Lectures Prevention of
Mental Health
Problems
Course of the master Health Sciences (VU)
Content
Introduction to prevention of mental health problems ................................................................................................... 1
Prevention of eating disorders.......................................................................................................................................... 6
Mental health prevention in children and adolescents .................................................................................................. 13
Prevention of psychosis .................................................................................................................................................. 17
Prevention of suicide ...................................................................................................................................................... 26
Prevention of depressive disorders ................................................................................................................................ 33
Prevention of addiction .................................................................................................................................................. 40
Prevention of posttraumatic stress disorder (PTSD) ...................................................................................................... 47
Wrapping up the course: important themes in prevention ........................................................................................... 53
,Introduction to prevention of mental health problems
Course introduction
Goals
- You can explain the most important theoretical and scientific concepts in the field of prevention of mental
health problems
- You can demonstrate a basic understanding of methods to identify who is at risk for developing mental
health problems
- You can discuss the relevance of different risk and protective factors for mental health problems
- You can describe relevant prevention programs for different mental health problems and the evidence for its
effectiveness
- You can conduct a systematic and critical review of the scientific literature in the field of mental health
prevention programs and report on it
- You can integrate gained knowledge on mental health prevention to make recommendations for further
research and practice
Course set-up
Lectures:
- Guest lecturers: experts in the field
Assignment:
- Literature study
- Poster presentation
- Support by a tutor
Assessment:
- Written exam (grade 5.5 or higher) (60% final grade)
- Literature review and poster presentation (grade 5.5 or higher) (40% final grade)
The global burden of mental health disorders
What do we mean by disease burden?
Burden of disease is expressed in Disability(/Daily) Adjusted Life Years (DALYs):
- The amount of ‘health loss’ in a population caused by illness, disability, or early death
- 1 DALY = 1 year of ‘healthy’ life lost to illness, disability or early death
- 0 DALY = ‘perfect health’ and no premature death
DALY = YLL (years life lost) + YLD (years lost due to disability)
- YLD are based on generic measures of quality of life and most important for the burden of mental health
disorders
- YLD is an estimate of reduction of quality of life
Disease burden of mental health disorders
Point prevalence = 16% of the population affected by mental health disorders
DALYs = 7% of total disease burden
YLD = 1/5 of all quality of life lost
Worldwide stats:
- Depression ranked second after HIV/AIDS
- Depression: 150 million (at each point in time
- 1 million suicides a year
- 90 million addictions
Why is the mental health burden so high?
First of all: common disease = high global burden
1
,World Health Organization (WHO) monitors the prevalence and incidence of disorders worldwide including mental
disorders:
Recurrence rates are high:
- The onset of mental health disorders is generally at an early age
- Mental health disorders often affect the working population
- Effect on what you can achieve in life
Worldwide variations
- Higher mental health burden in wealthier countries and countries with high income inequality
- People compare to others: when there are great socioeconomic inequalities, there are more mental
health disorders
- In LMIC (low-middle income) countries: poverty was related to more MH (mental health) burden
However:
- Empirical evidence form LMIC countries is scarce and based on population surveys
- In wealthier countries we screen more for mental health disorders → higher prevalence
- Despite efforts to scale up, treatments in LMIC countries are still lacking so the impact is more devastating
The global burden of disease of mental health disorders
= underestimated, due to:
- People with personality disorders are not included
- Indirect contributions of mental health disorders to mortality
- Suicide and self-harm are grouped under injuries
- Overlap with other (neurological) disorders
- People with chronic pain disorders are not included
2
, Averted YLD with treatment
Estimation of how much percent YLD can be averted with treatment:
- The numbers are quite low if you look at current treatments, but if you only look at evidence-based (EB)
interventions this number goes up
- It is better to treat everyone with evidence-based interventions
- If everyone gets optimal coverage and treatment, we still can not help everyone
➔ This means we need other ways to lift the burden of disease → prevention
How prevention can help: lifting the burden
- Prevention or treatment? → movement to prevention
- It is not one or the other
- 11-27% reduction of disease burden is possible by prevention
- Prevention offers new and cheaper options
Key issues in prevention
Classification of prevention
Traditional medicine:
- Primary: prevent onset of a disorder
- Secondary: early identification
- Tertiary: prevent recurrence, relapse or worsening
Mental health:
- Universal: targeting the population
- Selective: target subgroups that are at risk
- Indicated: target people in the early stages who experience symptoms (includes screening)
