A New Look at Primary Prevention

The renewed interest in primary prevention has been accompanied by changes in conceptualization. Investigators are reassessing their definitions of primary prevention and how it might work; they have placed new emphasis on precipitating factors in mental illness (rather than causative factors), and on mental health promotion—the strengthening of general mental health. This reconceptualization probably stems from the lack of knowledge about specific causation of mental illness and the mounting evidence for genetic factors. Efforts to focus on precipitating stresses in persons already mentally ill—overtly or in remission—are commendable, even though such efforts constitute secondary, not primary, prevention. As for mental health promotion, there seems to be little evidence that it is effective, at least if judged according to a decrease in diagnosable mental disorder. Research on primary prevention should be strongly urged but until we learn the outcome of such research, applied programs of prevention should proceed only on a pilot basis. A different perspective on primary prevention and a detailed description of the general disease prevention paradigm are presented in the companion piece by Bernard Bloom, Ph.D., beginning on page 839.