In this ‘Insights from the OxWell Student Survey‘ episode, Tanya Manchanda comments on the friendship findings from the OxWell survey, including an insight into the impact of friendships on mental health outcomes and friendship interventions for young people.
The ‘Insights from the OxWell Student Survey‘ series is a new mini-in conversation series that will explore the OxWell study and the impact of its findings for parents, teachers, policymakers and mental health professionals.
Discussion points include:
- What are friendships interventions and how effective are they?
- Definition of authentic social groups.
- The suitability of friendship interventions for different types of mental health issues.
- How to measure the quality of friendships.
- Differences in gender and age groups in help-seeking behaviours.
- Future plans for researching friendships and friendships interventions in the next OxWell wave.
OxWell is a large-scale student survey designed to measure the wellbeing of children and young people. It looks at mental wellbeing, anxiety, indicators of vulnerability such as bullying and loneliness, school experience, access to services, safety online and many more areas. It is a joint effort between schools, young people, the NHS, local authorities and the OxWell research team at the University of Oxford’s Department of Psychiatry.
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Tanya Manchanda is a PhD student in the Department of Psychiatry at the University of Oxford. Her research is centered around adolescent development and mental health, with a particular focus on understanding the impact of friendships on young people’s mental health and well-being. Tanya is currently working on investigating school-based intervention programs that aim to improve mental health outcomes for adolescents with the involvement of their authentic social group.
- Episode 1 – ‘Networks of Care: Insights from the OxWell Student Survey’, with Professor Mina Fazel, Dr. Emma Soneson, and Dr. Simon White
- Episode 3 – ‘Online Behaviours and the Impact on Mental Health: Insights from the OxWell Student Survey’, with Dr. Simona Skripkauskaite and Dr. Holly Bear
[00:00:01.449] Clara Faria: Hello, welcome to the Insights from the OxWell Student Survey series for the Association for Child and Adolescent Mental Health, or ACAMH for short. This is a new mini In Conversation series that will explore the OxWell Study and the impact of its findings for parents, Teachers, policymakers and mental health professionals. I’m Clara Faria, an ACAMH Young Person Ambassador and today, I have the pleasure of interviewing Tanya Manchanda, a PhD candidate from the University of Oxford.
OxWell is a largescale student survey designed to measure the wellbeing of children and young people. It looks at mental wellbeing, anxiety, indicators of vulnerability, such as bullying and loneliness, school experience, access to services, safety online and many more areas. It is a joint effort between schools, young people, the NHS, local authorities and the OxWell Research Team at the University of Oxford’s Department of Psychiatry.
In this episode, we will focus on the friendship findings from the OxWell Survey, including an insight into the impact of friendships on mental health outcomes and friendship interventions for young people. If you are a fan of our In Conversation series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or a review, and share with your friends and colleagues.
Welcome, Tanya, it’s really lovely to have you here. Can you start with an introduction, giving a, sort of, review of what you do, please?
[00:01:36.890] Tanya Manchanda: Hi, Clara. Thank you so much for having me here on your show today. So, like you introduced me, my name is Tanya Manchanda. I am a PhD student at the University of Oxford. I’m going into my third year, and I’ve been researching adolescent friendships and how they relate to adolescent mental health outcomes.
So, basically, I have been working with the OxWell Survey for two years, as well, and in the OxWell Survey, I am also looking at friendships, friendship quality, adolescent mental health and adolescent wellbeing.
[00:02:06.790] Clara Faria: I know that your research focuses on friendships and – as you said, and their impact on mental health outcomes and wellbeing, and I wanted to ask you, how effective are friendships as mental health interventions, because I know you published a very interesting systematic overview on the topic recently? Congratulations, by the way, on the publication.
[00:02:25.569] Tanya Manchanda: Thanks so much, Clara. So, well, friendship interventions for adolescent mental health can be defined as those interventions that incorporate an adolescent’s authentic social group, to some degree, which allows them to support a friend in need or teaches them how to support a friend in need. These are really different from peer interventions, which are more popular, but usually involve adolescents being assigned to a buddy or a peer, who’s usually older and has experience and overcomes some similar form of mental distress. Whereas friendship interventions aim to directly involve an adolescent’s authentic social group, which can be defined as individuals that adolescents are actually friends with, actually reaching out to, and are authentically in their social group, rather than assigned to them.
