Prevention of mental disorders

Last updated

Prevention of mental disorders are measures that try to decrease the chances of a mental disorder occurring. A 2004 WHO report stated that "prevention of these disorders is obviously one of the most effective ways to reduce the [disease] burden." [1] The 2011 European Psychiatric Association (EPA) guidance on prevention of mental disorders states "There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions." [2] A 2011 UK Department of Health report on the economic case for mental health promotion and mental illness prevention found that "many interventions are outstandingly good value for money, low in cost and often become self-financing over time, saving public expenditure". [3] In 2016, the National Institute of Mental Health re-affirmed prevention as a research priority area. [4]

Contents

Methods

Parenting

Parenting may affect the child's mental health, [5] [6] [7] [8] and evidence suggests that helping parents to be more effective with their children can address mental health needs. [9] [10] [11]

Assessing parenting capability has been raised in child protection and other contexts. [12] [13] [14] [15] Delaying of potential very young pregnancies could lead to better mental health causal risk factors such as improved parenting skills and more stable homes, [16] and various approaches have been used to encourage such behaviour change. [17] [18] Some countries run conditional cash transfer welfare programs where payment is conditional on behaviour of the recipients. Compulsory contraception has been used to prevent future mental illness. [19]

Pre-emptive CBT

Use of cognitive behavioral therapy (CBT) with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes. [20] [21] In 2014 the UK National Institute for Health and Care Excellence (NICE) recommended preventive CBT for people at risk of psychosis. [22] [23] As of 2018, some health providers now advocate pre-emptive use of CBT to prevent worsening of mental illnesses. [24]

Mental silence meditation

Sahaja meditators scored above control groups for emotional well-being and mental health measures on SF-36 ratings, leading to proposed use for mental illness prevention, although this result could be due to meditators having other characteristics leading to good mental health, such as higher general self care. [25] [26] [27]

Internet- and mobile-based interventions

A review found that a number of studies have shown that internet- and mobile-based interventions can be effective in preventing mental disorders. [28]

Specific diseases

Depression

For depressive disorders, when people participated in interventions, some studies show the number of new cases is reduced by 22% to 38%. [29] [30] These interventions included CBT. [31] [32] Such interventions also save costs. [33] Depression prevention continues to be called for. [34]

Anxiety

For anxiety disorders,

Psychosis

In those at high risk there is tentative evidence that psychosis incidence may be reduced with the use of CBT or other types of therapy. [40] [41] In 2014 the UK National Institute for Health and Care Excellence (NICE) recommended preventive CBT for people at risk of psychosis. [22] [23]

There is also tentative evidence that treatment may help those with early symptoms. [42] [43] Antipsychotic medications are not recommended for preventing psychosis. [22]

For schizophrenia, one study of preventative CBT showed a positive effect [40] and another showed neutral effect. [44]

Targeted vs universal

There has been an historical trend among public health professionals to consider targeted programmes. However identification of high risk groups can increase stigma, in turn meaning that the targeted people do not engage. Thus policy recommends universal programs, with resources within such programs weighted towards high risk groups. [45]

Universal prevention (aimed at a population that has no increased risk for developing a mental disorder, such as school programs or mass media campaigns) need very high numbers of people to show effect (sometimes known as the "power" problem). Approaches to overcome this are (1) focus on high-incidence groups (e.g. by targeting groups with high risk factors), (2) use multiple interventions to achieve greater, and thus more statistically valid, effects, (3) use cumulative meta-analyses of many trials, and (4) run very large trials. [46] [47]

History

History of mental illness prevention strategies

History of mental illness prevention programmes and research

Historically prevention has been a very small part of the spend of mental health systems. For instance the 2009 UK Department of Health analysis of prevention expenditure did not include any apparent spend on mental health. [66] The situation is the same in research. [67]

However more recently some prevention programmes have been proposed or implemented. Prevention programmes can include public health policies to raise general health, creating supportive environments, strengthening communities, developing personal skills, and reorienting services. [54]

In India the 1982 National Mental health Programme included prevention, [79] but implementation has been slow, particularly of prevention elements. [80] [81] [82]

It is already known that home visiting programs for pregnant women and parents of young children can produce replicable effects on children's general health and development in a variety of community settings. [83] Similarly positive benefits from social and emotional education are well proven. [84] Research has shown that risk assessment and behavioral interventions in pediatric clinics reduced abuse and neglect outcomes for young children. [85] Early childhood home visitation also reduced abuse and neglect, but results were inconsistent. [86]

Issues in implementation

Prevention programs can face issues in (i) ownership, because health systems are typically targeted at current cases, and (ii) funding, because program benefits come on longer timescales than the normal political and management cycle. [87] [88] Assembling collaborations of interested bodies appears to be an effective model for achieving sustained commitment and funding. [89]

Related Research Articles

Cognitive behavioral therapy Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Major depressive disorder Mental disorder involving persistent low mood, low self-esteem, and loss of interest

Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Those affected may also occasionally have delusions or hallucinations. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since.

A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitting, or occur as single episodes. Many disorders have been described, with signs and symptoms that vary widely between specific disorders. Such disorders may be diagnosed by a mental health professional, usually a clinical psychologist or psychiatrist.

