Summary: Prevention of Mental Health Problems
Lecture 1: Introduction 2
Lecture 2: Prevention & Depression 6
Lecture 3: Prevention of PTSD 12
Lecture 4: Early detection and prevention of psychosis 21
Lecture 5: An environmental perspective on prevention 27
Lecture 6: Prevention of addiction 33
Lecture 7: Suicide prevention 39
Lecture 8: Prevention in Children and Adolescents (C&A) 46
Lecture 9: New Stressors 51
Exam tips 54
1
,Lecture 1: Introduction
Goals = important to know of exam:
- Explain most important theoretical & scientific concepts in field of PMHP
- Basic understanding of methods to identify who is at risk
- Discuss relevance of different risk & protective factors
- Describe prevention programs for different MHP & evidence for its effectiveness
- Conduct systematic & critical review of scientific literature in the field & report on it
- Integrate gained knowledge on prevention to make recommendations for further
research & practice
Global burden of disease (BoD) = Disability Adjusted Life Years (DALYs)
- Amount of ‘health loss’ in a population caused by illness, disability, or early death
- 1 DALY = 1 healthy life year lost & 0 DALY = perfect health, no premature death.
DALY = YLL + YLD
- YLL = years life lost due to early death, YLD = years lost due to disability
- YLD based on generic measures of QoL & for burden of MHD
- YLD is an estimate of reduction QoL & more common in MHD, except suicide.
Top 10 causes of DALY in NL → most non-communicable diseases:
1. Ischaemic heart disease
2. Chronic obstructive pulmonary disease
3. Trachea, bronchus, lung cancers
4. Alzheimer disease & other dementias
5. Back & neck pain
6. Stroke
7. Falls
8. Diabetes mellitus
9. Depressive disorder
10. Anxiety disorder
From all disease burdens:16% affected by MHD, 7% of total BoD, ⅕ of all QoL lost (YLD)
Worldwide statistics: Depression = 2nd (150 mil), 1 mil suicides/year, 90 mil addictions
World Health Organization (WHO) = institute monitors prevalence & incidence of MHD:
- High prevalence mental disorder (⅔ all DALY’s) = anxiety, depression, addiction
- Low prevalence mental disorder (⅓ all DALY’s) = bipolar, schizophrenia, eating, ASD
Why is BoD of MHD as anxiety & depression so high?
- Onset of MHD is generally at early age
- High incidence = new cases
- High prevalence = recurrence rates are high
- MHD affects the working population
Worldwide variations: depend on diagnosis, most
West, some cultures MHD is not accepted.
- More MH burden in wealthier countries &
high income inequality
2
, - LMIC: poverty related to MH burden. Something about SES & MHD.
However:
- Empirical evidence from LMIC countries is scarce & based on population surveys
- Despite efforts to scale up, treatments in LMIC countries are still lacking so the
impact is more devastating.
Global BoD of MHD is underestimated:
- Chronic pain disorders & personality disorders are not included.
- Indirect contribution of MHD to mortality → depression + heart failure.
- Self harm & suicide fall under injury instead of
mental health.
- Overlap with other neurological disorders
Treatment
In general: good treatments for MHD.
2004: researcher estimated how much MHD we could
reduce with the current treatment, evidence-based & if we
could treat more (100%) → total of 40%, but still 60% with
MHD…
Prevention
- 11-27% reduction of disease burden possible by prevention
- Prevention offers new + cheaper options → money plays an important role!
- ‘An ounce of prevention is worth a pound of cure’ - Benjamin Franklin.
Health promotion vs prevention
- Promotion: of positive health by increasing well-being, competence, resilience &
creating supportive living conditions & environments → providing advice
- Prevention: reducing indicende, prevalence & recurrence of disorder (prevent onset)
- Difference = outcome → promotion:promote
well-being. Prevention: preventing MHD.
Mental health condition vs positive mental health
- Mental health condition: outcome prevention
- Positive mental health: outcome promotion
→ These concepts are theoretical in practice, they overlap
& are hard to distinguish.
Mental health/well-being = positive emotional well-being,
psychological & social functioning.
Prevention spectrum: important for prevention,
where are we? Universal, selective or indicated.
3
, Classification of prevention
Traditional medicine:
- Primary = prevent onset of a disorder
- Secondary = early identification & treatment in those diagnosed
- Tertiary = prevent recurrence, relapse, or worseling (disability)
Mental health primary prevention:
- Universal = targeting the population
- Selective = target subgroups that are at risks → behavioral intervention for people
with cancer after treatment.
- Indicated = target people in the early stages who experience symptoms (screen
people, close to secondary) → online mindfulness training to people with mild
symptoms of depression
Challenges in prevention
1. Complexity
- Often unknown who will develop disorder & what disorder
- Efforts may be a waste of time for some people
- Intention to treat: 20 - 30 individuals to treat to prevent one case
2. Low uptake of preventive interventions
- People often experience less urgency, no motivation → solve their own problems.
- Stigma against treatment.
3. Prevention interventions studies need large sample size
- High Number needed to Treat (NNT)
- Multiple programs & risk factors are genetic
- Takes a long time before people develop MHD, study
requires long follow-up
- Include people through school, work.
Who is at risk?
Diathesis-stress model
- Diathesis = predisposition/vulnerability to a disorder
- Stress = occurrence of severe environmental or life event
- Both are necessary for a disorder to develop!
Risk factors: psychopathology
1. Stressful environment or life event
2. Temperamental & personality traits
3. Neurobiological factors
4. Cognitive processes & biases
5. Genetic make-up
→ They interact (in a complex way) to have direct or indirect effects on the development of
psychopathology, causal pathways are difficult to determine.
