0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Articles   |    
Prevention of Mental Disorders, Substance Abuse, and Problem Behaviors: A Developmental Perspective
William R. Beardslee, M.D.; Peter L. Chien, M.D.; Carl C. Bell, M.D.
Psychiatric Services 2011; doi: 10.1176/appi.ps.62.3.247
View Author and Article Information

Send correspondence to Dr. Chien at the Community Mental Health Council, 8704 S. Constance Ave., Chicago, IL 60617 (e-mail: pchien2@gmail.com).

Copyright © 2011 by the American Psychiatric Association.

Robust scientific evidence shows that mental, emotional, and behavioral disorders can be prevented before they begin. This article highlights and expands points from a 2009 Institute of Medicine report to provide a concise summary of the literature on preventing mental illness. Because prevention requires intervention before the onset of illness, effective preventive approaches are often interdisciplinary and developmental. Evidence-based preventive strategies are discussed for the different phases of a young person's life. Specific recommendations to focus on parenting, child development, and the prevention of depression are made for a target audience of practicing psychiatrists and mental health professionals. Further systemic recommendations are to prioritize prevention and to coordinate and facilitate research on preventive practices in order to reduce suffering, create healthier families, and save money. (Psychiatric Services 62:247–254, 2011)

Abstract Teaser
Figures in this Article

Prevention in psychiatry is possible. A scientific base of evidence shows that we can prevent many mental, emotional, and behavioral disorders before they begin. This robust evidence is presented in the landmark 2009 Institute of Medicine (IOM) report titled Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities (1). In this article we highlight and expand key points from the IOM report. Using a developmental perspective, we discuss the effectiveness and implementation of prevention for mental, emotional, and behavioral disorders. With the possibility of reducing the human suffering of mental illness and the economic costs associated with it, psychiatry must act to implement preventive practice.

In our roles as psychiatrists, we see people after symptoms of a mental illness have emerged, after dysfunction has begun. We work hard to provide our best treatments to improve symptoms and outcomes for our patients. We take pride in stopping further symptom development, lessening episodes of illness, and facilitating recovery. Yet, how often do we work with people who do not show problems, in an effort to reduce their risk of developing future mental, emotional, or behavioral disorders?

There is an established and growing scientific body of evidence demonstrating methods to prevent mental illness before it starts. These preventive strategies reduce risk factors, enhance protective factors, and practice mental health promotion. They require using universal approaches that address the entire population, selective approaches for people at elevated risk, and indicated approaches for people showing early signs of an illness. Prevention requires a paradigm shift to implementing strategies before the onset of illness and treating the population before waiting for people to come to our door.

The scientific evidence for prevention is growing. In 1994 the IOM released its first report highlighting models of prevention for selected mental disorders, titled Reducing Risks for Mental Disorders: Frontiers for Prevention Research (2). Primarily, this report challenged the mental health community to apply a risk factor model—as is used in preventing cardiovascular disease and injuries—to the prevention of mental illness. The report recommended increased research and implementation of effective programs for primary prevention of mental disorders. Moreover, it introduced the categories of universal, selective, and indicated prevention to encourage multiple primary preventive interventions toward groups with differing risks.

Since that 1994 report, research and evidence for prevention has accumulated at an increasing rate. Approximately 400 additional randomized controlled prevention trials for mental, emotional, and behavioral disorders have been published, and data have accumulated from other types of trials, such as natural experiments and time-series analyses (1). This evidence provided the basis for the family, school, community, and office interventions presented in the 2009 IOM report. In this article we discuss selected evidence most relevant to psychiatrists and elucidate key findings from that report to illustrate the science of prevention—core principles of prevention in mental health (see box on this page), risk factors and protective factors for mental illness, and the fundamental neuroscience underlying prevention science. We also issue recommendations and discuss building the infrastructure for effective prevention.

Core principles of prevention 

Prevention of mental disorders requires a paradigm shift in mental health care.

  • Mental, emotional, and behavioral disorders are developmental.

  • Mental health and general medical health are inseparable.

  • Successful prevention is inherently interdisciplinary.

  • The support of young people depends on coordinated community-level systems.

  • A developmental perspective is key to successful prevention.

Prevention requires asking the question, “What does a child need one, three, and five years down the line?” It is inherently developmental in an effort to time preventive interventions to have their maximal impact, depending on the age and development of the child.

Prevention focuses on young people because half of all lifetime cases of mental, emotional, and behavioral disorders start by age 14, and three-fourths of disorders start by age 24 (3). In addition, first symptoms typically occur two to four years before progressing to diagnosable disorders. This prevention window, depicted in Figure 1, provides years of distinct opportunities for indicated preventive interventions as well as universal and selective interventions that could be used before symptoms arise (1).

+

Risk factors and protective factors

The characteristic periods in which symptoms usually appear and a diagnosis is made likely represent key biological and psychosocial risk factors that occur at those ages (4). Identified groups of risk factors, in addition to biological and genetic disease vulnerabilities, include socioeconomic disadvantage, family dysfunction, parental risk characteristics, and stressful life events. Knowing this allows us to better target risk factors and promote protective factors for different age groups. This emphasis on developmentally appropriate risk and protective factors was not a feature of the report in 1994 and represents a significant advance.

In addition, promoting developmental competencies is central to understanding the related concept of mental well-being. The IOM report positively defined mental health as an “ability to achieve developmentally appropriate tasks (developmental competence); a positive sense of self-esteem, mastery, well being, and social inclusion; and the ability to cope with adversity” (1). Just as in physical fitness, where individuals may have better health than others, mental well-being exists on a spectrum regardless of whether individuals are symptomatic. Furthering developmental competencies improves mental health and simultaneously serves as a protective factor against the onset of mental illness (5).

+

Preventive interventions

Considering these developmental risk and protective factors, we have multiple opportunities for preventive interventions through an individual's young adulthood (Figure 2). Early in the course of development, there is evidence supporting interventions that are broad based and that foster strengths and skills within the family, the parents, and the child. These include high-quality out-of-home care and home visitation by a nurse, as well as interventions such as adequate nutrition during pregnancy (6,7).

