How building resiliency in young adults could help address a mental health crisis

When it comes to treating diseases of the body, such as diabetes, heart disease, and cancer, early diagnosis and treatment play a key role in keeping patients healthy and improving their quality of life.

The same principle applies to diseases of the mind, such as depression, anxiety and psychosis, where early intervention and treatment can also be beneficial.

Mental illness continues to be a major public health issue in the United States, particularly among youth and young adults.

According to the National Institute of Mental Health, nearly one in ten youth in the U.S., aged six to 17 years, have experienced a major depressive episode in the past year. Suicide is the second leading cause of death among individuals aged 10 to 34.

This week, we interviewed Dr. Daphne Holt, the director of the Resilience and Prevention Program and the Emotion and Social Neuroscience Laboratory at Massachusetts General Hospital, an MGH Research Scholar from 2018 to 2023, and an associate professor of Psychiatry at Harvard Medical School. Holt and her team are working on ways to identify the early signs of psychiatric disorders in youth and provide them with tools to manage their mental health.

"I came to a realization about a decade ago that little progress had been made in developing preventive approaches in psychiatry, unlike most other areas of medicine, such as infectious disease, oncology and cardiology," Holt states.

One of the challenges in early identification of symptoms of depression and anxiety is the lack of measurable biological indicators for these diseases, such as those that can be identified through a blood test or an MRI.

In modern medicine, diagnoses for psychiatric disorders are based on self-reported symptoms, explains Holt. Clinicians ask questions such as "Do you have little interest or pleasure in doing things?" or "Are you feeling down, depressed, or hopeless?"

"One could argue that we need these types of biomarkers in psychiatry more than in other fields of medicine since 'self-report' of subjective symptoms is a particularly unreliable source of information at times, especially in people who have illnesses that may affect their judgment and their ability to perceive themselves accurately," Holt says.

This self-report method may also overlook individuals who do not meet the criteria for a diagnosable illness but still suffer from a variety of symptoms and may be at risk of developing more severe mental illness later on. Many youth fall into this category because although symptoms of mental disorders can start during childhood, the peak time of onset for many mental illnesses is during late adolescence and early adulthood.

To address this challenge, Holt founded and currently leads the MGH Resilience and Prevention Program, which focuses on identifying youths with early signs of mental illness and teaching them resilience training to improve their mental health.

Training individuals in techniques that foster resilience when they may be at-risk for developing a mental illness equips them with the skills needed to better "bounce back" in the face of adversity. So far, this program has been tested and shown success in reducing or eliminating the early signs of mental illness in college students, adolescents, and healthcare workers.

"We conducted a randomized control trial that showed our program for at-risk young adults works. It significantly decreased early symptoms of mental illness long-term more so than a control condition. Since then, we have started training clinicians in this approach to hopefully implement it on a broader scale."

Could this program be the next step in promoting youth mental health?