Our Researcher of the Month, Tanya Manchanda, is a PhD student whose research focuses on understanding the impact of friendships on young people’s mental health outcomes. Friendships are vital throughout our lives, but particularly in the teen years. Studies have shown that if they are in crisis or feel depressed, teens are more likely to turn to their friends than trained professionals or other adults and that they tend to have a higher sense of comfort and trust around their close peers than with other people they know. Close adolescent friendships predict higher interpersonal happiness and are actually a protective factor for good mental health into adulthood. Strong friendships also appear to reduce the negative effects of peer victimisation.

In a newly published paper, Tanya and her co-authors review and synthesise existing literature on mental health interventions that involve teens’ authentic friends or social group, exploring their efficacy and the different roles they might play in supporting mental health outcomes. Given the indisputable support that friends provide to each other during adolescent development, Tanya found surprisingly few interventions that actively involve friends. Despite a comprehensive worldwide search, only 24 studies are included in her scoping review and only 18 in her systematic review. Whilst one of these interventions was Japanese, all others were developed and implemented in either Australia, the UK or the US. Within these interventions, three prominent themes emerged; mental health literacy, help-seeking and friendship-building.

This important new paper shows that, despite being a key source of informal support for teens, especially in times of crisis, currently, friends are rarely involved in mental health interventions. The few interventions that do exist show that well-considered friendship interventions have the potential to improve and protect adolescent mental health and can be implemented in a natural setting, using teens’ pre-existing social circle as a source of informal support.

Summary

Tanya’s review shows that a broad range of different interventions have been tried, from those seeking to improve general mental health literacy, to male-only interventions targeting the reduction of self-harm, and school-based interventions designed to prompt girls to seek help for friends with disordered eating habits. Some of the interventions, such as Mental Health First Aid and “Making the Link”, have been well studied with consistent positive findings. The majority of others are novel in their implementation as adolescent friendship interventions.

Most existing interventions which harness teens’ authentic social groups are not designed primarily to develop friendships. Instead, in the main, they aim to improve mental health literacy, to better equip adolescents to support themselves and their friends. The results are promising. Many of the studies reported changes or increases in help-seeking attitudes towards friends, along with greater confidence in supporting a friend in emotional distress or experiencing a mental health illness. A common outcome was that teens would encourage friends to seek mental health support from an adult or a professional, such as a psychologist or counsellor. The studies mainly focused on the friends being trained and their outcomes, rather than outcomes for the recipients of their support.

One particularly interesting intervention (Kognito Face2Face) incorporated the use of simulations and virtual peers. These were used to train adolescents in supporting friends with a mental illness or in times of emotional distress, with the aim of suicide prevention. Participating teens were placed in a simulated college environment and asked to interact with virtual peers who might be at risk and make decisions on whether or not they required a professional referral. It was successful in eliciting supportive responses from participants.

A few studies included in the review did aim primarily to combat social isolation and build friendships. These were most frequently implemented in a university context. In one example, an incoming cohort of undergraduate engineering students was allocated to a social support group during a university induction, where they completed activities designed to strengthen friendship ties. The results showed that, although these students made friendships through which they sought emotional support in the short-term, these had diminished by the one-year follow-up. The authors of the paper hypothesised that, whilst students now had different friends, the intervention provided them with a temporary social network which eased their transition to university. Another study (Groups for Health) in Australia targeted undergraduate students who had screened positive for psychological distress and social isolation. This intervention tried to increase social connectedness and group identity formation in an effort to help participants build friendships to combat feelings of isolation and distress. It was found to improve mental health, wellbeing and social connectedness, both immediately after the intervention and at a six monthly follow-up.

Long-term effects of the interventions on mental health and wellbeing were not assessed in the studies reviewed. However, all of the included studies reported some positive effects, especially immediately after the intervention.

Implications

Implications for schools

It’s important to note that mental health interventions involving teens’ authentic friendship groups are few and far between, little is currently known about this important potential area and, because many of the interventions are ‘one offs’, it is hard to fully evaluate their success. However, Tanya’s review and analysis of existing studies is a must read for any school looking to develop or implement friendship interventions.

Those that yielded positive results tended to have an aspect of interactivity. Role-playing, showing vignettes or providing teens with hypothetical examples of different scenarios seem to be effective methods when training teens in mental health literacy. School staff should carefully consider what kind of intervention might best fit their setting, who will deliver any intervention and whether they have had appropriate training, whether or not interventions are evidence-based and what they are trying to achieve.

In general, remember that friendships are vital for healthy adolescent development. Teachers can look out for students who are isolated and nudge them to connect with others (perhaps by partnering them up with others in the classroom environment). Helping teens to foster close social bonds is important.

Implications for parents

Model an appreciation of friendships in family life. Ask teens about their friendships, find out what is going well and show interest if something isn’t! Get to know about their social circle. Nudge them to evaluate who they could turn to if they needed support. Remind teens of the agency they have in supporting their friends and just how important this role can be.