During the school years, interventions that both foster academic development and cultivate social and emotional skills offer great promise (8,9). In adolescence, interventions targeted to more specific disorders are appropriate—in particular, substance abuse prevention and depression prevention (1013).

Policy interventions that strengthen communities and support families throughout their children's developmental stages are preventive. In addition, many individual programs are preventive for children from families in distress, such as from divorce, parental depression, bereavement, or serious medical illness (14,15).

Developmental neuroscience supports the possibility of prevention. The core construct of developmental plasticity complements the core premise of preventive intervention—that it is possible to intervene in the environments of developing children and their families in order to maximize development (16).

Environmental influences are a factor in all stages of brain development. Early stages of brain development, including cell proliferation, differentiation, and migration, are primarily under the control of regulatory genes (17). However, these stages can be disturbed by nutritional deficiencies, infections, toxins, and substance use, which predispose the individual to cognitive, behavioral, and mental health problems (7,18,19). Thus, beginning in gestation, healthy maternal and prenatal care can facilitate proper brain development and the prevention of problems or illness.

From the early childhood years through the early adult years, synapse formations and neural refinement are responsive to stimulation and deprivation (20,21). Thus preventive interventions can enlist parents, families, and communities to provide nurturing care for the child or young adult. In the adult years, brain plasticity continues, which allows for changes in self-regulation or the establishment of protective factors like social support. A constant interplay of genetics and a person's environment governs mental disorders. The environment affects people differently, depending on their genetics, and particular genetic risks activate only with certain environmental influences (22).

The following interventions are particularly relevant to psychiatrists because they either provide evidence about the prevention of specific diseases or focus on the social and emotional skills of parents, a regular clinical population group. Many other preventive examples are detailed in the IOM report.

+

Parenting programs

Parenting programs have evidence-based, preventive outcomes for children. These programs have been effectively used as primary prevention for children without symptoms (universal prevention), with elevated risk factors (selective prevention), and with subsyndromal symptoms (indicated prevention).

Most of these programs work with parents of preschool-age through middle school-age children to encourage noncritical, consistent disciplinary techniques and positive interactions with their children. Many also focus on social skills and emotional communication. The direct outcomes of these programs for parents have included increased competency in using parenting techniques, improved parent self-confidence, and improved communication within the family (6,23,24).

Parenting programs have demonstrated long-term, decreased aggressive and antisocial behaviors (2426), less substance use (1012), and fewer arrests for the children of the involved parents (27). As a group, parenting programs also demonstrated improved academic success and better classroom behavior of the children (28,29). The outcomes of parenting programs have been replicated in many settings, including different regions (30), different countries (24,31), and different cultural groups, including African-American populations (32).

These parenting programs work by two primary mechanisms. They provide caregivers with social and emotional skills to support youths, and they provide youths with an environment that cultivates the social and emotional skills necessary for healthy affect regulation (33).

+

Prevention of depression

Another area that shows great promise is the prevention of depression. The preventive trials that have shown the strongest results have been with two high-risk groups: high-risk adolescents (13,3436) and pregnant women (13,37,38). The most common methods of preventing the onset of depressive disorders are using cognitive-behavioral strategies and psychoeducational, family-based approaches.

Challenging negative assumptions in cognitive-behavioral groups has been shown in multisite trials to be effective for adolescents (39) of various populations and cultural groups (40). Using a cognitive approach delivered through the schools, the Penn Resiliency Program cut the rate of moderate to severe depressive symptoms in half (41). This program has been shown to be adaptable and beneficial for Latino clients (42).

Psychoeducational approaches involving parents and the family in conversations about depression have led to decreases in depressive symptomatology and overall increases in family functioning (43). Similar results have been shown with inner-city, single-parent families in racial-ethnic minority groups (44), Latino families (45), and in settings like Head Start (46,47) and in a wide array of prevention programs in Europe (48).

Two separate meta-analyses confirmed that parenting programs reduce depressive symptoms among youths (49) and reduce the incidence of depressive disorders (50). Some evidence has shown similar strategies to be effective in the prevention of anxiety disorders (51,52).

Evidence confirms the value of social and emotional skills training across the school-age years. Various school-based and other programs to foster social and emotional learning have shown significant increases in academic functioning and reduction in symptomatology (53,54). Some, including the Baltimore City Project, have shown that interventions delivered in first or second grade can have effects into late adolescence (55). The PATHS program (Promoting Alternative Thinking Strategies) provides a particularly powerful example of how emotional understanding and regulation can reduce aggressive, disruptive, and depressive symptoms (53,56). There was also strong support for interventions that involve multiple sectors at once. For example, the Seattle Social Development Project delivered an intervention that involved parents, teachers, and schoolchildren simultaneously during the grammar school years. This intervention showed long-term positive effects on mental health more than a decade later (57).

These approaches highlight the substantial economic savings that can materialize with prevention. The cost of mental, emotional, and behavioral disorders for young people was estimated at $247 billion in 2007, with consideration of direct costs of mental health and health services, productivity, and crime (1). This estimate did not consider indirect costs, such as the cost for a family to care for a child with mental illness or the additional cost for a school to educate him or her.

Prevention programs would save these costs. Aos and colleagues' (58) cost-benefit analysis showed that savings from effective programs far outweighed their costs. For example, the Strengthening Families Program realized reduced drug use, reduced delinquency, and increased academic performance (1012,59,60). It created savings for families, schools, the juvenile justice system, and the health and mental health care systems. These outcomes in such various systems highlight the interdisciplinary nature and savings of prevention, estimated at $8 for every $1 invested in this program (58).

These benefits and outcomes have the potential to last many years, multiplying these savings over the lifetimes of the youths affected. Many parenting programs have documented multiyear outcomes (15,25,59). In addition, the Seattle Social Development Project showed sustained interdisciplinary outcomes over at least 15 years after an elementary school intervention. Into their mid- to late-20s, program participants showed significantly fewer mental disorders, and they sustained positive directional patterns for 27 out of the 28 tracked outcomes across school, work, community, health, mental health, crime, and sexual behaviors (57). An independent cost analysis estimated that this project returned $3.14 for every dollar spent (58).

