Dr Clio Berry, Lecturer in Healthcare Evaluation and Improvement in Primary Care and Public Health at BSMS, led a team of researchers from the University of Sussex and the University of East Anglia to investigate evidence on the role of hopefulness in mental health treatment for young people with depression.
This project was an 'insight analysis' funded by Wellcome Trust as part of a new initiative to collate knowledge on the core components of interventions which improve the lives of young people with mental health problems.
The review involved bringing together published scientific evidence and grey literature to better understand how hopefulness can be enhanced in specific psychotherapies and more generally within standard mental healthcare. The project also involved bringing together a panel of young people with lived experience of depression to explore their perspectives on hopefulness and how it can be enhanced. The key conclusions are that hopefulness does appear to be of key importance to young people with depression – both as a 'primer' in encouraging help-seeking and treatment engagement and as an outcome of interventions. There’s a little evidence that hopefulness may be a mechanism by which depression and other outcomes themselves improve, but there is definitely a need for further research.
This project explored whether hopefulness is a particularly important and helpful part (or “active ingredient”) of interventions or services for young people with depression. Depression describes an experience of low mood, changes to sleep or appetite, and feelings of worthlessness.
Dr Clio Berry says: "We thought that hopefulness might be particularly important because people with depression often feel hopeless. Hopefulness can help to provide people with motivation and resilience. We thought that hopefulness could be increased through specific talking therapies like Cognitive Behavioural Therapy (CBT) for depression. We also thought mental health workers could more generally help increase hopefulness through how they talk and interact with young people."
The researchers searched for all of the scientific literature focusing on hopefulness in interventions for young people with major or complex depression. Complex depression means depression alongside other mental health problems like anxiety or psychosis. They searched more than 8,000 research studies and found 31 that they thought were relevant.
Dr Berry adds: "We found that the evidence was quite poor quality overall, for example involving only small numbers of participants. However, the studies suggested that some specific interventions might help to increase hopefulness and reduce depression. These interventions included CBT and activity-based interventions, like wilderness skills therapy or yoga and meditation. We also looked at evidence on hopefulness in mental health care more generally. The studies suggested that engaging with mental health services could increase young people’s hopefulness when they had a positive relationship with a caring, hopeful, authentic, and competent worker. Being in a therapy group with other young people could help to increase hopefulness through a sense of shared goals and experiences."
The research team also collaborated with a group of young people who had lived experience of low mood or depression. They said hopefulness is unique to each individual but can be shared and will “ripple out” across people and that mental health workers need to sensitively and gently encourage hopeful thinking. At the same time, they said that mental health services do not focus enough on hopefulness. The group said they can positively influence their own hopefulness through (1) spending time with people and pets and in nature, (2) letting other people support them, (3) enjoying small everyday things, and (4) celebrating successes. The group’s top priority for future research was to study how marginalisation (for example, sexual or ethnic minority status) interacts with how young people experience hopefulness.
Our final conclusions from the scientific evidence and work with the lived experience group are:
- Certain talking-therapies (eg CBT) and activity therapies may increase hopefulness for young people with depression
- Engagement with mental health care more generally can increase hopefulness, particularly through positive relationships with workers and offering opportunities for group therapy/activities with other young people. Mental health workers should not be too explicit or directive about encouraging hopefulness. Instead, workers should try to connect with young people’s unique ways of feeling more hopeful.
To find out more about this study, you can download an infographic below.
Download the infographic here >