Self-help interventions for young people with persistent physical symptoms: A systematic review

Objective: Persistent physical symptoms are frequent among young people causing considerable social, psychological, and economic consequences. Easily accessible interventions adapted to non-specialized settings are needed. We aimed to systematically review randomized controlled trials on self-help interventions for young people with persistent physical symptoms compared to active or passive control groups. Our purpose was to 1) describe applied therapeutic approaches and content and 2) examine potential effects on symptom burden and psychosocial outcomes. Methods: We included randomized controlled trials on minimal contact self-help interventions for young people with persistent physical symptoms. Systematic literature searches in PubMed, Cochrane Central, Embase, and PsycINFO were conducted. Study selection, data extraction and quality assessment were performed independently by two reviewers. A narrative synthesis of the effects was performed. Results: We identified 11 studies on self-help interventions for young people. The methodological quality of the studies was generally low. Participants suffered from impairing fatigue, headache, abdominal pain, and musculoskeletal or multi-site pain. Applied therapeutic approaches were cognitive behavioral therapy, relaxation training, hypnotherapy, and written self-disclosure. Outcomes were diverse and mainly related to symptom burden, whereas psychosocial outcomes were only sporadically examined. Overall, evidence of effectiveness of self-help interventions in alleviating symptom burden was weak, and potential effects could not be linked to one specific theoretical approach. Conclusion: Few self-help interventions of diverse content exist for young people with persistent physical symptoms. Rigorously designed studies that include recommended outcome domains assessed by aligned measures are needed to determine and compare the clinical value of such interventions.