Beyond the economic argument that billions of dollars could be saved in health care costs, practicing prevention supports the central mission of mental health promotion—to improve people's lives. Effective prevention reduces illness and its associated suffering. Currently, mental, emotional, and behavioral disorders create the largest burden of disease in the United States for any category of illness (61) because of their early onset and length of morbidity. In youths aged 15–24, almost half of disability-adjusted life years lost are associated with mental, emotional, and behavioral disorders (1). In addition to the morbidity, chronic mental illnesses are associated with up to 25 years of premature mortality (62). Effective prevention alleviates this suffering and stops the impact of disability and disruptive behaviors of mental illness on the lives of individuals and families.

At the same time, the outcomes of the preventive interventions create more developmentally competent children with enhanced social and emotional skills, better academic achievement, and improved general health. Parents are more nurturing, and both children and parents have less mental illness. Fewer children are taken from their parents, families are more cohesive, and schools become better educational environments (813,2334,57).

Addressing broader public and social risk factors provides another approach to prevent mental, emotional, and behavioral disorders. For example, poverty often entails “a range of material hardships, such as overcrowding, frequent moves (which often mean changes of school), poor schools, limited health care, unsafe and stressful environments, and sometimes lack of adequate food” (1).

The IOM report strongly endorses the idea that poverty is a potent risk factor for many emotional and behavioral disturbances. It also endorses the position that poverty must be addressed: “One factor lurks in the background of every discussion of the risks for mental, emotional, and behavioral disorders and antisocial behavior: poverty. • Although not the focus of this report, there is evidence that changes in social policy that reduce exposure to these risks are at least as important for preventing mental, emotional and behavioral disorders in young people as other preventive interventions. We are persuaded that the future mental health of the nation depends crucially on how, collectively, the costly legacy of poverty is dealt with” (1). Collective action on social and economic policies directed toward poverty and other common risk factors, such as exposure to violence, social isolation, and discrimination, is as important as other measures to the prevention of mental disorders.

We have two sets of recommendations—one for the individual psychiatrist and mental health clinician and the other for the mental health system.

+

For the mental health clinician

Our main recommendation for psychiatrists and practicing mental health clinicians is to think and act more preventively (see the box on this page for specific recommendations).

Recommendations for the psychiatrist and mental health clinician 
  • Understand evidence-based practices for mental health promotion and prevention. Look for opportunities when these might apply.

  • Support the mental health and parenting skills of parents.

  • Encourage the developmental competencies of children. Use preventive strategies for children at risk, such as children of parents with a mental illness or children with family stresses (such as divorce or job loss).

  • Practice appropriate preventive strategies for the setting in which you work. Support and refer to preventive programs in other settings as appropriate.

  • Promote widespread use of evidence-based prevention and health promotion in schools, in communities, and in health care.

  • Advocate for addressing the common risk factors for mental illness, such as poverty and exposure to violence.

Some approaches can be conducted in an office. For example, mental health clinicians can run groups for adolescents displaying subsyndromal depressive symptoms to prevent the onset of depression. Family sessions can be offered for depressed parents and their children without depressive symptoms (34,35,43). Supporting parenting skills and treating depressive symptoms of parents to remission can prevent mental illness for their children (63).

Mental health promotion should also be incorporated as a part of an individual's development. Encouraging a child to explore an interest in the piano may have a positive effect on mental health by developing competency and self-efficacy. Such a health promotion approach makes sense in any individual or group intervention (64).

Because health promotion and prevention require action before the onset of illness, many intervention efforts occur outside of traditional health care agencies. Accordingly, psychiatrists can promote preventive examples in settings such as homes, schools, and community organizations.

Mental health professionals should support the parenting programs discussed previously for their many improved mental health and substance abuse outcomes. Children whose mothers were visited by nurses in home visitation programs showed more cognitive and social-emotional competence and were less likely to become involved in the juvenile justice system (65). These nurse home visitation programs received $1.5 billion in the recent health care reform legislation (Patient Protection and Affordable Care Act) and deserve further advocacy and implementation support for their beneficial mental health outcomes.

Even the preliminary evidence that omega-3 fatty acids are neuroprotective (66) and preventive of psychosis, with few major side effects (67), can be a preventive nutritional recommendation in settings such as public school systems. Such evidence highlights the systemic need for further clinical and implementation research into preventive practices.

+

For the mental health system

As emphasized in the IOM report, the two central systemic recommendations are first, to make healthy mental, emotional, and behavioral development a national priority, and second, to coordinate and integrate prevention approaches across all federal and state agencies.

With the recent health care reform law, the National Prevention, Health Promotion, and Public Health Council has been created to better support preventive efforts. This council, whose establishment was recommended in the IOM report, has the potential to create more visibility for preventive efforts. Mental health advocates need to ensure that this council will include equal representation for the prevention of mental, emotional, and behavioral disorders.

The second recommendation is to coordinate prevention research and implementation efforts. The new council mentioned above should coordinate the interdisciplinary efforts of the Departments of Health and Human Services, Justice, and Education toward a comprehensive federal strategy to promote mental health and prevent mental, emotional, and behavioral disorders.

Similarly, states and communities need to develop a networked system for funding and coordinating prevention efforts. One idea is to dedicate funding in mental health block grants for prevention efforts, much as substance abuse block grants set aside funding for substance abuse prevention. Another strategy is “braided” implementation and research funding, which pairs funding for research with funding for implementation of preventive programs.

In addition, the National Institute of Mental Health should develop a comprehensive, long-term, preventive research plan. Research should emphasize programs with multiple beneficial outcomes, such as parenting programs and programs that show promise for high-prevalence disorders such as depression and anxiety. More research is also needed on effective implementation and dissemination strategies, including ways to effectively adapt interventions to different cultural backgrounds.

