NHS talking therapies may be less effective in 16-24-year-olds

Talking therapies offered on the NHS for depression and anxiety appear to be less effective for teenagers and young adults, a study has found.

Analysis of data from almost 310,000 patients aged 16-24 years who had an episode of treatment by the NHS Talking Therapies service found they were less likely to have improved or recovered compared with those aged 25 to 65.

The findings published in The Lancet Psychiatry suggest more work is needed to tailor mental health services to young people to ensure they are as effective as they can be, the team from University College London said.

This is particularly the case because rates of depression and anxiety in young people are rising, they added.

Yet there are also concerns about the risk-to-benefit ratio of antidepressant medication for this age group.

Data from 2015 to 2019 of 1.5 million people who used the service – which can include cognitive behavioural therapy (CBT), guided self-help, counselling or interpersonal therapy – found significant differences in effectiveness with age.

People aged 16-24 years were around 25% less likely to meet the threshold for reliable recovery after having talking therapy, and 17% less likely to meet criteria for reliable improvement than those aged 25-65, they reported.

Extrapolating their findings, the researchers said if talking therapies were as effective for young adults as those over 25, over 20,000 more younger adults would have reliably recovered from their psychological disorder in England across the period they looked at.

This equates to approximately 5,000 young people each year, they said.

The pattern was the same when the intensity of treatment and engagement with services was taken into account.

However, those under 25 years of age were reported to cancel sessions and drop out of treatment more often.

Study lead Dr Rob Saunders, associate professor of mental health data science at UCL, said: ‘Talking therapy is an effective treatment for depression and anxiety disorders, and particularly tends to be preferred to pharmacological treatment by younger adults.

‘Our analysis shows that talking therapies offered by the NHS are effective for younger adults, but as they are more effective for working-age adults, we believe there is work to be done to improve services for young adults.

He added: ‘Rates of depression and anxiety in young adults are rising, so there is an urgent need to ensure we are offering them the best possible mental health care.’

Senior author Professor Argyris Stringaris, a clinician and neuroscientist at UCL, said: ‘Young people may find it harder to navigate services which have been set up for adults, and are more likely to miss sessions or stop attending altogether.

‘Additionally, the late teens and early 20s are a point of transition for many people, which can involve plenty of stressful life events and changes that may make it more difficult to consistently attend.

‘Working together with young people should help optimise the content of treatment and the ways in which it is delivered.’

But young people may suffer from depression and anxiety problems that may differ somehow in their causes from those affecting adults; early onset depression could have different causes and may require different approaches to treatment, he continued.

‘This is an area that requires a lot of new basic and clinical research.’

The NHS Talking Therapies report for 2023/24 said the service in England handled 1.83 million referrals – an increase of 4% on the previous year. Of those 1.26 million accessed Talking Therapy services.