were aimed at the whole adolescent population and had primary and secondary aims of promoting mental health or preventing mental disorders, reducing risk behaviors, or reducing self-harm and suicide. Effect estimates across 25 intervention components were converted to standardized mean differences.

Of the 25 intervention components, 7 were associated with more successful psychosocial intervention programs: interpersonal skills, emotional regulation, alcohol and drug education, mindfulness, problem solving, assertiveness training, and stress management. The presence of interpersonal skills in a program was consistently associated with larger positive effect sizes for mental health, depression and anxiety prevention, and prevention of substance use. Inclusion of emotional regulation and alcohol and drug education in an intervention were also associated with significant effects over multiple outcomes. The remaining 4 components were associated with positive effects in 1 outcome category only.

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