Looking through a wider lens: review of self or community approaches for addressing anxiety and depression in children and young people
Lauren Garland shares her thoughts on the new review we published on self-care for young people.
Growing up, we always had pets in the house. Cats, hamsters, fish – a menagerie of small animals. As a teenager I struggled with my mental health at times, and when feeling anxious and stressed, taking a moment to curl up with the cat in the quiet of my bedroom really helped me to calm down. If I felt particularly low, talking to my mum helped me to get things off my chest. Even just sitting together on the sofa and watching Neighbours reminded me that I wasn’t alone.
Most of us have things we do to help ourselves manage when we are struggling. That’s not to negate the importance of specialist services. For some they can be a lifeline; investment in and research into professionally mediated help remains vital. But young people have told us that professional help is often just one part of managing and addressing symptoms – if we zoom in too closely, we may miss out on a bigger picture of support.
Over the last year, the Anna Freud National Centre for Children and Families has opened up a conversation about self-care with young people around the country through focus groups and an online survey (which is open until January). The conversation is ongoing, but so far young people have told us that they use a wide variety of approaches to manage their mental health – among which listening to music, watching films and TV, and personal hygiene are popular choices. We are calling these ‘self or community approaches’ to managing and addressing mental health.
Alongside this, we wanted to find out more about the research that has been done in this area – what it can tell us about the range of non-professionally mediated interventions for those with anxiety, depression, or both, and whether there is any evidence that these approaches are effective. With these questions in mind, we conducted a review of the existing literature which has been published in The Lancet Psychiatry.
So what did we find? The scoping review identified 132 self or community approaches, and we were struck by the diversity of this list. Some of the approaches we expected to see – talking to someone you trust, for instance, physical exercise, or using a mindfulness app. Others, such as visiting a fortune teller, we found more surprising. Some, like self-harm and using drugs and alcohol, we might consider coping strategies rather than self-care approaches.
Our systematic review of effectiveness from the literature identified in the scoping review found only 38 studies on seven types of intervention that met our inclusion criteria. 16 studies were based on cognitive or behavioural principles, ten focused on physical exercise, five on light therapy, three on dietary supplements, two on massage therapy, one on online peer support, and one on dogs.
Next to the vast range of approaches identified, the evidence of effectiveness is limited. Evidence suggested that light therapy could be effective for seasonal depression, and that digital interventions based on attention bias modification are ineffective for anxiety. Mixed evidence was available on the effectiveness of computerised CBT and physical exercise for depression. All other studies were inconclusive when it comes to effectiveness.
Reflecting on the review Pavan Gill, a Young Champion at the Anna Freud National Centre, said:
“There are many different ways to cope with stress and anxiety such as mindfulness colouring, playing a musical instrument, even singing in the shower. Personally I was very surprised when I found out how few effectiveness studies had been conducted.”
More robust evaluation is needed to understand the potential for self and community approaches to help young people experiencing anxiety and depression. We do not suggest shifting the research focus away from professionally-mediated support, but based on this literature review and our ongoing dialogue with young people, we believe there would be value in looking at mental health support for children and young people through a wider lens.