And so, friendship interventions will, basically, directly involve these friends, because adolescents naturally reach out to their friends most for support when they’re distressed. Now, these interventions can consist of mental health first aid training for adolescents, encouraging help seeking behaviour, or teaching adolescents to notice any signs of when their friend may need help, to name a few.
In my review, we, basically, found that participants were either recruited from schools, universities or colleges, or the wider community. There were two groups that we identified throughout these studies that I reviewed. First was the friend who was actually being trained in the intervention. So, this was, for the adolescents at the intervention, was actually delivered to, and then, we had the friend who received the support, so the adolescents who were potentially being offered support by their intervention trained friend. The interventions that we found were typically delivered one of three ways: either completely online or remotely, completely in-person, or they were a hybrid and had an online component and then, an in-person session.
Then, these interventions had two major outcome groups. So, we had the actual measured outcomes of the friendship intervention on the friend who was being trained. And then, we had the inferred outcomes of the intervention on the friend who actually received the support or potentially received the support. Now, these outcomes were inferred because none of the studies actually measured the outcomes of the friends who were receiving support by the adolescents who were trained in the interventions, so these were just self-reported by the trained adolescents, when they said, “Oh, well, I supported my friend this way.”
In most studies, the trained friend had increased confidence to provide support to their friend and they also had increased mental health literacy, and they knew where to seek help for themselves and for others. Then, the inferred outcomes of the intervention on the friend who was the potential recipient of any support were threefold. So, the trained friend either directly provided support to the friend who was receiving the support, or the trained friend encouraged their friend to seek support from an adult or a professional. Or lastly, the trained friend could reach out to an adult or a professional directly, to then help support their friend in need. So, those were, kind of, the two outcome groups that we had. We had the measured outcomes of the intervention on the friend who was trained and then, the inferred outcomes of the intervention on the friend who received the support.
In terms of effectiveness, while we did find evidence for the potential of friendship interventions in supporting adolescent mental health, we concluded that more interventions, which are solely friendship targeted, need to be conducted in order to understand their true effect. And this is because almost all of the interventions that we found, they did have friend support and a friendship intervention incorporated in some way, but it was usually a secondary or a tertiary outcome, with the main objective being increasing mental health literacy, or they were targeted towards a specific mental health outcome.
We also, again, didn’t have the actual measured outcomes of any intervention on the potential recipient of the support. So we’re not really sure how this training can actually impact the adolescent who is in need of the support from their friend. So, that was a little longwinded way of saying that while these have potential for being effective, we’re not really sure how effective they can be until more research has been done into friendship dynamics and direct friendship interventions.
[00:06:30.110] Clara Faria: Thank you, Tanya. That was really interesting, and you mentioned that some interventions were targeted at groups that had specific mental health issues. In your review and in your research in general, do you find that friendship interventions are particularly suited for a specific type of mental health issues? For example, are they particularly suited for eating disorders or other specific type of disorder?
[00:06:55.740] Tanya Manchanda: So, basically, the friendship interventions that we found had different targets, and within these targets, I was, kind of, able to map out the different mental health outcomes that the interventions aim to target. So, what we found was that all of the interventions focused on general mental health and wellbeing improvement or literacy in some way. Then, there was a chunk which focused on improving help seeking, so help seeking of adolescents. So, that would be, you know, reaching out to adults for support, reaching out to a trusted individual for support, and just overall, improving help seeking.
And within this, we found that some interventions were targeted towards substance misuse. So, we had two that were targeted towards substance misuse. We had one for cannabis, one for alcohol, but then, again, these also were for general mental health and wellbeing and improving help seeking, but did have more of a target. And then, we actually did find an intervention that was for eating disorders.
