Depression and anxiety are the leading contributors to health burden among adolescents worldwide. We are working with the Welcome Trust, UK to advance science so no one is held back by mental health problems. We are one of selected number of teams funded by Welcome to review the evidence on which aspects of interventions really make a difference in preventing and treating youth anxiety and depression. Each commissioned team reviewed the evidence for one active ingredient. The active ingredients are diverse and cover the range of options, from improving gut microbiome function to increasing financial resources via cash transfer, from the use of antidepressants to increased self-compassion.

Role of relaxation technique as an “Active Ingredient” to treat anxiety and depression in adolescents aged 14-24 years 

Our team looked at ‘Relaxation Techniques’ the active ingredient we deemed among the most likely to help. Relaxation techniques such as meditation, yoga and breathing exercises have been used to improve adolescent mental health and wellbeing globally. However, the evidence on effectiveness of relaxation techniques to reduce distress, anxiety and depression in adolescents is unclear.

Our team searched 10 academic data bases to evaluate the scientific literature on the effectiveness of relaxation techniques in treating adolescent distress, anxiety and depression globally. We evaluated 58 experimental studies of relaxation-based interventions conducted with 8009 adolescents with distress, anxiety and depression, aged 14-24 years.

The current evidence from scientific literature indicates that relaxation techniques are highly effective in treating anxiety; moderately effective in reducing distress and have only a weak effect on improving depression in adolescents aged 14-24 years. Moreover, face-to-face delivered relaxation techniques are more effective compared to online delivery of relaxation techniques to reduce anxiety in adolescents. The qualitative accounts of adolescents who received relaxation training for the treatment of anxiety and depression revealed that adolescents found relaxation techniques easy to understand, learn and use. Frequently reported challenges were difficulty in finding time to practice the relaxation techniques and experience of heightened sensory sensitivity, perceptual and physical changes while practicing relaxation techniques.

Based upon the current evidence available in scientific literature we can conclude that relaxation techniques are one of the simplest, effective and low-risk techniques, that can be implemented universally to all adolescents in educational settings to treat distress, anxiety and depression. A key advantage of using relaxation techniques such as yoga, meditation and breathing exercises, is that they are widely acceptable to promote well-being and mental health in adolescents and do not pose the risk of stigmatization as a result of seeking care for mental health problems. Further studies to evaluate the effectiveness of relaxation techniques with at-risk adolescents from low resource settings are warranted.

Consultations with youth with lived experience of depression and anxiety between the ages of 14-24

GIHD is unique to have pioneered the use of community-based approach to mental health research and service development in Pakistan and bring a wealth of experience in engaging end-users to inform the development of innovations. End-user perspectives about the usefulness of an individual intervention component are vital to design multicomponent interventions. Such information could potentially be important in tailoring psychosocial interventions to particular target groups and conditions and ensuring that scarce resource effort is invested on the most cost-effective interventions. As part of Wellcome’s Phase 2 Active Ingredients (AIs) initiative, we consulted 121 young people with lived-experience of mental health difficulties residing in the UK, India, South Africa, Pakistan, Kenya, and Australia to provide insights into existing AIs list; identify what is missing in the current list; highlight promising ingredients and contextual considerations not yet identified.

Role of family support as an “Active Ingredient” to treat anxiety and depression in adolescents aged 14-24 years 

We systematically reviewed and evaluated the scientific literature on the role of family support interventions to reduce the symptoms of anxiety and depression in young people. Additionally, we consulted young people with lived experience of mental health difficulties, and their caregivers, about the role of family support in youth mental health. 

The current evidence indicates that family support interventions are highly effective in treating anxiety and depression in young people. Family based interventions combined with Cognitive Behavioural Therapy (CBT) are highly effective in treating anxiety in young people. Family support interventions, delivered to parent/caregivers without any mental health illnesses, yielded better treatment effects in young people with depressive symptoms, compared to interventions delivered to parents with mental health difficulties. All studies including in the review were from High Income Countries (HICs), highlighting a major research gap on examining the impact of family support on adolescent anxiety and depression in Low- and Middle-Income Countries (LMICs). 

According to young people, family support in the prevention of anxiety and depression means providing a safe environment to the child; showing them affection and having an open, empathetic and non-judgmental communication with them. With respect to the treatment, the expectations of young people from parents are to support them in seeking treatment; provide them emotional support throughout the treatment process and in following the treatment regime. However, sustainable engagement of families in the treatment can be hampered by the lack of mental health awareness among parents and due to mental health stigma. Considerations should be given to mental health stigma, cultural context, and accessibility and affordability of the programmes while developing and implementing family support based mental health interventions, especially in resource-poor settings.