Future Looks Promising for Mental Illness Prevention

Since effective treatments for mental illnesses emerged only during the 20th century, it is probably not surprising that scientifically based mental illness prevention is only now coming of age, stated George Alexopoulos, M.D., director of the Weill-Cornell Institute of Geriatric Psychiatry, in a recent interview.

Indeed, “there has been a huge explosion of work in mental illness prevention during the past decade,” Carol Koplan, M.D., told Psychiatric News. She is a child and adolescent psychiatrist and assistant adjunct professor in health policy at Emory University, where she teaches a class in prevention of mental disorders to students in the master’s-degree program in public health.

“There are probably 20 or 30 good randomized clinical trials indicating that the onset of common mental disorders like depression and anxiety can be delayed and in some cases prevented,” Charles Reynolds, M.D., a professor of geriatric psychiatry at the University of Pittsburgh, said. For instance, cognitive-behavioral therapy and interpersonal therapy have been found to be effective in reducing the incidence of major depressive episodes in people who have already had mild or subsyndromal depressive symptoms. A Dutch study found a 50 percent reduction in the incidence of major depression among mildly depressed primary care patients who received a stepped-care intervention, compared with the incidence among primary care patients who received treatment as usual. Other studies showed that low-dose antidepressants or problem-solving therapy helped reduce the incidence of major and minor depression in post-stroke patients.

“A number of clinical trials,” Reynolds noted, “have also supported a role for lithium in suicide prevention in people living with bipolar disorder and for clozapine for people living with schizophrenia. In addition, we performed the PROSPECT study—the Prevention of Suicide in Primary Care Elderly: Collaborative Trial study—which showed that the implementation of evidence-based depression-care guidelines in primary care practices could reduce the prevalence of suicidal ideation.”

In the opinion of Michael Compton, M.D., M.P.H., a professor of psychiatry at George Washington University and a preventive medicine specialist, two recent mental illness prevention studies deserve special notice. “In 2009, Garber and colleagues published a study in JAMA showing that a group-based cognitive-behavioral program reduced the rate of depressive episodes in adolescent offspring of depressed parents,” he said. “In 2010, Amminger and coworkers published a study in the Archives of General Psychiatry showing that omega-3 fatty acids, or fish oils, reduced the risk of transition to psychosis among young people deemed to be at very high risk for a psychotic disorder.”

One of the most impressive mental illness prevention studies conducted to date, Koplan suggested, was designed by David Olds, Ph.D., director of the Prevention Research Center for Family and Child Health at the University of Colorado. Nurses visited high-risk mothers from lower socioeconomic backgrounds during pregnancy and for two years after to help them give their children a good start in life. Olds and his colleagues then followed the children and their mothers for several years to see whether the intervention made a difference in mental and behavioral health outcomes. It did. For example, the mothers experienced fewer arrests and convictions, engaged in less child abuse and neglect, and abused substances less than did control mothers. By 2008, Olds’ program, which was called the Nurse-Family Partnership, was operating in 24 states (Psychiatric News, August 1, 2008). By July 2012, it was operating in 41 states, according to the Nurse-Family Partnership Web site.

Another prominent advance in mental illness prevention, Koplan pointed out, is the Interactive Screening Program (ISP) of the American Foundation for Suicide Prevention (AFSP). The ISP is an anonymous, interactive Web-based method of reaching out to students at risk of suicide. It has been shown to be effective in getting these students into treatment. The ISP is now being used in more than 40 colleges and universities in the United States, according to the AFSP Web site.

“There has also been very good research on drug- and alcohol-abuse prevention,” said Christopher Oleskey, M.D., M.P.H., an assistant professor of psychiatry at Yale University.

Information about mental illness prevention can be found in "The Clinical Manual of Prevention in Mental Health", published by American Psychiatric Publishing. APA members can purchase the book at a discount at http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemID=62347.