This intervention only included adolescent girls. I mean, I think it was at a girls only school and, basically, you know, the Trainers for the intervention taught these adolescents to look out for certain signs when they’re having lunch with their friends, for example. What are some certain signs of eating disorders? And then, how to have a conversation with a friend and then, how to reach out to someone, like a Teacher, or like a Councillor, someone trusted, to get support for a friend that they think might be in need of that support. And then, we also had some targeted towards male mental health only and then, we had some for reducing self-harm and friendship building.
So, yeah, so there are some interventions that can be specifically suited for a very specific mental health issue and the few that I did find did seem to be effective.
[00:08:39.250] Clara Faria: That’s really interesting, Tanya. Thank you, and as you mentioned before, when struggling with their mental health, research has shown that adolescents tend to turn to their friends, rather than to trained professionals or other adults. In your review, were there any particular methods that seemed to be most successful in teaching adolescents how to best support their friends?
[00:09:01.240] Tanya Manchanda: Yes, I actually did find that the studies, or the interventions, that included some sort of interactive component or some sort of demonstrative roleplay component, actually seemed to be the most successful and the most effective, and then, also, interventions that had some sort of booster dose of the intervention. So, I guess, starting off with the roleplay or interactive component, that could be something like if it’s an online intervention, showing adolescents vignettes of hypothetical peers who may be in need of help and then, adolescents have to, kind of, navigate through that and choose, well, how would you provide support to this individual that you’re seeing on the screen?
Or the male mental health intervention, for example, had a roleplay component where one individual would roleplay being the individual that needed help and then, one would provide the help. And then, there was another one that focused on, kind of, providing direct support that also included a roleplay component and individuals would take turns being the support provider and then, the support seeker.
So, any interventions that included some sort of roleplay, demonstrative or interactive component like this, seemed to have successful results, and then, interventions that had a booster dose seemed to have better results at follow-up. So, adolescents tend to retain more information about what they were taught.
[00:10:20.830] Clara Faria: Now, turning to OxWell, how are you studying friendships in the OxWell Student Survey and how can we measure the quality of those relationships? How can we measure the quality of friendships?
[00:10:31.640] Tanya Manchanda: So, in the OxWell Student Survey, we’ve asked adolescents to tell us about the quality of their friendships. So, we have the self-reported friendship quality and then, we also have adolescents telling us who they reach out to when they need mental health support. And then, we’ve further, actually, broken this down on the friendship aspect by asking them if they are reaching out to their friends online or if they’re reaching out to the friends in-person. And then, we have some items that we’ve added in the 2023 OxWell Survey, which are from the McGill Friendship Questionnaire, and these ask adolescents about their friendship functions and their importance. So, we’re, kind of, hoping to really break down the friendship dynamics in order to really see how we can best support adolescent friendships in mental health.
[00:11:18.269] Clara Faria: What’s your favourite finding from OxWell with regards to friendships? Did anything surprise you?
[00:11:24.370] Tanya Manchanda: Yeah. So, my favourite finding from OxWell is that most adolescents do tend to report having high quality friendships. So, we definitely have more higher quality friendships than lower quality friendships, and I mean, this is great, because past research on friendships emphasises the importance for adolescents for maintaining high-quality friendships. And then, another thing that we found is that adolescents, again, are reaching out to their friends most for support, but what most surprised me is that many adolescents are actually not finding the support helpful. So, we do see that – a bit of a gap there.
So, I’m hoping that intervening at the friendship level for adolescents and really figuring out the friendship dynamics, like what qualities do adolescents value in friends, you know, how does friendship quality relate to mental health and wellbeing? So, hoping that intervening at the friendship level for adolescents can address this, kind of, discrepancy that we have between adolescents reaching out to their friends most for support, but then not finding it helpful. And then, maybe this research can inform an intervention, or inform ways in which we can make adolescents find friend support more helpful, especially if we have an intervention in which they’re trained in how to best support each other.
[00:12:31.260] Clara Faria: How does building authentic social groups differ across gender and age? Did you find any differences in help seeking behaviours? And also, I know we use these terms ‘interchangeably’, but if you could just briefly explain to our audience, what is an authentic social group, I think it would help a bit?
