Have you ever met a young person who is clearly struggling, but whose difficulties do not seem to fit any single label? This is far more common than it sounds. Adolescence is a period of rapid change, and many young people experience distress that falls between “typical ups and downs” and a diagnosable condition. Research suggests a substantial proportion of adolescents report persistent symptoms of anxiety or low mood without meeting formal diagnostic criteria. This points to a growing group whose needs often remain unmet (Chiu et al., 2016).
Modern pressures, including academic competition, social media comparison, and the long tail of Covid (Jiang, 2021), have been linked to rising emotional difficulties. Though increased mental health awareness is positive, it can also obscure matters, as everyday challenges are often labelled in clinical terms, subsequently making it harder to discern when intervention is truly necessary. Diagnostic frameworks (DSM/ICD) help structure care, but they rely on clinical judgement and lack biological markers, which results in contrasting difficulties under the same label.
This systemic structure leaves a sizeable group experiencing genuine distress but not meeting the threshold for formal care. A recent systematic review and meta-analysis by Radunz et al. (2025) examines whether transdiagnostic interventions, that is, approaches targeting shared emotional and cognitive processes, can provide effective, inclusive support for this underserved population.
Young people experiencing distress often fall through the cracks of a system built around diagnosis. Is treating the struggle, not the label, the answer?
Methods
To understand what helps young people experiencing distress before a diagnosis is given, Radunz et al. (2025) conducted a systematic review and meta-analysis. Searches across APA PsycInfo, MEDLINE, and Scopus identified 68 randomised controlled trials involving 10,805 participants aged 25 years and under. Participants had no confirmed mental health diagnosis, but showed elevated transdiagnostic psychopathology, typically defined as scoring above threshold on multiple validated symptom subscales. Interventions varied, with many drawing on CBT-based or skills-focused approaches, delivered online or face-to-face. Control conditions included treatment as usual, minimal-contact support, or waitlist controls.
To account for variability in intervention content and outcome measures, random-effects models were utilised and effect sizes reported using Cohen’s d. Outcomes were grouped into depression, anxiety, quality of life, suicidality or self-harm, and disordered eating. Study quality was assessed using CONSORT-based criteria, and “common elements” were coded to identify components linked to change.
Results
Radunz et al. (2025) found that transdiagnostic interventions produced small but statistically significant improvements in several major areas of youth mental health (see Table 1). When results across eligible trials were pooled, the interventions showed positive effects for depression (d = 0.25) and anxiety (d = 0.22), implying a modest reduction in symptoms compared with control conditions. Improvements in quality of life were smaller (d = 0.11) but still statistically significant. By contrast, there were too few eligible studies to draw concrete conclusions about suicidality or disordered eating, highlighting these outcomes as central areas of uncertainty within the current evidence base.
Table 1 – Summary of pooled effect sizes from Radunz et al. (2025)
| Outcome | Number of Studies (k) | Pooled Effect Size (Cohen’s d) | Interpretation |
| Depression | 64 | 0.25 | Small but consistent improvement |
| Anxiety | 57 | 0.22 | Small improvement |
| Quality of Life | 19 | 0.11 | Smaller improvement, but still significant effect |
| Suicidality / Self-harm | 4 | No pooled estimate | Too few studies |
| Disordered Eating | 5 | No pooled estimate | Too few studies |
Statistical heterogeneity was low based on I² estimates (e.g., 13.1% for depression, 10.8% for anxiety). However, the authors emphasised substantial clinical and methodological heterogeneity across studies, arising from differences in intervention content and measurement tools. This means pooled effects must be interpreted as broad patterns rather than precise estimates, necessitating the use of random-effects models.
Moderator analyses gave a clearer understanding of who benefits most: adolescents (ages 12–17) showed significant improvements across both depression and anxiety, while effects for younger children and young adults were less consistent. Furthermore, face-to-face approaches produced clearer symptom reductions than online programmes (which showed no significant pooled effects), suggesting that relational or guided elements may be particularly important for this age group.
CBT-based approaches were the most frequently studied and demonstrated greater effectiveness relative to other models. Analysis of “common elements” in successful interventions highlighted several shared therapeutic ingredients, including emotional literacy, cognitive literacy, psychoeducation, and problem-solving. While these associations are not causal, they are suggestive; these shared components may contribute to improved outcomes.
Finally, the quality assessment showed wide variation in how well the included trials were designed and reported. Only 28.9% met eight or more of the ten CONSORT criteria, meaning many studies lacked sufficient methodological detail. This does not undermine the overall direction of the findings; however, it makes interpreting individual effect sizes more challenging and highlights the need for more transparent reporting in future research.
Transdiagnostic interventions produced small but consistent reductions in depression and anxiety with adolescents, and face-to-face delivery, showing the clearest gains.
Conclusion
Overall, this meta-analysis suggests that transdiagnostic interventions may be a useful early option for young people experiencing elevated distress. Improvements in anxiety, depression, and quality of life were small but consistent across studies, pointing to the potential value of approaches that target shared psychological processes rather than specific diagnoses.