4
Lecture 1: Introduction 2
Lecture 2: Prevention & Depression 6
Lecture 3: Prevention of PTSD 12
Lecture 4: Early detection and prevention of psychosis 21
Lecture 5: An environmental perspective on prevention 27
Lecture 6: Prevention of addiction 33
Lecture 7: Suicide prevention 39
Lecture 8: Prevention in Children and Adolescents (C&A) 46
Lecture 9: New Stressors 51
Exam tips 54
1
,Lecture 1: Introduction
Goals = important to know of exam:
- Explain most important theoretical & scientific concepts in field of PMHP
- Basic understanding of methods to identify who is at risk
- Discuss relevance of different risk & protective factors
- Describe prevention programs for different MHP & evidence for its effectiveness
- Conduct systematic & critical review of scientific literature in the field & report on it
- Integrate gained knowledge on prevention to make recommendations for further
research & practice
Global burden of disease (BoD) = Disability Adjusted Life Years (DALYs)
- Amount of ‘health loss’ in a population caused by illness, disability, or early death
- 1 DALY = 1 healthy life year lost & 0 DALY = perfect health, no premature death.
DALY = YLL + YLD
- YLL = years life lost due to early death, YLD = years lost due to disability
- YLD based on generic measures of QoL & for burden of MHD
- YLD is an estimate of reduction QoL & more common in MHD, except suicide.
Top 10 causes of DALY in NL → most non-communicable diseases:
1. Ischaemic heart disease
2. Chronic obstructive pulmonary disease
3. Trachea, bronchus, lung cancers
4. Alzheimer disease & other dementias
5. Back & neck pain
6. Stroke
7. Falls
8. Diabetes mellitus
9. Depressive disorder
10. Anxiety disorder
From all disease burdens:16% affected by MHD, 7% of total BoD, ⅕ of all QoL lost (YLD)
Worldwide statistics: Depression = 2nd (150 mil), 1 mil suicides/year, 90 mil addictions
World Health Organization (WHO) = institute monitors prevalence & incidence of MHD:
- High prevalence mental disorder (⅔ all DALY’s) = anxiety, depression, addiction
- Low prevalence mental disorder (⅓ all DALY’s) = bipolar, schizophrenia, eating, ASD
Why is BoD of MHD as anxiety & depression so high?
- Onset of MHD is generally at early age
- High incidence = new cases
- High prevalence = recurrence rates are high
- MHD affects the working population
Worldwide variations: depend on diagnosis, most
West, some cultures MHD is not accepted.
- More MH burden in wealthier countries &
high income inequality
2
, - LMIC: poverty related to MH burden. Something about SES & MHD.
However:
- Empirical evidence from LMIC countries is scarce & based on population surveys
- Despite efforts to scale up, treatments in LMIC countries are still lacking so the
impact is more devastating.
Global BoD of MHD is underestimated:
- Chronic pain disorders & personality disorders are not included.
- Indirect contribution of MHD to mortality → depression + heart failure.
- Self harm & suicide fall under injury instead of
mental health.
- Overlap with other neurological disorders
Treatment
In general: good treatments for MHD.
2004: researcher estimated how much MHD we could
reduce with the current treatment, evidence-based & if we
could treat more (100%) → total of 40%, but still 60% with
MHD…
Prevention
- 11-27% reduction of disease burden possible by prevention
- Prevention offers new + cheaper options → money plays an important role!
- ‘An ounce of prevention is worth a pound of cure’ - Benjamin Franklin.
Health promotion vs prevention
- Promotion: of positive health by increasing well-being, competence, resilience &
creating supportive living conditions & environments → providing advice
- Prevention: reducing indicende, prevalence & recurrence of disorder (prevent onset)
- Difference = outcome → promotion:promote
well-being. Prevention: preventing MHD.
Mental health condition vs positive mental health
- Mental health condition: outcome prevention
- Positive mental health: outcome promotion
→ These concepts are theoretical in practice, they overlap
& are hard to distinguish.
Mental health/well-being = positive emotional well-being,
psychological & social functioning.
Prevention spectrum: important for prevention,
where are we? Universal, selective or indicated.
3
, Classification of prevention
Traditional medicine:
- Primary = prevent onset of a disorder
- Secondary = early identification & treatment in those diagnosed
- Tertiary = prevent recurrence, relapse, or worseling (disability)
Mental health primary prevention:
- Universal = targeting the population
- Selective = target subgroups that are at risks → behavioral intervention for people
with cancer after treatment.
- Indicated = target people in the early stages who experience symptoms (screen
people, close to secondary) → online mindfulness training to people with mild
symptoms of depression
Challenges in prevention
1. Complexity
- Often unknown who will develop disorder & what disorder
- Efforts may be a waste of time for some people
- Intention to treat: 20 - 30 individuals to treat to prevent one case
2. Low uptake of preventive interventions
- People often experience less urgency, no motivation → solve their own problems.
- Stigma against treatment.
3. Prevention interventions studies need large sample size
- High Number needed to Treat (NNT)
- Multiple programs & risk factors are genetic
- Takes a long time before people develop MHD, study
requires long follow-up
- Include people through school, work.
Who is at risk?
Diathesis-stress model
- Diathesis = predisposition/vulnerability to a disorder
- Stress = occurrence of severe environmental or life event
- Both are necessary for a disorder to develop!
Risk factors: psychopathology
1. Stressful environment or life event
2. Temperamental & personality traits
3. Neurobiological factors
4. Cognitive processes & biases
5. Genetic make-up
→ They interact (in a complex way) to have direct or indirect effects on the development of
psychopathology, causal pathways are difficult to determine.
4