The scientific evidence for the prevention of mental, emotional, and behavioral disorders allows us to envision a better future. Imagine what our society, our schools, our communities, and our health care system would be like if organized by these preventive principles (see box on this page).

A Future Founded on Prevention 
  • Families and children have access to the best available, evidence-based, preventive interventions delivered in their communities in a culturally competent and respectful way.

  • Preventive interventions are provided as a routine component of school, health, and community service systems.

  • Children and their families have multiple points of entry for preventive services (including schools, health care settings, and youth centers).

  • Teachers, child care workers, health care providers, and others are routinely trained to support the emotional and behavioral health of young people and the prevention of mental disorders.

  • Families and communities partner in developing and implementing preventive interventions.

  • Innovative, evidence-based preventive interventions are rapidly deployed in multiple systems.

  • A well-organized public health monitoring system tracks the incidence and prevalence of mental, emotional, and behavioral disorders and directs appropriate resources.

If we follow these preventive principles of promoting mental health and intervening early, our children and families would be supported in developing the skills they need to create happy lives free from mental illness. Our society could dedicate more of its resources to create vibrant schools, neighborhoods, and health care facilities. Our schools could promote appropriate developmental, self-efficacy, and communication skills. Our policies could address the common ills of poverty, violence, discrimination, and social isolation.

“The scientific foundation has been created for the nation to create a society in which young people arrive at adulthood with the skills, interests, assets, and health habits needed to live healthy, happy, and productive lives in caring relationships with others. This movement can be guided by a vision of a well-organized system of organizations, programs, and policies to ensure strong families and schools and nurturing neighborhoods” (1).

The foundation is established; will we prioritize continued research and infrastructure? The evidence is here; will we practice its interventions? Prevention is possible—let's make it real.

The authors thank A. Kathryn Power, M.Ed., of the Substance Abuse and Mental Health Services Administration and the members of the Institute of Medicine Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions.

The authors report no competing interests.

O'Connell  ME;  Boat  T;  Warner  KE Preventing Mental, Emotional, and Behavioral Disorders Among Young People:Progress and Possibilities .  Washington, DC,  National Academies Press, 2009. Available at www.iom.edu/CMS/12552/45572/64120.aspx
 
Mrazek  PJ;  Haggerty  RJ:  Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research .  Washington DC,  National Academies Press, 1994
 
Kessler  RC;  Berglund  P;  Demler  O  et al:  Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.  Archives of General Psychiatry 62:593–602, 2005
 
Shanahan  L;  Copeland  W;  Costello  EJ:  Specificity of putative psychosocial risk factors for psychiatric disorders in children and adolescents.  Journal of Child Psychology and Psychiatry 49:34–42, 2008
 
Durlak  JA;  Weissberg  RP;  Pachan  M:  A meta-analysis of after-school programs that seek to promote personal and social skills in children and adolescents.  American Journal of Community Psychology 45:294–309, 2010
 
Olds  DL;  Sadler  L;  Kitzman  H:  Programs for parents of infants and toddlers: recent evidence from randomized trials.  Journal of Child Psychology and Psychiatry 48:355–391, 2007
 
Pitkin  RM:  Folate and neural tube defects.  American Journal of Clinical Nutrition 85:285S–288S, 2007
 
Greenberg  MT;  Weissberg  RP;  O'Brien  MU  et al:  Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning.  American Psychologist 58:466–474, 2003
 
Hoagwood  KE;  Olin  SS;  Kerker  BD  et al:  Empirically based school interventions target at academic and mental health functioning.  Journal of Emotional and Behavioral Disorders 15:66–94, 2007
 
Spoth  RL;  Redmond  C;  Shin  C:  Randomized trial of brief family interventions for general populations: adolescent substance use outcomes 4 years following baseline.  Journal of Consulting and Clinical Psychology 69:627–642, 2001
 
Spoth  RL;  Clair  S;  Shin  C  et al:  Long-term effects of universal preventive interventions on methamphetamine use among adolescents.  Archives of Pediatric and Adolescent Medicine 160:876–882, 2006
 
Spoth  RL;  Redmond  C;  Lepper  H:  Alcohol initiation outcomes of universal family-focused preventive interventions: one- and two-year follow-ups of a controlled study.  Journal of Studies on Alcohol and Drugs 13(suppl):103–111, 1999
 
Barrera  AZ;  Torres  LD;  Muñoz  RF:  Prevention of depression: the state of the science at the beginning of the 21st century.  International Review of Psychiatry 19:655–670, 2007
 
Wolchik  SA;  Sandler  IN;  Weiss  L  et al:  New Beginnings: an empirically-based program to help divorced mothers promote resilience in their children; in Handbook of Parent Training: Helping Parents Prevent and Solve Problem Behaviors . Edited by Briesmeister  JM;  Schaefer  CE  New York,  Wiley, 2007
 
Sandler  IN;  Ayers  TS;  Wolchik  SA  et al:  Family Bereavement Program: efficacy of a theory-based preventive intervention for parentally bereaved children and adolescents.  Journal of Consulting and Clinical Psychology 71:587–600, 2003
 
Shonkoff  JP;  Boyce  WT;  McEwen  BS:  Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention.  JAMA 301:2252–2259, 2009
 
Rhinn  M;  Picker  A;  Brand  M:  Global and local mechanisms of forebrain and midbrain patterning.  Current Opinion in Neurobiology 16:5–12, 2006
 
Fruntes  V;  Limosin  F:  Schizophrenia and viral infection during neurodevelopment: a pathogenesis model? Medical Science Monitor 14:RA71–RA77, 2008
 
Williams  J;  Ross  L:  Consequences of prenatal toxin exposure for mental health in children and adolescents.  European Child and Adolescent Psychiatry 16:243–253, 2007
 
Kandel  ER;  Schwartz  JH;  Jessell  TM (eds):  Principles of Neural Science , 4th ed.  Stamford, Conn,  Appleton and Lange, 2000
 