- Relapse
3
Mental Health
Problems
Course of the master Health Sciences (VU)
Content
Introduction to prevention of mental health problems ................................................................................................... 1
Prevention of eating disorders.......................................................................................................................................... 6
Mental health prevention in children and adolescents .................................................................................................. 13
Prevention of psychosis .................................................................................................................................................. 17
Prevention of suicide ...................................................................................................................................................... 26
Prevention of depressive disorders ................................................................................................................................ 33
Prevention of addiction .................................................................................................................................................. 40
Prevention of posttraumatic stress disorder (PTSD) ...................................................................................................... 47
Wrapping up the course: important themes in prevention ........................................................................................... 53
,Introduction to prevention of mental health problems
Course introduction
Goals
- You can explain the most important theoretical and scientific concepts in the field of prevention of mental
health problems
- You can demonstrate a basic understanding of methods to identify who is at risk for developing mental
health problems
- You can discuss the relevance of different risk and protective factors for mental health problems
- You can describe relevant prevention programs for different mental health problems and the evidence for its
effectiveness
- You can conduct a systematic and critical review of the scientific literature in the field of mental health
prevention programs and report on it
- You can integrate gained knowledge on mental health prevention to make recommendations for further
research and practice
Course set-up
Lectures:
- Guest lecturers: experts in the field
Assignment:
- Literature study
- Poster presentation
- Support by a tutor
Assessment:
- Written exam (grade 5.5 or higher) (60% final grade)
- Literature review and poster presentation (grade 5.5 or higher) (40% final grade)
The global burden of mental health disorders
What do we mean by disease burden?
Burden of disease is expressed in Disability(/Daily) Adjusted Life Years (DALYs):
- The amount of ‘health loss’ in a population caused by illness, disability, or early death
- 1 DALY = 1 year of ‘healthy’ life lost to illness, disability or early death
- 0 DALY = ‘perfect health’ and no premature death
DALY = YLL (years life lost) + YLD (years lost due to disability)
- YLD are based on generic measures of quality of life and most important for the burden of mental health
disorders
- YLD is an estimate of reduction of quality of life
Disease burden of mental health disorders
Point prevalence = 16% of the population affected by mental health disorders
DALYs = 7% of total disease burden
YLD = 1/5 of all quality of life lost
Worldwide stats:
- Depression ranked second after HIV/AIDS
- Depression: 150 million (at each point in time
- 1 million suicides a year
- 90 million addictions
Why is the mental health burden so high?
First of all: common disease = high global burden
1
,World Health Organization (WHO) monitors the prevalence and incidence of disorders worldwide including mental
disorders:
Recurrence rates are high:
- The onset of mental health disorders is generally at an early age
- Mental health disorders often affect the working population
- Effect on what you can achieve in life
Worldwide variations
- Higher mental health burden in wealthier countries and countries with high income inequality
- People compare to others: when there are great socioeconomic inequalities, there are more mental
health disorders
- In LMIC (low-middle income) countries: poverty was related to more MH (mental health) burden
However:
- Empirical evidence form LMIC countries is scarce and based on population surveys
- In wealthier countries we screen more for mental health disorders → higher prevalence
- Despite efforts to scale up, treatments in LMIC countries are still lacking so the impact is more devastating
The global burden of disease of mental health disorders
= underestimated, due to:
- People with personality disorders are not included
- Indirect contributions of mental health disorders to mortality
- Suicide and self-harm are grouped under injuries
- Overlap with other (neurological) disorders
- People with chronic pain disorders are not included
2
, Averted YLD with treatment
Estimation of how much percent YLD can be averted with treatment:
- The numbers are quite low if you look at current treatments, but if you only look at evidence-based (EB)
interventions this number goes up
- It is better to treat everyone with evidence-based interventions
- If everyone gets optimal coverage and treatment, we still can not help everyone
➔ This means we need other ways to lift the burden of disease → prevention
How prevention can help: lifting the burden
- Prevention or treatment? → movement to prevention
- It is not one or the other
- 11-27% reduction of disease burden is possible by prevention
- Prevention offers new and cheaper options
Key issues in prevention
Classification of prevention
Traditional medicine:
- Primary: prevent onset of a disorder
- Secondary: early identification
- Tertiary: prevent recurrence, relapse or worsening
Mental health:
- Universal: targeting the population
- Selective: target subgroups that are at risk
- Indicated: target people in the early stages who experience symptoms (includes screening)
- Relapse
3
