The bi-directional influence of social functioning and mental health symptoms during psychological treatment: A cross-lagged analysis in young adults

Young adults (17–25 years old) are at greater risk of experiencing depression or anxiety, and have worse psychological therapy outcomes compared to working-age and older adults. Social functioning and related constructs are valued as outcomes of treatment, and may be particularly important to young adults, who report loneliness and a lack of social support. The relationship between social functioning and mental health during treatment in this group therefore requires further exploration. Four random intercept cross-lagged panel models were fitted to model the session-by-session change in measures of social functioning and mental health symptoms over the course of treatment among patients of NHS talking therapies for anxiety and depression services. A total of 19,600 young adults who had received at least three sessions of psychological therapy were included. There was evidence of a significant bi-directional relationship between social functioning and mental health symptoms between the third and sixth session of treatment, although associations between earlier sessions were less stable. As both mental health symptoms and social functioning were predictive of later symptom severity, further research into how support to improve social functioning could improve treatment outcomes could improve experiences of, and outcomes of treatment. Such support may also account for contextual factors relating to employment or education in this population, as some differences according to employment status emerged.