Cost-effective approaches to protecting adolescent mental health
Among the interventions included in our analysis, the most cost-effective were those to treat mild depression through group-based cognitive behavioral therapy (CBT) or internet-based CBT. The strong return on investment results for these interventions results from their efficient use of provider time to help multiple adolescents at once as well as the strong link between treating depression and thereby preventing suicide.
School-based programs to prevent anxiety, depression, and suicide also provided high ROIs, indicating that the interventions are cost-effective. These ‘universal’ programs include all young people within an age cohort in a school, regardless of their mental health, and emphasize preventing problems before they arise or become severe. These positive results highlight the potentially important role for schools for improving adolescent mental health. We explored this topic in more detail in the UNICEF State of the World’s Children 2021 report.
Several interventions returned an ROI less than 1, including treatment of bipolar disorder. This result indicates that the costs to implement exceed its population-level benefits. Rather than suggesting that these conditions should not be treated, these results can guide us to explore how to deliver these important interventions in a more cost-effective manner.
Gaps in evidence for adolescent mental health
A key learning from this investment case study was about the limitations of the current evidence base. Almost all the evidence on intervention design and effectiveness comes from high-income countries (HIC). While we were able to adapt estimates around the cost of delivering interventions in each country, we did not make changes to the estimated effect size or program design in different countries. Nonetheless the dearth of low- and middle-income country (LMIC) studies limits the degree to which interventions can be tailored for implementation in low- and middle-income countries. In addition, there may be important differences in the needs and responses of young people within the adolescent population that should be accounted for in the design of programs. Implementation research is needed to identify how to tailor interventions to meet the needs for example of the most vulnerable adolescents, such as those experiencing violence or lacking housing.
We recommend that governments and global health funders increase their investment in adolescent mental health. To support scaling up these investments, further research is needed to better understand:
- the effects of mental health interventions on long-term outcomes
- how to tailor and scale up mental health interventions in LMICs
- how to reach the most vulnerable young people with mental health interventions
Country-level investment cases for adolescent mental health
We are continuing work in this area by developing national-level adolescent mental health investment cases in five countries (Egypt, England, India, Indonesia, and Mexico). These analyses will adapt our global model to produce country-specific results. Further, we know that economic evidence is only one element of what countries need to inform prioritization and implementation of interventions. For this reason, we are also conducting research to understand the readiness and feasibility of implementing different interventions in each nation, which will add further contextual information to help interpret the results of the investment cases.
Funding for this work was provided by AstraZeneca’s Young Health Programme.
Visit RTI’s Center for Noncommunicable Diseases for more information about our work.
School-Based Interventions for Adolescent Mental Health | RTI
Adolescent Mental Health in Low- and Middle-Income Countries | RTI