About one-third (10 of 29) of studies evaluated a universal prevention program, which engaged general populations of young people regardless of lived experience or risk of depression. One-third (10 of 29) studies were of indicated prevention programs, involving young people experiencing distress or depression symptoms. Eight studies were of selective prevention programs, involving groups of young people who are known to be at heightened risk of depression due to social determinants e.g. LGBTIQA+ young people. There were two treatment studies where young people met criteria for a diagnosis of depression.
From these studies, it is not possible to confidently say whether programs with a social support element are more likely or not to be beneficial for addressing youth depression. This is partly because of how studies were designed and conducted. It is also partly because studies showed a mix of positive and non-significant results. This doesn’t mean that interventions with a social support element are not effective, only that they are not more effective than other programs.
The features of programs with a social support component that make them more promising for addressing depression in young people are an important finding from this review. The following sections provide a summary of the evidence for different program types.
Evidence for universal Prevention programs
Studies of universal prevention programs (10 studies, total 6954 participants) were mostly delivered in educational settings including secondary school and university, using a mix of in-person, hybrid, and online formats (4–13). Based on this research, it appears that universal prevention programs with an explicit focus on strengthening relationships and building interpersonal and communication skills may be the most promising. In addition – in line with previous research – the evidence suggests that a whole-school approach to mental health and wellbeing is most useful. For instance, the largest study to find positive results evaluated a school-based intervention (MindOut) focused on social awareness and relationship management as part of a whole-school approach to wellbeing, engaging students, staff, parents and the community (6).
evidence for Selective prevention programs
Studies of selective prevention programs (eight studies, total 1878 participants) focused on specific populations, including LGBTQA+ young people, young parents, and young people with recent non-suicidal self-injury, as well as specific settings, including correctional or reform facilities, foster care, secondary schools with majority marginalised students, and mental health clinics (14–21). Two studies found longer-term benefits (4–6 months later) (14,20), one of which had not found positive results in the shorter-term (20). Based on these studies, there is some evidence to suggest that those tailored to specific populations and delivered by specialist providers may be most promising for improving both depression and social support outcomes. For instance, the largest study to find positive results evaluated a six-month, home-based parenting model for young caregivers, which was delivered by trained child and parenting service providers and designed to improve parenting behaviours and promote family social support using motivational interviewing techniques (SafeCare) (14).
Evidence for indicated prevention programs
Studies of indicated prevention programs (nine studies, total 1068 participants) included young people with symptoms of depression or distress and were delivered in educational and clinical settings, with many using digital platforms (e.g. smartphone app, website, email, text message, videoconferencing) (3,22–29). While more than half found benefits for reducing symptoms of depression, only two studies examined longer-term outcomes and found that positive impacts were not maintained within 6–12 months later (22,25). Delivery format may be a key factor, with interventions that were entirely self-directed showing fewer positive outcomes. Notably, some digital platforms showed potential for worsening depression symptoms and perceived social support, although these were single studies with concerns for how the research was designed and participant dropout rates (3,27). Overall, however, the current research highlights the need for careful consideration when developing and choosing indicated prevention programs with social support elements.
Evidence for treatment programs
Only two studies included young people with symptoms that met criteria for diagnosis of depression (30,31). Both studies evaluated interpersonal psychotherapy (IPT), which focuses on addressing symptoms by improving interpersonal relationships (32). In one study, changes in family social support – but not friend social support – predicted depression at follow-up (31). Based only on these results, it is not possible to confidently say whether interventions with a social support element are beneficial as a treatment for youth depression, due to the limited number of studies. However, there is strong evidence in favour of IPT for the treatment of depression in adolescents and adults from other published reviews, which suggests that this may be an appropriate approach for some young people whose symptoms meet criteria for diagnosis (33,34).