Smyke  AT;  Koga  SF;  Johnson  DE  et al:  The caregiving context in institution-reared and family-reared infants and toddlers in Romania.  Journal of Child Psychology and Psychiatry 48:210–218, 2007
 
Rutter  M;  Moffitt  TE;  Caspi  A:  Gene-environment interplay and psychopathology: multiple varieties but real effects.  Journal of Child Psychology and Psychiatry 47:226–261, 2006
 
Ireland  JL;  Sanders  MR;  Markie-Dadds  C:  The impact of parent training on marital functioning: a comparison of two group versions of the Triple P-positive parenting program for parents of children with early-onset conduct problems.  Behavioural and Cognitive Psychotherapy 31:127–142, 2003
 
Bell  CC;  Bhana  A;  Petersen  I  et al:  Building protective factors to offset sexually risky behaviors among black South African youth: a randomized control trial.  Journal of the National Medical Association 100:936–944, 2008
 
Reid M  J;  Webster-Stratton  C;  Hammond  M:  Follow-up of children who received the Incredible Years intervention for oppositional-defiant disorder: maintenance and prediction of 2-year outcome.  Behavior Therapy 34:471–491, 2003
 
Hoath  FE;  Sanders  MR:  A feasibility study of enhanced group Triple P-positive parenting program for parents of children with attention-deficit/hyperactivity disorder.  Behaviour Change 19:191–206, 2002
 
Dishion  TJ;  Kavanagh  K:  Intervening in Adolescent Problem Behavior: A Family-Centered Approach .  New York,  Guilford, 2003
 
Mbwana  K;  Terzian  M;  Moore  KA:  What Works for Parent Involvement Programs for Children: Lessons From Experimental Evaluations of Social Interventions [fact sheet] .  Washington, DC,  Child Trends, 2009
 
Spoth  RL;  Randall  GK;  Shin  C:  Experimental support for a model of partnership-based family intervention effects on long-term academic success.  School Psychology Quarterly 23:70–89, 2008
 
Prinz  RJ;  Sanders  MR:  Adopting a population-level approach to parenting and family support interventions.  Clinical Psychology Review 27:739–749, 2007
 
Sanders  MR;  Ralph  A;  Sofronoff  K  et al:  Every family: a population approach to reducing behavioral and emotional problems in children making the transition to school.  Journal of Primary Prevention 29:197–222, 2008
 
Brody  GH;  Kogan  SM;  Chen  YF  et al:  Long-term effects of the strong African American families program on youths' conduct problems.  Journal of Adolescent Health 43:474–481, 2008
 
Bell  CC;  McBride  DF:  Affect regulation and prevention of risky behaviors.  JAMA 304:565–566, 2010
 
Clarke  GN;  Hawkins  W;  Murphy  M  et al:  Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention.  Journal of the American Academy of Child and Adolescent Psychiatry 34:312–321, 1995
 
Clarke  GN;  Hornbrook  M;  Lynch  F  et al:  A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents.  Archives of General Psychiatry 12:1127–1134, 2001
 
Young  JF;  Mufson  L;  Davies  M:  Efficacy of interpersonal psychotherapy-adolescent skills training: an indicated preventive intervention for depression.  Journal of Child Psychology and Psychiatry 47:1254–1262, 2006
 
Zlotnick  C;  Miller  IW;  Pearlstein  T  et al:  A preventive intervention for pregnant women on public assistance at risk for postpartum depression.  American Journal of Psychiatry 163:1443–1445, 2006
 
Crockett  K;  Zlotnick  C;  Davis  M  et al:  A depression preventive intervention for rural low-income African-American pregnant women at risk for postpartum depression.  Archives of Women's Mental Health 11:319–325, 2008
 
Garber  J;  Clarke  GN;  Weersing  VR  et al:  Prevention of depression in at-risk adolescents: a randomized controlled trial.  JAMA 301:2215–2224, 2009
 
Cuijpers  P;  Muñoz  RF;  Clarke  GN  et al:  Psychoeducational treatment and prevention of depression: the “Coping with Depression” course thirty years later.  Clinical Psychology Review 29:449–458, 2009
 
Gillham  JE;  Hamilton  J;  Freres  DR  et al:  Preventing depression among early adolescents in the primary care setting: a randomized controlled study of the Penn Resiliency Program.  Journal of Abnormal Child Psychology 34:203–219, 2006
 
Cardemil  EV;  Reivich  KJ;  Beevers  CG  et al:  The prevention of depressive symptoms in low-income, minority children: two-year follow-up.  Behaviour Research and Therapy 45:313–327, 2007
 
Beardslee  WR;  Wright  EJ;  Gladstone  TRB  et al:  Long-term effects from a randomized trial of two public health preventive interventions for parental depression.  Journal of Family Psychology 21:703–713, 2008
 
Podorefsky  DL;  McDonald-Dowdell  M;  Beardslee  WR:  Adaptation of preventive interventions for a low-income, culturally diverse community.  Journal of the American Academy of Child and Adolescent Psychiatry 40:879–886, 2001
 
D'Angelo  EJ;  Llerena-Ouinn  R;  Shapiro  R  et al:  Adaptation of the preventive intervention program for depression for use with predominantly low-income Latino families.  Family Process 48:269–291, 2009
 
Beardslee  WR;  Avery  MW;  Ayoub  C  et al:  Family Connections: helping early Head Start/Head Start staff and parents address mental health challenges.  Journal of Zero to Three 29:34–42, 2009
 
Beardslee  WR;  Ayoub  C;  Avery  MW  et al:  Family Connections: an approach for strengthening early care systems in facing depression and adversity.  American Journal of Orthopsychiatry 80:482–495, 2010
 
Solantaus  T;  Toikka  S;  Alasuutari  M  et al:  Safety, feasibility and family experiences of preventive interventions for children and families with parental depression.  International Journal of Mental Health Promotion 11:15–24, 2009
 
Horowitz  JL;  Garber  J:  The prevention of depressive symptoms in children and adolescents: a meta-analytic review.  Journal of Consulting and Clinical Psychology 74:401–415, 2003
 
