Anxiety and depression in young people: finding the next generation of treatments and approaches

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Our mission is to help find the next generation of treatments and approaches to prevent, manage and stop relapse of anxiety and depression in young people worldwide. Here's what we're doing and how.

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Our mission is to help find the next generation of treatments and approaches to prevent, manage and stop relapse of anxiety and depression in young people worldwide.

To do this, we need to better understand what helps different people the most. Specifically: what works, for whom, in what contexts and why?

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We’ve convened researchers across the mental health science community to identify and review the 'active ingredients' of effective interventions for youth anxiety and depression.  

By 'active ingredients' we mean those aspects of an intervention that drive clinical effect, are conceptually well defined, and link to specific hypothesised mechanisms of action. In other words, those aspects most likely to make a difference in preventing, treating or managing mental health difficulties.  

These ingredients will be different for different people and could span biological, cognitive, relational and societal approaches. For example, they could include practicing relaxation techniques, taking antidepressants or having access to more financial resources. 

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1. What the evidence tells us

Anxiety and depression are holding millions of people back in life. However, we still know very little about underlying mechanisms of how current mental health treatments work (Holmes et al., 2018) or why they do not work for everyone (Cuijpers, 2017). And there has been no improvement in outcomes over the past 50 years. 
 
The mental health science community is fragmented, with different disciplines taking different approaches and not enough interdisciplinary learning. Researchers lack a common language for describing problems, interventions and outcomes (Allsopp et al., 2019, Krause et al., 2018). 
 
There is even less learning from other areas of academia, including the humanities, law, economics, mathematics and philosophy, where potentially relevant research is taking place (Siegle et al., 2018)

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2. Our approach 

We’re bringing the mental health science community together to forge a common research agenda around active ingredients. We’re focusing on those most likely to help the most young people in the most contexts, globally. In the process, we’re working to establish a common language – based on a common set of metrics – that all researchers, across disciplines, can use.  

In 2020, we launched our first project to build a foundational set of active ingredients, funding 30 teams from across the world to review the existing evidence.  

We then commissioned two research teams to explore what had been learned and what was missing, with young people with lived experience of anxiety and depression, researchers, clinicians and other stakeholders from across the world. The qualitative insights from that research have helped us to refine our work by bringing to the fore new voices and ideas from across the mental health science community. 

In 2021, we funded another 21 research teams to review an additional set of active ingredients. See all the researchers we've funded so far

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3. Our values

We want to help build a more diverse and inclusive mental health science community, underpinned by a shared focus on finding new solutions. 

Through our work, we aim to:  

  • encourage collaboration – mental health science is inherently interdisciplinary. By bringing researchers from different disciplines to collaborate on the same issue, we hope to break down existing siloes and weave knowledge together. 
  • improve inclusivity and global representation – we’re funding researchers from all over the world and making a concerted effort to involve those in low- and middle-income contexts, to help make mental health science more diverse and inclusive.   
  • involve people with lived experience – mental health research has had little input from people with lived experience of mental health problems. This is why we’re asking all the research teams we fund to seek input from young people with lived experience and include their insights in their work.    
  • be transparent – we’re at the start of a journey and know that we can only make progress by acknowledging existing limitations in the field and working together to resolve them. We are keen to learn in public, alongside and as part of the mental health science community, to stop young people being held back by mental health problems. 
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Researchers we’ve funded

So far, we’ve funded more than 50 research teams to review the evidence for active ingredients, and two teams to explore what others think of our approach.

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Active ingredient Team Key reference
Affective awareness: knowing how one feels  Joanne Beames (Australia), Aliza Werner-Seidler

Sendzik et al., 2017

Behavioural activation: increasing engagement with positive activities Kanika Malik (India), Bruce Chorpita, Vikram Patel Martin & Oliver, 2019
Circadian rhythms: better sleep-wake cycles Ian Hickie (Australia), Joanne Carpenter, Jacob Crouse Carpenter et al., 2021
Decentering: better able to shift perspective Marc Bennett (UK), Tim Dalgleish, Tamsin Ford

Powers & LaBar, 2019

Digital quality social connection Lindsay Dewa (UK), Emma Lawrance, Hutan Ashrafian, Lily Roberts Hare-Duke et al., 2019
Economic transfers: increased financial resources via cash transfers Johannes Haushofer (USA & Kenya), Jimena Romero, Kristina Esopo

