Approaches to early intervention for common mental health problems in young people: a systematic review

Effective early support for children and young people is a high priority. Early intervention approaches for young people with psychosis or eating disorders have substantial supporting evidence, but well-established approaches to delivering a prompt, effective response to young people presenting with early symptoms of anxiety and depression are lacking.

We conducted a systematic review of outcomes of early interventions or approaches for young people (between 11 and 25 years) with initial symptoms of depression, anxiety and other common mental health difficulties. Five bibliographic (MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science Core Collection) and two grey literature (HMIC and PsycExtra) databases were searched for papers relating to youth, early intervention and common mental health problems. We conducted a narrative synthesis of models and assessed quality using CASP checklists.

We included 38 studies (43 publications): of these, seven studies (in eight publications) were randomised controlled trials. RCTs were high quality but other studies tended to lack control groups and be of lower quality. Approaches broadly aimed to provide a more comprehensive and effective early response to symptom onset, with primary goals falling into one of (1) making care more comprehensive and joined up, (2) increasing speed or ease of access to support or (3) providing targeted support for specific needs in addition to anxiety and depression. Some evidence indicates that these approaches may facilitate access and reduce waiting times in the short-term, whilst decreasing burden on other mental health or emergency services. Significant improvements in mental health and wellbeing compared to controls were also reported across most studies with comparator groups, alongside high acceptability of the support offered.

Overall, models of early intervention for depression and anxiety show promise in improving access, experience and outcomes of care for young people. However, high heterogeneity of interventions and outcomes measured limits certainty. More robust controlled studies are needed, alongside comprehensive details of support received by young people through the intervention, and evidence of what works for whom in which settings.