Cuijpers  P;  Van Straten  A;  Smit  F  et al:  Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions.  American Journal of Psychiatry 165:1272–1280, 2008
 
Rapee  RM;  Kennedy  S;  Ingram  M  et al:  Prevention and early intervention of anxiety disorders in inhibited preschool children.  Journal of Counsulting and Clinical Psychology 73:488–497, 2005
 
Dadds  MR;  Holland  DE;  Laurens  KR  et al:  Early intervention and prevention of anxiety disorders in children: results at 2-year follow-up.  Journal of Counsulting and Clinical Psychology 67:145–150, 1999
 
Conduct Problems Prevention Research Group:  The effects of a multiyear universal social-emotional learning program: the role of student and school characteristics.  Journal of Consulting and Clinical Psychology 78:156–168, 2010
 
Sawyer  MG;  MacMullin  C;  Graetz  B  et al:  Social skills training for primary school children: a one-year follow-up study.  Journal of Paediatrics and Child Health 33:378–383, 1997
 
Kellam  SG;  Brown  CH;  Poduska  JM  et al:  Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes.  Drug and Alcohol Dependence 95:S5–S28, 2008
 
Kam  CM;  Greenberg  M;  Kusche  C:  Sustained effects of the PATHS curriculum on the social and psychological adjustment of children in special education.  Journal of Emotional and Behavioral Disorders 12:66–78, 2004
 
Hawkins  JD;  Kosterman  R;  Catalano  RF  et al:  Effects of social development intervention in childhood: 15 years later.  Archives of Pediatrics and Adolescent Medicine 162:1133–1141, 2008
 
Aos  S;  Lieb  R;  Mayfiel  J  et al:  Benefits and Costs of Prevention and Early Intervention Programs for Youth . No 04-07-3901.  Olympia,  Washington State Institute for Public Policy, 2004
 
Spoth  RL;  Redmond  C;  Shin  C:  Reducing adolescents' aggressive and hostile behaviors: randomized trial effects of a brief family intervention 4 years past baseline.  Archives of Pediatrics and Adolescent Medicine 154:1248–1257, 2000
 
Trudeau  L;  Spoth  R;  Randall  GK  et al:  Longitudinal effects of a universal family-focused intervention on growth patterns of adolescent internalizing symptoms and polysubstance use: gender comparisons.  Journal of Youth and Adolescence 36:740–745, 2007
 
 The Global Burden of Diseases, Injuries, and Risk Factors Study .  Geneva,  World Health Organization, 2008. Available at www.who.int/healthinfo/global_burden_disease/GBD_2005_study/en/index.html
 
Lutterman  T;  Ganju  V;  Schacht  L  et al:  Sixteen-State Study on Mental Health Performance Measures . DHHS pub no SMA03-3835.  Rockville, Md,  Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, 2003
 
Pilowsky;  Wickramaratne  P;  Talati  A  et al:  Children of depressed mothers 1 year after the initiation of maternal treatment: findings from the STAR*D Child Study.  American Journal of Psychiatry 165:1136–1147, 2008
 
Griffin  G;  McEwen  E;  Samuels  B  et al  Infusing protective factors for children in foster care.  Psychiatric Clinics of North America , in press
 
Olds  DL;  Henderson  CR;  Cole  R  et al:  Long-term effects of nurse home visitation on children's criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial.  JAMA 280:1238–1244, 1998
 
Hibbeln  JR;  Ferguson  TA;  Blasbalg  TL:  Omega-3 fatty acid deficiencies in neurodevelopment, aggression and autonomic dysregulation: opportunities for intervention.  International Review of Psychiatry 18:107–118, 2006
 
Amminger  GP;  Schäfer  MR;  Papageorgiou  K  et al:  Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial.  Archives of General Psychiatry 67:146–154, 2010
 
References Container

Figure 1 

Age at which symptoms of common mental disorders first appear and are diagnosed

Figure 2 

Preventive intervention opportunities, by developmental phase to young adulthood

+

References

O'Connell  ME;  Boat  T;  Warner  KE Preventing Mental, Emotional, and Behavioral Disorders Among Young People:Progress and Possibilities .  Washington, DC,  National Academies Press, 2009. Available at www.iom.edu/CMS/12552/45572/64120.aspx
 
Mrazek  PJ;  Haggerty  RJ:  Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research .  Washington DC,  National Academies Press, 1994
 
Kessler  RC;  Berglund  P;  Demler  O  et al:  Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.  Archives of General Psychiatry 62:593–602, 2005
 
Shanahan  L;  Copeland  W;  Costello  EJ:  Specificity of putative psychosocial risk factors for psychiatric disorders in children and adolescents.  Journal of Child Psychology and Psychiatry 49:34–42, 2008
 
Durlak  JA;  Weissberg  RP;  Pachan  M:  A meta-analysis of after-school programs that seek to promote personal and social skills in children and adolescents.  American Journal of Community Psychology 45:294–309, 2010
 
Olds  DL;  Sadler  L;  Kitzman  H:  Programs for parents of infants and toddlers: recent evidence from randomized trials.  Journal of Child Psychology and Psychiatry 48:355–391, 2007
 
Pitkin  RM:  Folate and neural tube defects.  American Journal of Clinical Nutrition 85:285S–288S, 2007
 
Greenberg  MT;  Weissberg  RP;  O'Brien  MU  et al:  Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning.  American Psychologist 58:466–474, 2003
 
Hoagwood  KE;  Olin  SS;  Kerker  BD  et al:  Empirically based school interventions target at academic and mental health functioning.  Journal of Emotional and Behavioral Disorders 15:66–94, 2007
 
Spoth  RL;  Redmond  C;  Shin  C:  Randomized trial of brief family interventions for general populations: adolescent substance use outcomes 4 years following baseline.  Journal of Consulting and Clinical Psychology 69:627–642, 2001
 