[00:12:49.100] Tanya Manchanda: Yeah, so, this is actually another interesting finding and one of my favourite findings to talk about. But starting off, an authentic social group is a voluntary mutual relationship that adolescents engage in. So, it’s not forced friendship, it’s not assigned friendship, or peers. It’s – these are individuals that are mutually choosing to hang out together, to spend time together, and are in an actual social group. Now, this doesn’t have to be only, you know, friends from school. It can include cousins, it can include, you know, any sort of other individuals that adolescents may consider to be part of their authentic social group.
So, I guess your question was asking about differences across gender and across age. So, starting off with gender, which is one of my favourite findings, is that we actually did find a gender difference in the OxWell Student Survey. So, this was quite interesting, because we found that self-reporting adolescent boys actually have the highest quality friendships and tend to have better mental health, as well, and are just more likely to find friend support helpful. And this is in comparison to girls and in comparison to gender non-binary individuals.
So, gender non-binary individuals, on the other hand, reported the lowest quality friendships and tended to score on the poorest mental health domains and poorest on wellbeing, as well. So, what was interesting was that though gender non-binary individuals reported having the lowest quality friendships, they actually reached out to their friends most for support. Girls reached out second most, and boys reached out the least. So, what we’re finding is that this group of individuals, they – you know, they’re saying that they’re not really having high quality friendships, but they do reach out to their friends for mental health support. So, I think that this is something that needs to be explored in more detail and I think this gender difference is quite interesting.
Another thing that we see is that there are differences across year groups, or across age. So, we, basically, split it up into the younger adolescent year groups and the older adolescent year groups. So, as adolescents increase in year group, their mental health actually declines, and their friendship quality also declines. So, this difference is a bit more pronounced for gender non-binary individuals again, but I’m hoping to explore that a little bit more in the OxWell 2023 Survey, where we have some more information for gender non-binary individuals.
[00:15:28.480] Clara Faria: Thank you, Tanya, and that’s really an important finding, right? And one of my favourite things about OxWell is that you actually study the gender non-binary individuals, because they are just not recognised at all in many surveys. So, that’s a really, really important finding and I’m really curious to see what you will find in the OxWell 2023 analysis.
Which leads me onto our next question, and also, our last. So, thank you for your time, Tanya. Looking to the future, could you share a bit more about your plans for the next OxWell waves regarding friendships and friendships interventions?
[00:16:05.110] Tanya Manchanda: Yeah, of course. So, in terms of looking at next steps, so one thing that I’ll be exploring, for sure, is the friendships and friendship qualities of gender non-binary individuals. And I think this will be quite interesting to see, you know, what friendship functions are most important to them, what do they value in friends? Another thing that I’ll be exploring is online versus in-person friendships. So, how do these friendships differ and how does support seeking online versus face-to-face differ? I mean, you know, we’ve obviously been through this massive pandemic, where everything was remote and, you know, reaching out to friends was all remote, as well. So, I wonder, have things changed now? Like, are individuals still wanting to reach out to their friends online when they want to get some sort of mental health support, or do they prefer to reach out in-person?
And then, I’m hoping that these findings will be able to inform the best target for a friendship intervention. So, what year group needs this more? Can it be targeted towards certain year groups? Can it be changed for certain year groups, or, you know, what gender needs this more? Like, do our – do gender non-binary individuals – would they benefit more from a friendship intervention, especially if they have low quality friendships, but want more support? So, hopefully, with the OxWell Student Survey and with the results that we find from the OxWell Student Survey, we can inform a very useful and targeted friendship intervention.
[00:17:29.760] Clara Faria: I’m really curious to see those analyses and those findings. Once again, thank you so much for your time, Tanya. For more details on Tanya Manchanda, please visit the OxWell and ACAMH websites, www.acamh.org and oxwell.org, and also our Twitter @acamh. ACAMH Is spelt A-C-A-M-H. Do keep an eye out for other podcasts in the Insights from the OxWell Student Survey series, including episodes on self-harm, sleep and more, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with your friends and colleagues.