However, the picture is not straightforward. Limited evidence relating to suicidality and eating-related outcomes, alongside mixed study quality, indicates that important uncertainties remain. These findings highlight the need to consider carefully the strength of the evidence and what it means when translated into real-world practice.
Small but consistent evidence supports transdiagnostic approaches as a promising early option for distressed youth, though gaps in evidence around suicidality and eating outcomes urge cautious application.
Strengths and limitations
A major strength is the synthesis of 68 RCTs involving over 10,000 young people, providing a coherent understanding that far exceeds the reach of single trials. The sheer scale mitigates the risk of small samples and lends stability to the pooled effects. Methodologically, the use of preregistration, CONSORT checks, and random-effects models strengthens credibility by reducing analytic flexibility and systematically acknowledging genuine diversity. A further strength lies in examining “common elements” across interventions. This strategically shifts the focus away from broad treatment labels toward specific skills (like emotional literacy) relevant for designing brief, feasible early interventions.
Despite these strengths, several limitations temper how confidently the findings can be applied. Strict inclusion criteria limited the scope (e.g., excluding parent-only programmes and inpatient settings). Crucially, external validity is constrained by a participant pool skewed towards mid-to-older adolescents and predominantly female samples. This demographic imbalance is significant because different groups (e.g., younger children or boys) may present distress or respond to skills-based approaches differently, making generalisation beyond the studied groups difficult (NAEYC, 2020; Sheikh et al., 2024).
Inconsistency in measurement further complicates interpretation. “Elevated distress” was defined using a wide range of questionnaires and cut-offs, meaning participants were not identified uniformly. Additionally, most outcomes relied heavily on self-report measures, increasing the risk that observed changes reflect reporting differences, not genuine improvement. Critically, tests for publication bias using Egger’s regression suggested potential publication bias for depression outcomes. This implies studies finding null or small effects were likely unpublished, suggesting the review’s pooled effect size for depression is an overestimation of the true intervention benefit.
Finally, intervening before a diagnosis carries a conceptual risk. It may inadvertently pathologise fluctuations that are a typical part of adolescent development. This tension must be carefully weighed when designing compassionate early-help pathways. Radunz et al. (2025) offer a careful synthesis, but the findings, given the uneven study quality and this ethical risk, must be applied with exceptional thoughtfulness.
The review has notable strengths, but the risk of pathologising normal adolescent development tempers confidence in the findings.
Implications for practice
The findings from Radunz et al. (2025) point towards a practical use for transdiagnostic interventions in the earlier stages of youth mental health care. Many young people experience distress that affects their daily lives but receive little support because their symptoms do not yet meet diagnostic thresholds. This creates a service gap in which options are often limited to either doing nothing and “keeping an eye on things” or referring to CAMHS and facing unacceptably long waits. Short, skills-based interventions targeting emotions, thinking patterns, and coping strategies could provide timely support. Such approaches could be delivered by school counsellors, youth workers, or other non-specialist staff, fitting naturally within stepped-care models without replacing specialist CAMHS.
The paper also raises broader policy questions. As CAMHS continues to struggle with demand, systems built around diagnosis often exclude young people with mixed or unclear presentations. A transdiagnostic approach challenges this by focusing on struggles, not labels. This aligns with current NHS priorities around prevention and community support. If policymakers invested in accessible, low-intensity interventions, it could ease pressure on crisis pathways and allow support to happen earlier, before things reach breaking point.
However, equity cannot be an afterthought. Although studies spanned diverse regions including Europe, North America, Asia, and parts of Africa, most trials were concentrated in higher-income countries, and only around one-fifth were conducted in low- or middle-income settings. This matters because the apparent effectiveness may partly reflect the high resource levels of the health systems in which they were tested. That being so, it remains unclear whether similar benefits would emerge in contexts where local resources, culture, and delivery methods differ substantially.
There are also important questions for future research. Evidence relating to self-harm, suicidality, and eating-related difficulties remains sparse, despite their relevance in youth mental health. Stronger trials are needed to understand whether transdiagnostic approaches are appropriate or effective for these outcomes. Further studies would benefit from clearer definitions of distress, more stable ways of measuring change, and follow-up periods that extend beyond the immediate end of treatment, so it becomes possible to see whether early gains last or influence later diagnoses.
On a personal level, these findings resonate with experiences from my work in youth settings and clinical training. Many young people present with real distress that does not yet look like a disorder, but waiting until it becomes one feels ethically counterintuitive. Transdiagnostic approaches provide a way of supporting young people earlier, while still respecting the difference between normal emotional turbulence and genuine clinical need. The challenge now is building a system that can deliver this kind of help consistently and fairly.
Findings support integrating brief, skills-based transdiagnostic interventions into stepped-care models and early-help pathways.
Statement of interests
Ecem Rana Akturk has no conflicts of interest to declare.
Edited by
Dr Dafni Katsampa
Links
Primary paper
Marcela Radunz, Catherine Johnson, Tim Dalgleish, Roz Shafran, Tracey D. Wade (2025). Transdiagnostic interventions in prediagnostic youth with elevated distress: A meta-analysis of outcomes. Journal of Consulting and Clinical Psychology, 93(9), 627–641.
Other references
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