Spoth  RL;  Clair  S;  Shin  C  et al:  Long-term effects of universal preventive interventions on methamphetamine use among adolescents.  Archives of Pediatric and Adolescent Medicine 160:876–882, 2006
 
Spoth  RL;  Redmond  C;  Lepper  H:  Alcohol initiation outcomes of universal family-focused preventive interventions: one- and two-year follow-ups of a controlled study.  Journal of Studies on Alcohol and Drugs 13(suppl):103–111, 1999
 
Barrera  AZ;  Torres  LD;  Muñoz  RF:  Prevention of depression: the state of the science at the beginning of the 21st century.  International Review of Psychiatry 19:655–670, 2007
 
Wolchik  SA;  Sandler  IN;  Weiss  L  et al:  New Beginnings: an empirically-based program to help divorced mothers promote resilience in their children; in Handbook of Parent Training: Helping Parents Prevent and Solve Problem Behaviors . Edited by Briesmeister  JM;  Schaefer  CE  New York,  Wiley, 2007
 
Sandler  IN;  Ayers  TS;  Wolchik  SA  et al:  Family Bereavement Program: efficacy of a theory-based preventive intervention for parentally bereaved children and adolescents.  Journal of Consulting and Clinical Psychology 71:587–600, 2003
 
Shonkoff  JP;  Boyce  WT;  McEwen  BS:  Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention.  JAMA 301:2252–2259, 2009
 
Rhinn  M;  Picker  A;  Brand  M:  Global and local mechanisms of forebrain and midbrain patterning.  Current Opinion in Neurobiology 16:5–12, 2006
 
Fruntes  V;  Limosin  F:  Schizophrenia and viral infection during neurodevelopment: a pathogenesis model? Medical Science Monitor 14:RA71–RA77, 2008
 
Williams  J;  Ross  L:  Consequences of prenatal toxin exposure for mental health in children and adolescents.  European Child and Adolescent Psychiatry 16:243–253, 2007
 
Kandel  ER;  Schwartz  JH;  Jessell  TM (eds):  Principles of Neural Science , 4th ed.  Stamford, Conn,  Appleton and Lange, 2000
 
Smyke  AT;  Koga  SF;  Johnson  DE  et al:  The caregiving context in institution-reared and family-reared infants and toddlers in Romania.  Journal of Child Psychology and Psychiatry 48:210–218, 2007
 
Rutter  M;  Moffitt  TE;  Caspi  A:  Gene-environment interplay and psychopathology: multiple varieties but real effects.  Journal of Child Psychology and Psychiatry 47:226–261, 2006
 
Ireland  JL;  Sanders  MR;  Markie-Dadds  C:  The impact of parent training on marital functioning: a comparison of two group versions of the Triple P-positive parenting program for parents of children with early-onset conduct problems.  Behavioural and Cognitive Psychotherapy 31:127–142, 2003
 
Bell  CC;  Bhana  A;  Petersen  I  et al:  Building protective factors to offset sexually risky behaviors among black South African youth: a randomized control trial.  Journal of the National Medical Association 100:936–944, 2008
 
Reid M  J;  Webster-Stratton  C;  Hammond  M:  Follow-up of children who received the Incredible Years intervention for oppositional-defiant disorder: maintenance and prediction of 2-year outcome.  Behavior Therapy 34:471–491, 2003
 
Hoath  FE;  Sanders  MR:  A feasibility study of enhanced group Triple P-positive parenting program for parents of children with attention-deficit/hyperactivity disorder.  Behaviour Change 19:191–206, 2002
 
Dishion  TJ;  Kavanagh  K:  Intervening in Adolescent Problem Behavior: A Family-Centered Approach .  New York,  Guilford, 2003
 
Mbwana  K;  Terzian  M;  Moore  KA:  What Works for Parent Involvement Programs for Children: Lessons From Experimental Evaluations of Social Interventions [fact sheet] .  Washington, DC,  Child Trends, 2009
 
Spoth  RL;  Randall  GK;  Shin  C:  Experimental support for a model of partnership-based family intervention effects on long-term academic success.  School Psychology Quarterly 23:70–89, 2008
 
Prinz  RJ;  Sanders  MR:  Adopting a population-level approach to parenting and family support interventions.  Clinical Psychology Review 27:739–749, 2007
 
Sanders  MR;  Ralph  A;  Sofronoff  K  et al:  Every family: a population approach to reducing behavioral and emotional problems in children making the transition to school.  Journal of Primary Prevention 29:197–222, 2008
 
Brody  GH;  Kogan  SM;  Chen  YF  et al:  Long-term effects of the strong African American families program on youths' conduct problems.  Journal of Adolescent Health 43:474–481, 2008
 
Bell  CC;  McBride  DF:  Affect regulation and prevention of risky behaviors.  JAMA 304:565–566, 2010
 
Clarke  GN;  Hawkins  W;  Murphy  M  et al:  Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention.  Journal of the American Academy of Child and Adolescent Psychiatry 34:312–321, 1995
 
Clarke  GN;  Hornbrook  M;  Lynch  F  et al:  A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents.  Archives of General Psychiatry 12:1127–1134, 2001
 
Young  JF;  Mufson  L;  Davies  M:  Efficacy of interpersonal psychotherapy-adolescent skills training: an indicated preventive intervention for depression.  Journal of Child Psychology and Psychiatry 47:1254–1262, 2006
 
Zlotnick  C;  Miller  IW;  Pearlstein  T  et al:  A preventive intervention for pregnant women on public assistance at risk for postpartum depression.  American Journal of Psychiatry 163:1443–1445, 2006
 
Crockett  K;  Zlotnick  C;  Davis  M  et al:  A depression preventive intervention for rural low-income African-American pregnant women at risk for postpartum depression.  Archives of Women's Mental Health 11:319–325, 2008
 
Garber  J;  Clarke  GN;  Weersing  VR  et al:  Prevention of depression in at-risk adolescents: a randomized controlled trial.  JAMA 301:2215–2224, 2009
 