Lund et al., 2010

Emotion regulation: improved management of emotions

Alexander Daros (Canada), Lena C. Quilty, Sasha Allen

Sarah Skeen (South Africa), Mark Tomlinson, G.J Melendez-Torres

Moltrecht et al., 2020

Pandey et al., 2018
Engagement with the arts Kamala Easwaran (India), Yog Japee, Tasneem Raja Hacking et al., 2008
Exposure: facing one’s fears in a planned manner Jennie Hudson (Australia), Ron Rapee, Viv Wuthrich, Cathy Creswell Plaisted et al., 2020  
Gut microbiome: improving gut microbiome function Kathrin Cohen Kadosh (UK), Jennifer Lau, Glenn Gibson Liu et al., 2019
Helpful attentional and interpretational thinking patterns Jennifer Lau (UK), Victoria Pile, Colette Hirsch Bagianti et al., 2020
Hopefulness: learning to be more hopeful Clio Berry (UK), Jo Hodgekins, David Fowler Esteves et al., 2013
Loneliness reduction Ellie Pearce (UK), Roz Shafran, Gerhard Andersson Ma et al., 2020
Mental imagery: helpful use of emotional mental imagery Victoria Pile (UK), Jennifer Lau, Emily Holmes

Holmes et al., 2016

Neighbourhood cohesion: increased neighbourhood social connection Josefien Breedvelt (Netherlands), Claudi Bockting, Claire Niedzwiedz Kingsbury et al., 2015

Perfectionism reduction

Tracey Wade (Australia), Sarah Egan, Roz Shafran Egan et al., 2011
Physical activity: more bodily movement Alan Bailey (Australia), Alexandra Parker, Rosemary Purcell Bailey et al., 2018 
Problem solving

Daniel Michelson (UK), Vikram Patel, Bruce Chorpita

Karolin Krause (Canada), Darren Courtney, Peter Szatmari

Robyn Mildon (Australia), Jane Lewis, Bryce D. McLeod, Kristina Metz

Chorpita & Daleiden, 2009

Zhou et al., 2015

Bell & D’Zurilla, 2009

Reduced levels of inflammation in the body Lianne Schmaal (Australia), Yara Toenders Milaneschi et al., 2020
Relaxation techniques: better stress response via relaxation Syed Usman Hamdani (Pakistan), Ahmed Waqas, Atif Rahman Caldwell et al., 2019
Repetitive negative thinking reduction Imogen Bell (Australia), Mario Alvarez-Jimenez, John Gleeson Monteregge et al., 2020
Selective serotonin reuptake inhibitors: use of antidepressants Cath Harmer (UK), Susannah Murphy, Argyris Stringaris, Liliana Capitão Cousins & Goodyer, 2015 
Self-compassion Sarah Egan (Australia), Clare Rees, Amy Finlay-Jones Ferrari et al., 2019
Self-evaluation: improved view of self Faith Orchard (UK), Laura Pass, Brioney Gee, Tim Clarke Orchard et al., 2019
Sense of mattering Dean Ho (Singapore), Matt Oon, Theodore Kee

Flett, 2018

Social relationships: facilitating improvements in social relationships  Paul Badcock (Australia), Kate Filia Duffy et al., 2019
Urban access to green space Issy Bray (UK), Danielle Sinnett, Faith Martin Houlden et al., 2018

 

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Teams reviewing active ingredients (2020)
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Active ingredient Team Key reference
Agency: developing a sense of agency through social action Mariana Steffen (Brazil), Paul Heritage, Jennifer Lau Kirkman et al., 2015
Collaborative goal setting and tracking Jenna Jacob (UK), Inga Spuerck, Milos Stankovic Feltham et al., 2018
Communication in families Pete Lawrence (UK), Marian Bakermans-Kranenburg, Pasco Fearon Lawrence et al., in press

Cultural connection: connection with one’s own culture

Nicole Anne D’souza (Canada), Srividya Iyer, Jaswant Guzder Jongen et al., 2020
Emotional controllability: beliefs about the extent to which emotions are controllable Matt Somerville (UK), Iris Mauss, Amy Harrison Ford & Gross, 2018
Emotional granularity: improved ability to characterise emotional experiences Darren Dunning (UK), Marc Bennett, Tim Dalgleish Barrett, 2006
Family support Zill-e-Huma (Pakistan), Syed Usman Hamdani, Amy Finlay-Jones Pedersen et al., 2019
Grief reduction: use of strategies to target feelings of grief Lauren Breen (Australia), Sarah Egan, Clare Rees Simbi et al., 2020
Hippocampal neurogenesis: growth of new neurons in the hippocampal region of the brain Alessandra Borsini (UK), Maura Boldrini Anacker & Hen, 2017
Mental health literacy

Darya Gaysina (UK), Daniel Michelson, Wezi Mhango

Sandesh Dhakal (Nepal), Felipe Botero Rodriguez (Colombia), Jennifer Lau

Laurenzi et al., 2020

Wei et al., 2013
Omega-3 supplements Natalie Reily (Australia), Samantha Tang, Helen Christensen Zhang et al., 2019
Peer support: support from a peer who has experienced anxiety and/or depression Magenta Simmons (Australia), Ellie Brown, Sarah Bostock King & Simmons, 2018
Remote measurement technologies: use of remote technologies to monitor changes in biology, behaviour, and environment relevant to the problems  Annabel Walsh (UK), Valeria Mondelli, Alastair van Heerden Sequeira et al., 2020
School connectedness: sense of connection to school life  Monika Raniti (Australia), George Patton, Susan Sawyer Marraccini & Brier, 2017
Self-disclosure: sharing information with others about personal experiences and characteristics Pattie Gonsalves (India), Daniel Michelson, Sweta Pal Luo & Hancock, 2020
Sense of purpose  Emily Hielscher (Australia), James Scott, Tara Crandon Schippers & Zeigler, 2019
Social inclusion: improved inclusion for those who are minoritized on the basis of their identity (eg, sexual and gender)

Gemma Lewis (UK), Alexandra Pitman, Talen Wright

Xanthe Hunt (South Africa), Jason Bantjes, Tom Shakespeare
 

Gower et al., 2018

van Bergen et al., 2019
Spiritual and religious beliefs Shilpa Aggarwal (India), George Patton, Nicola Reavley Yonker et al., 2012
Working alliance: a functional and collaborative relationship with a helper  Jermaine Dambi (Zimbabwe), Rhulani Chauke, Malinda Utete, Rhiana Mills Ardito & Rabellino, 2011
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Teams reviewing active ingredients (2021)
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  • Amy Finlay-Jones (Telethon Kids Institute, Australia) and Syed Usman Hamdani (University of Liverpool, UK, and Human Development Research Foundation, Pakistan)
  • Jenna Jacob and Julian Edbrooke-Childs (Child Outcomes Research Consortium, UK)
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Teams exploring qualitative insights (2020)
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Our lived experience advisors 

We’re working closely with our lived experience advisors to make sure that we invest our money and efforts in the types of support that are most important to young people.

The advisors help us decide on who to commission and they support our funded researchers to involve young people with lived experience in their research. They are: 

  • Dhriti Sarkar, India
  • Dion Agnuza, Indonesia
  • Kamini Hari, United Kingdom
  • Margaret Odhiambo, Kenya
  • Natasha Swingler, Australia
  • Tania Pandia, Indonesia
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What we’ve learned so far
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In October 2021 we published a report summarising the findings from the 30 teams we commissioned in 2020 to review the evidence for 27 active ingredients. Later this year, we will be publishing a second report with the findings from the teams commissioned in 2021.

We’ve also teamed up with the Mental Elf to share what we’ve learned so far via blogspodcasts, and videos.

You can also read publications by members of our mental health team and some of our funded teams below.

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Peer-reviewed publications by our funded teams
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Meet the team
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  • Professor Miranda Wolpert, Director of Mental Health, Wellcome
  • Dr Catherine Sebastian, Head of Evidence, Mental Health, Wellcome
  • Dr Inês Pote, Senior Research Manager, Mental Health, Wellcome 
  • Cristina Doherty, Project Officer, Mental Health, Wellcome 
  • Dr Kate Martin, Head of Lived Experience, Mental Health, Wellcome
  • Grace Gatera, Lived Experience Consultant, Mental Health, Wellcome

If you have any questions or comments about this work, email activeingredients@wellcome.org 

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