Prevention in Mental Health: Lifespan Perspectives

This year, the public health community mourned the loss of one of its pioneers: Lester Breslow, M.D., Professor Emeritus at the University of California, Los Angeles, Fielding School of Public Health. In the groundbreaking Alameda County Study, Dr. Breslow was one of the first to empirically demonstrate that healthy behaviors (e.g., physical activity, moderate weight, no smoking, no excessive alcohol consumption, regular sleep) were directly linked to increased longevity (1). The notion that public health research should encompass the prevention of chronic illnesses as well as communicable diseases was seen as radical for its time. In their book Prevention in Mental Health: Lifespan Perspectives, Drs. Jeste and Bell open with a similar prescient theme: “the goal of this monograph is to inform the mental health community that prevention of several psychiatric disorders is not a futuristic fantasy but is possible and even practical today” (p. xiii). By reviewing the state of the science in the prevention of mental and behavioral disorders, they provide a vision for a future paradigm that embraces a public health model of prevention that may also seem radical for our time but in essence has already been substantiated through empirical research.

In this monograph, published by Psychiatric Clinics of North America, the editors compiled a cogent set of chapters that summarize current and emerging research in the prevention of mental and behavioral disorders. The book is comprehensive and covers the most common conditions ranging across the lifespan, including dementia, postpartum depression, and mental and behavioral disorders in children/adolescents; it not only highlights the crucial role of unwanted “co-travellers,” such as metabolic syndrome and HIV, but addresses research on the social determinants of mental health (e.g., youth violence). Each chapter provides an up-to-date synopsis of the key risk factors and relevant research studies, either completed or under way, that are focused on prevention efforts, ultimately leading to the argument that public health approaches can be successfully applied in mental health.

Much of the book's content is shaped by the editors' unique but complementary backgrounds that have led them down the path of preventive mental health. Dr. Jeste, a geriatric psychiatrist, has been interested in the prevention of cognitive impairment and the role of emotional aging. Dr. Bell has performed extensive research on violence and other social determinants of mental health. Traditional risk factors for mental illness are discussed throughout the book, but emerging research related to protective or resilience factors is also presented, bringing hope to many underserved communities that might be used to a more deterministic and reactive research model. As Dr. Bell states, “risk factors are not predictive factors because of protective factors” (p. 185). As each chapter presents the state of the science in identifying these resilience factors, one is struck by how findings from the Alameda County study (e.g., diet, physical activity, sleep) are echoed. Nonetheless, the psychological and emotional toll that persons with mental or behavioral disorders often experience can make adoption of these healthy behaviors especially challenging. Hence, what makes this book particularly important to the field of public health as well as to psychiatry is recognition that these prevention strategies must be accompanied by understanding of the underlying emotional, environmental, and psychological factors that can facilitate or impede health behavior change in vulnerable groups. Hence, from the complementary perspectives of Drs. Jeste and Bell, one can see how the broader field of health promotion/prevention research can in turn be shaped by this emerging psychiatric research.

Moreover, what is particularly noteworthy is how many of the chapters provide research “pearls,” or primers on methodological issues of particular salience to prevention in mental health. The reader is first introduced to the concept of behavioral vaccines, defined as “repeated simple behavior(s) that reduce morbidity or mortality and increase well-being” (p. 3). As with medical vaccines, behavioral vaccines may involve low-cost population-level approaches, such as public service announcements regarding bullying or omega-3 fatty acid supplementation. The chapter on Internet-based depression prevention stretches the concept of behavioral vaccines even further, providing a thorough review of technology-based interventions for depression. Other research pearls include a primer on the methodological issues in applying the number needed to treat, often used to gauge efficacy in medication trials, to measure the effectiveness of prevention interventions for late-life depression. There is also a section on dementia that offers the reader a succinct description of meta-analyses and the promises and pitfalls of this approach when assessing interventions ranging from pharmacotherapy to social support-based approaches. Moreover, the chapter on genomics provides a well-written synopsis on history, current research trends, and policy and insurance implications. For clinicians, a practical guide to prevention of co-occurring conditions, including metabolic syndrome monitoring, is also provided in the chapter on serious mental illness.

Finally, suggested areas for future research are widely discussed throughout the book. Notably, the chapter on Internet technologies introduces the role of emerging implementation research, particularly in facilitating the adoption of new technologies or behavioral vaccines. Some of the implementation and dissemination of mental health prevention interventions may require a sequel to this already comprehensive monograph, especially as ongoing prevention research studies come to fruition. Yet in keeping with the public health framework, this emerging field of research may end up taking a page from the Centers for Disease Control and Prevention (CDC) experience with the research to practice framework to ultimately get effective research off the academic shelf and into communities (2). Developed in the 1990s, the CDC research to practice framework was developed to identify and rapidly disseminate HIV prevention interventions in community-based settings in response to the growing epidemic and was recently adapted to translate mental health treatments to community practices (3). Ultimately Prevention in Mental Health provides guidance for the next generation of mental health research and, by focusing on prevention efforts, leads the call for this emerging paradigm shift toward a public health model that holds promise in reducing the burden of mental disorders in our communities.