Cuijpers  P;  Muñoz  RF;  Clarke  GN  et al:  Psychoeducational treatment and prevention of depression: the “Coping with Depression” course thirty years later.  Clinical Psychology Review 29:449–458, 2009
 
Gillham  JE;  Hamilton  J;  Freres  DR  et al:  Preventing depression among early adolescents in the primary care setting: a randomized controlled study of the Penn Resiliency Program.  Journal of Abnormal Child Psychology 34:203–219, 2006
 
Cardemil  EV;  Reivich  KJ;  Beevers  CG  et al:  The prevention of depressive symptoms in low-income, minority children: two-year follow-up.  Behaviour Research and Therapy 45:313–327, 2007
 
Beardslee  WR;  Wright  EJ;  Gladstone  TRB  et al:  Long-term effects from a randomized trial of two public health preventive interventions for parental depression.  Journal of Family Psychology 21:703–713, 2008
 
Podorefsky  DL;  McDonald-Dowdell  M;  Beardslee  WR:  Adaptation of preventive interventions for a low-income, culturally diverse community.  Journal of the American Academy of Child and Adolescent Psychiatry 40:879–886, 2001
 
D'Angelo  EJ;  Llerena-Ouinn  R;  Shapiro  R  et al:  Adaptation of the preventive intervention program for depression for use with predominantly low-income Latino families.  Family Process 48:269–291, 2009
 
Beardslee  WR;  Avery  MW;  Ayoub  C  et al:  Family Connections: helping early Head Start/Head Start staff and parents address mental health challenges.  Journal of Zero to Three 29:34–42, 2009
 
Beardslee  WR;  Ayoub  C;  Avery  MW  et al:  Family Connections: an approach for strengthening early care systems in facing depression and adversity.  American Journal of Orthopsychiatry 80:482–495, 2010
 
Solantaus  T;  Toikka  S;  Alasuutari  M  et al:  Safety, feasibility and family experiences of preventive interventions for children and families with parental depression.  International Journal of Mental Health Promotion 11:15–24, 2009
 
Horowitz  JL;  Garber  J:  The prevention of depressive symptoms in children and adolescents: a meta-analytic review.  Journal of Consulting and Clinical Psychology 74:401–415, 2003
 
Cuijpers  P;  Van Straten  A;  Smit  F  et al:  Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions.  American Journal of Psychiatry 165:1272–1280, 2008
 
Rapee  RM;  Kennedy  S;  Ingram  M  et al:  Prevention and early intervention of anxiety disorders in inhibited preschool children.  Journal of Counsulting and Clinical Psychology 73:488–497, 2005
 
Dadds  MR;  Holland  DE;  Laurens  KR  et al:  Early intervention and prevention of anxiety disorders in children: results at 2-year follow-up.  Journal of Counsulting and Clinical Psychology 67:145–150, 1999
 
Conduct Problems Prevention Research Group:  The effects of a multiyear universal social-emotional learning program: the role of student and school characteristics.  Journal of Consulting and Clinical Psychology 78:156–168, 2010
 
Sawyer  MG;  MacMullin  C;  Graetz  B  et al:  Social skills training for primary school children: a one-year follow-up study.  Journal of Paediatrics and Child Health 33:378–383, 1997
 
Kellam  SG;  Brown  CH;  Poduska  JM  et al:  Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes.  Drug and Alcohol Dependence 95:S5–S28, 2008
 
Kam  CM;  Greenberg  M;  Kusche  C:  Sustained effects of the PATHS curriculum on the social and psychological adjustment of children in special education.  Journal of Emotional and Behavioral Disorders 12:66–78, 2004
 
Hawkins  JD;  Kosterman  R;  Catalano  RF  et al:  Effects of social development intervention in childhood: 15 years later.  Archives of Pediatrics and Adolescent Medicine 162:1133–1141, 2008
 
Aos  S;  Lieb  R;  Mayfiel  J  et al:  Benefits and Costs of Prevention and Early Intervention Programs for Youth . No 04-07-3901.  Olympia,  Washington State Institute for Public Policy, 2004
 
Spoth  RL;  Redmond  C;  Shin  C:  Reducing adolescents' aggressive and hostile behaviors: randomized trial effects of a brief family intervention 4 years past baseline.  Archives of Pediatrics and Adolescent Medicine 154:1248–1257, 2000
 
Trudeau  L;  Spoth  R;  Randall  GK  et al:  Longitudinal effects of a universal family-focused intervention on growth patterns of adolescent internalizing symptoms and polysubstance use: gender comparisons.  Journal of Youth and Adolescence 36:740–745, 2007
 
 The Global Burden of Diseases, Injuries, and Risk Factors Study .  Geneva,  World Health Organization, 2008. Available at www.who.int/healthinfo/global_burden_disease/GBD_2005_study/en/index.html
 
Lutterman  T;  Ganju  V;  Schacht  L  et al:  Sixteen-State Study on Mental Health Performance Measures . DHHS pub no SMA03-3835.  Rockville, Md,  Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, 2003
 
Pilowsky;  Wickramaratne  P;  Talati  A  et al:  Children of depressed mothers 1 year after the initiation of maternal treatment: findings from the STAR*D Child Study.  American Journal of Psychiatry 165:1136–1147, 2008
 
Griffin  G;  McEwen  E;  Samuels  B  et al  Infusing protective factors for children in foster care.  Psychiatric Clinics of North America , in press
 
Olds  DL;  Henderson  CR;  Cole  R  et al:  Long-term effects of nurse home visitation on children's criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial.  JAMA 280:1238–1244, 1998
 
Hibbeln  JR;  Ferguson  TA;  Blasbalg  TL:  Omega-3 fatty acid deficiencies in neurodevelopment, aggression and autonomic dysregulation: opportunities for intervention.  International Review of Psychiatry 18:107–118, 2006
 
Amminger  GP;  Schäfer  MR;  Papageorgiou  K  et al:  Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial.  Archives of General Psychiatry 67:146–154, 2010
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 7

Related Content
Articles
Books
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 63.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 63.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 5.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 39.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 56.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles