“Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth”: National Academies Report Calling for a Decade of Children and Youth

Three approaches to the problem of how to prevent pathological development and promote healthy development were highlighted. These are:

As one specific example from the many that could have been chosen, the report examines the evidence that perinatal depression in the mother has well-documented effects on the infant’s development and that these have long-lasting consequences to the brain and social development of the offspring across the lifespan.

The report concludes that we need to redouble our efforts to screen for clinical depression during pregnancy and the postpartum period and provide evidence-based treatment to the mother. In addition, we need to screen for the risk for perinatal depression and provide evidence-based preventive interventions (such as those recently recommended by the U.S. Preventive Services Task Force [5, 6]). Recent meta-analyses suggest that interventions focused on individuals at risk, that is, “indicated” preventive interventions, may be most efficient (6, 7) and thus the most practical way to introduce preventive interventions into routine health care. A new goal for the health care system should be to reduce the likelihood of onset of clinical depression in the mother who has mild symptoms or is at high risk because of a history of depression or other factors. Successfully preventing clinical depression perinatally may help avoid the difficult decision of whether to prescribe antidepressant medication during pregnancy. The combination of preventive and treatment interventions (for those whose depression is not prevented) can protect the infant from the sequelae of maternal depression and promote healthy development from the start of life. Early interventions during the life cycle could potentially have lifelong benefits. The report contains many other valuable recommendations that address preventive interventions for conditions beyond parental depression, such as anxiety disorders, substance misuse, and other mental, emotional, and behavioral conditions.

The report proposes several recommendations, many of which are at the policy level, including:

Advances in the past 25 years, as documented in the three National Academies reports (1–3), challenge the field of mental health to look beyond treatment to the areas of prevention and promotion to reduce the incidence and the consequent prevalence of mental, emotional, and behavioral disorders. The call to focus beyond the individual and to examine family, community, and societal influences on mental health is not new to psychiatry. The social and community psychiatry movement has been addressing many of these issues since at least the 1960s. What is new is that science has advanced enough now to link together such outcomes as “infant birthweight, gestational age, and some childhood behaviors … to interactions between DNA sequence variation and aspects of prenatal environments, such as maternal smoking, depression, and body mass index” (1, p. 48).

What does this mean for psychiatry? First, increased attention and preventive intervention are needed early in symptom presentation before the course of a disorder crosses clinical threshold. Second, we need to recognize and pay attention to high-risk youths and high-risk situations; for example, the offspring of an acutely depressed parent may be at high risk. Third, stakeholders should join the interests of child and adult psychiatry, primary care, prenatal care, pediatrics, and behavioral neuroscience into actionable initiatives with the explicit goal of benefiting not only the individual but the health of the population as well.

Since this report was completed, the world has experienced a pandemic, which has affected the lives of everyone. The rates of depression, anxiety, and suicide, especially among the young, are reported to be rising. The recommendations of this report are even more relevant now.