Teenagers who join a choir, play weekend football, or volunteer at a local museum may be building a shield against depression and anxiety that lasts for years. This matters because youth mental health is in crisis, yet most prevention efforts focus on treating problems after they emerge. Community leisure activities—music, arts, sports, volunteering, and cultural heritage—have never been rigorously tested as a *prevention* tool for the general population, only as a treatment. The researcher will analyse five large UK cohort studies tracking young people over 15 years, using advanced statistical methods to determine whether these activities actually prevent anxiety and depression, and whether the benefits hold up regardless of a young person’s socioeconomic background. If the research shows that community activities work as a preventive measure, it could shift public health strategy away from clinic-based treatment toward integrated, community-based approaches. The project will also evaluate three practical routes for scaling up access: through community organisations, schools, or clinical referral. The final output will be a coproduced primary prevention strategy ready for real-world testing, with the potential to improve population mental health at a scale that individual therapy cannot reach.
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Background With increasing challenges from poverty and a lack of accessible support, youth mental health is in crisis. Identifying scalable sustainable approaches that can prevent youth anxiety and depression is a public health priority. Community leisure activities (voluntary non-work activities done for enjoyment, specifically through engagement with community assets) have great potential. However, they have previously only been considered as a treatment strategy. We know that there are inequalities in young people's access to community activities that are in line with the social determinants of health. Exactly what these disparities are and whether community activities can prevent youth anxiety and depression despite these inequalities remains unknown. We must understand these questions to develop primary prevention strategies. Aims and objectives I will triangulate evidence to determine whether community activities can be used as a primary prevention strategy for youth anxiety and depression. I have three objectives: Test the effect of community activities on youth anxiety and depression Identify whether community activities could be a universal prevention strategy Evaluate which approaches have most promise for addressing inequalities in access to community activities and preventing anxiety and depression Methods WP1: Building evidence (years 1-2) I will use five large population-based cohorts of young people in the UK to test whether doing community activities (music, arts, crafts, sports, volunteering, culture, heritage) can prevent anxiety and depression over 15 years. In a series of studies, I will map confounders and use novel statistical methods for causal inference to establish whether there are longitudinal relationships with incidence and symptom levels, independent of socioeconomic inequalities. I will identify the strongest activity ingredients (type, frequency, sustained engagement) and assess whether relationships are robust across time and place. WP2: Universal prevention (years 2-3) I will identify whether community activities could be a universal prevention strategy. In the same five cohorts, I will use a theoretically informed approach to explore how inequitable engagement patterns are, identifying barriers to accessing activities. I will also test whether relationships between community activities, anxiety, and depression differ across population groups, indicating whether any benefits of community activities could be realised equitably, with equal outcomes for everybody. WP3: Prevention strategies (years 3-5) I will evaluate three potential routes for increasing access to community activities and thus preventing anxiety and depression: via the community, through schools, or clinical referral. I will use natural experiments with administrative data, capitalising on the latest methodological developments to test which approach should be taken forward for further evaluation. Dissemination and impact Using a coproduced engagement plan, I will share findings with young people (podcasts, blogs, media), community organisations and health/educational professionals (evidence summaries, webinar), policymakers (policy brief, presentations), and researchers (papers, conferences). Findings will inform ongoing research and practice and enable the strategic move towards integrated community-based approaches to prevention, which is not possible without these foundational analyses. This work will culminate in coproduction of a primary prevention strategy for future testing, which has great potential to prevent youth anxiety and depression, improving population health.
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