Psychosis Abnormal condition of the mind

Psychosis is an abnormal condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

Schizophrenia Mental disorder characterized by psychosis

Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations, delusions, paranoia, and disorganized thinking. Other symptoms include social withdrawal, decreased emotional expression, and apathy. Symptoms typically develop gradually, begin during young adulthood, and in many cases never become resolved. There is no objective diagnostic test; the diagnosis is used to describe observed behavior that may stem from numerous different causes. Besides observed behavior, doctors will also take a history that includes the person's reported experiences, and reports of others familiar with the person, when making a diagnosis. To diagnose someone with schizophrenia, doctors are supposed to confirm that symptoms and functional impairment are present for six months (DSM-5) or one month (ICD-11). Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders, and obsessive–compulsive disorder.

Anxiety disorder Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatiguability, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

Postpartum depression Endogenous major depressive episode experienced by women after giving birth

Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder associated with childbirth, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. Onset is typically between one week and one month following childbirth. PPD can also negatively affect the newborn child.

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis is made when the person has symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion for a diagnosis of schizoaffective disorder is the presence of psychotic symptoms for at least two weeks without any mood symptoms present. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. It is imperative for providers to accurately diagnose patients, as treatment and prognosis differ greatly for each of these diagnoses.

Richard Bentall is a Professor of Clinical Psychology at the University of Sheffield in the UK.

Mental health Level of psychological well-being

Mental health encompasses emotional, psychological, and social well-being. It influences cognition, perception, and behavior. It also determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others. From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, subjective assessments, and competing professional theories all affect how one defines "mental health". Some early signs related to mental health problems are sleep irritation, lack of energy and thinking of harming yourself or others.

Suicide prevention Collective efforts to reduce the incidence of suicide

Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. Suicide is a serious public health problem that can have long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide can be prevented by learning the warning signs, promoting prevention and resilience, and committing to social change.

Expressed emotion (EE), is a measure of the family environment that is based on how the relatives of a psychiatric patient spontaneously talk about the patient. It specifically measures three to five aspects of the family environment: the most important are critical comments, hostility, emotional over-involvement, with positivity and warmth sometimes also included as indications of a low-EE environment. The psychiatric measure of expressed emotion is distinct from the general notion of communicating emotion in interpersonal relationships, and from another psychological metric known as family emotional expressiveness.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children with mothers who have experienced traumatic or stressful events during pregnancy can increase the child's risk of mental health disorders and other neurodevelopmental disorders. Kaiser Permanente and the Centers for Disease Control and Prevention's 1998 study on adverse childhood experiences determined that traumatic experiences during childhood are a root cause of many social, emotional, and cognitive impairments that lead to increased risk of unhealthy self-destructive behaviors, risk of violence or re-victimization, chronic health conditions, low life potential and premature mortality. As the number of adverse experiences increases, the risk of problems from childhood through adulthood also rises. Nearly 30 years of study following the initial study has confirmed this. Many states, health providers, and other groups now routinely screen parents and children for ACEs.

In medicine, a prodrome is an early sign or symptom that often indicates the onset of a disease before more diagnostically specific signs and symptoms develop. It is derived from the Greek word prodromos, meaning "running before". Prodromes may be non-specific symptoms or, in a few instances, may clearly indicate a particular disease, such as the prodromal migraine aura.

Mental health literacy

Mental health literacy has been defined as "knowledge and beliefs about mental disorders which aid their recognition, management or prevention. Mental health literacy includes the ability to recognize specific disorders; knowing how to seek mental health information; knowledge of risk factors and causes, of self-treatments, and of professional help available; and attitudes that promote recognition and appropriate help-seeking". The concept of mental health literacy was derived from health literacy, which aims to increase patient knowledge about physical health, illnesses, and treatments.

Depression is a symptom of some physical diseases; a side effect of some drugs and medical treatments; and a symptom of some mood disorders such as major depressive disorder or dysthymia. Physical causes are ruled out with a clinical assessment of depression that measures vitamins, minerals, electrolytes, and hormones. Management of depression may involve a number of different therapies: medications, behavior therapy, psychotherapy, and medical devices.

Early intervention in psychosis is a clinical approach to those experiencing symptoms of psychosis for the first time. It forms part of a new prevention paradigm for psychiatry and is leading to reform of mental health services, especially in the United Kingdom and Australia.

Patrick McGorry Australian psychiatrist

Patrick Dennistoun McGorry FAA FASSA FAHMS FRCP FRANZCP is an Irish-born Australian psychiatrist known for his development of the early intervention services for emerging mental disorders in young people.

Panic disorder Anxiety disorder characterized by reoccurring unexpected panic attacks

Panic disorder is a mental and behavioral disorder, specifically an anxiety disorder characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something terrible is going to happen. The maximum degree of symptoms occurs within minutes. There may be ongoing worries about having further attacks and avoidance of places where attacks have occurred in the past.

Claudi Bockting is a Dutch clinical psychologist and Professor of Clinical Psychology in Psychiatry at the University of Amsterdams Faculty of Medicine. Her research program focuses on identifying etiological factors of common mental health disorders such as depression, anxiety disorders and substance abuse, and developing evidence-based psychotherapeutic interventions.

References

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