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Mental Illness Prevention and Promotion
Abstract
There has been a remarkable growth of high quality empirical studies in the prevention of mental illness and the promotion of mental health over the past three decades. A series of reports (Institute of Medicine (IOM), Reducing risks for mental disorders: Frontiers for preventive intervention research, 1994; National Advisory Mental Health Council Workgroup, Blueprint for change: Research on child and adolescent psychiatry, 2001; Beardslee and Gladstone, Facilitating pathways: Care, treatment and prevention in child and adolescent mental health, 2004) has documented progress in the prevention of mental illness. More recently, the Institute of Medicine issued two new reports, one focused entirely on the prevention of emotional and behavioral disorders in youth (National Research Council and Institute of Medicine, Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities, 2009) and another with a specific focus on parental depression (National Research Council and Institute of Medicine, Depression in parents, parenting, and children, 2009). This progress has occurred through the definition of a set of rigorous standards for the conduct of research in prevention (e.g., testing of theoretically driven hypotheses, use of valid assessment instruments, blind assessment of subjects separate from intervention delivery, evaluation of outcomes over the long term, etc.), primarily using randomized trial designs. Yet, against the backdrop of successfully conducted prevention trials and efforts to promote mental health, virtually nothing has been written about the needs of caregivers who engage in prevention and health promotion and, in particular, what kinds of special supports they need. Caring for caregivers in prevention settings is absolutely essential to the success of preventive intervention efforts to date and will be even more important if such efforts are to be widely implemented in large-scale programs.
... it is knowing how to use it and feel competent in decision making (Loureiro & Miranda, 2010). On the other hand, according to (Beardslee & Gladstone, 2014) it is necessary to shift the focus from health promotion to disease prevention. ...
Conceptual Framework: Given the high prevalence of young people suicide, schools are a privileged means of prevention. The existence of the first National Suicide Prevention Plan (2013-2017) is an indicator of awareness of the problem, whose objectives will be to increase health information and education, involving the entire school community. The Health Education Projects (HEPs) in schools aim to promote health education with the participation of all educational agents, however, there is scarce of evidences about the implementation and participation
of the teachers in them.
Objective: The present research aims to identify teacher’s experiences with suicide situation, as well as study teacher’s participation on HEPs at schools.
Methods: Data were gathered from 1144 teachers, both genders, aged between 24 and 69 (M= 45.57; SD = 7.31) who filled out self-reported questionnaire.
Results: Teachers’ have high contact suicidal behavior (attempted and/or
committed) in work context, from both students and co-workers, as well in their private environment. The results evidence that 89.9% of the responders work in school who have implemented HEPs, as well 56.1% of responders participate in this program.
Discussion: The results are discussed in order to provide some actions to
promote a safe and healthy school environment, with attention to the involvement of teachers for student’s health promotion.
Keywords: Suicide, Health Promotion at School, Teachers Involvement
The President's New Freedom Commission on Mental Health has called for a fundamental transformation of the nation's approach to mental health care. In the report Achieving the Promise: Transforming Mental Health Care in America (2003), the commission identifies two principles as the foundation for successful transformation: Services and treatments must be consumer and family centered, building on strengths, and care must focus on coping with and building resilience to face life's challenges. These principles are given legs in Investing in Children, Youth, Families, and Communities: Strengths-Based Research and Policy, in which coeditors Maton, Schellenbach, Leadbeater, and Solarz bring together a diverse and expert team of authors to highlight an impressive body of evidence that supports just such a transformative shift away from the deeply ingrained, historical deficits approach and toward a focus on building on strengths and fostering resiliency. One barrier identified by the President's New Freedom Commission (2003) subcommittee on children as a current hindrance to the implementation of a transforming vision for children's mental health is the gap that exists between "what we know and what we do." Investing in Children, Youth, Families, and Communities addresses that gap by identifying the various reasons for this gap (differences in goals, priorities, orientation, methods, and time schedules), pairing as coauthors scholars with expertise in the psychosocial aspects of an issue with social policy expertise, and calling for a strength-based policy approach that shifts from short-term fixes to long-term investments in future outcomes (Chapter 2). This science-to-practice approach, including implications for policy and program development within each chapter, seeks to bring the divergent worlds of policy and research together and should enhance and broaden the book's appeal across a wider audience. While modeling an innovative approach to reducing the gap between "what we know and what we do," there is a sense throughout the book that the policymakers are a stable group of agency administrators and that the gap can be greatly reduced by improved communication. This view does not acknowledge the key role played by state and federal legislatures, their generally short tenure, and their impact on those agency policymakers.
Context.
—Home-visitation services have been promoted as a means of improving maternal and child health and functioning. However, long-term effects have not been examined.
Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism, and inefficacy. The past 25 years of research has established the complexity of the construct, and places the individual stress experience within a larger organizational context of people's relation to their work. Recently, the work on burnout has expanded internationally and has led to new conceptual models. The focus on engagement, the positive antithesis of burnout, promises to yield new perspectives on interventions to alleviate burnout. The social focus of burnout, the solid research basis concerning the syndrome, and its specific ties to the work domain make a distinct and valuable contribution to people's health and well-being.
The 2009 Institute of Medicine report on prevention of mental, emotional, and behavioral disorders (National Research Council & Institute of Medicine, 2009b) presented evidence that major depression can be prevented. In this article, we highlight the implications of the report for public policy and research. Randomized controlled trials have shown that the incidence of major depressive episodes can be significantly reduced. Meta-analyses suggest that 22% to 38% of major depressive episodes could be prevented with currently available methods. We argue that if major depressive episodes can be prevented, the health care system should provide routine access to evidence-based depression prevention interventions, just as it provides inoculations for other common and debilitating health problems. At the same time, researchers should pursue the major directions advocated by the Institute of Medicine report to increase the enduring effectiveness of future prevention interventions. These directions include taking a developmental perspective, learning to identify groups at high risk, and testing evidence-based interventions that are likely to have the widest reach. Scientific evidence has shown that clinical depression can be averted. Our societies must take action to reduce clinical depression to the lowest possible level. This article is one of three in a special section (see also Biglan, Flay, Embry, & Sandler, 2012; Yoshikawa, Aber, & Beardslee, 2012) representing an elaboration on a theme for prevention science developed by the 2009 report of the National Research Council and Institute of Medicine.
This article considers the implications for prevention science of recent advances in research on family poverty and children's mental, emotional, and behavioral health. First, we describe definitions of poverty and the conceptual and empirical challenges to estimating the causal effects of poverty on children's mental, emotional, and behavioral health. Second, we offer a conceptual framework that incorporates selection processes that affect who becomes poor as well as mechanisms through which poverty appears to influence child and youth mental health. Third, we use this conceptual framework to selectively review the growing literatures on the mechanisms through which family poverty influences the mental, emotional, and behavioral health of children. We illustrate how a better understanding of the mechanisms of effect by which poverty impacts children's mental, emotional, and behavioral health is valuable in designing effective preventive interventions for those in poverty. Fourth, we describe strategies to directly reduce poverty and the implications of these strategies for prevention. This article is one of three in a special section (see also Biglan, Flay, Embry, & Sandler, 2012; Muñoz, Beardslee, & Leykin, 2012) representing an elaboration on a theme for prevention science developed by the 2009 report of the National Research Council and Institute of Medicine.
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.
The purpose of this review was to evaluate whether the Penn Resiliency Program (PRP), a group cognitive-behavioral intervention, is effective in targeting depressive symptoms in youths. We identified 17 controlled evaluations of PRP (N = 2,498) in which depressive symptoms had been measured via an online search of PsycINFO, Medline, ERIC, and ProQuest Dissertations and Theses and by requesting data from PRP researchers. We combined effect sizes (ESs; Glass's d), using random effects models at postintervention and two follow-up assessments (6-8 and 12 months postintervention). PRP participants reported fewer depressive symptoms at postintervention and both follow-up assessments compared with youths receiving no intervention, with ESs ranging from 0.11 to 0.21. Subgroup analyses showed that PRP's effects were significant at 1 or more follow-up assessments among studies with both targeted and universal approaches, when group leaders were research team members and community providers, among participants with both low and elevated baseline symptoms, and among boys and girls. Limited data showed no evidence that PRP is superior to active control conditions. Preliminary analyses suggested that PRP's effects on depressive disorders may be smaller than those reported in a larger meta-analysis of depression prevention programs for older adolescents and adults. We found evidence that PRP significantly reduces depressive symptoms through at least 1-year postintervention. Future PRP research should examine whether PRP's effects on depressive symptoms lead to clinically meaningful benefits for its participants, whether the program is cost-effective, whether CB skills mediate program effects, and whether PRP is effective when delivered under real-world conditions.
Article is available online through PubMed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4667774/
Adolescent offspring of depressed parents are at markedly increased risk of developing depressive disorders. Although some smaller targeted prevention trials have found that depression risk can be reduced, these results have yet to be replicated and extended to large-scale, at-risk populations in different settings.
To determine the effects of a group cognitive behavioral (CB) prevention program compared with usual care in preventing the onset of depression.
A multicenter randomized controlled trial conducted in 4 US cities in which 316 adolescent (aged 13-17 years) offspring of parents with current or prior depressive disorders were recruited from August 2003 through February 2006. Adolescents had a past history of depression, current elevated but subdiagnostic depressive symptoms, or both. Assessments were conducted at baseline, after the 8-week intervention, and after the 6-month continuation phase.
Adolescents were randomly assigned to the CB prevention program consisting of 8 weekly, 90-minute group sessions followed by 6 monthly continuation sessions or assigned to receive usual care alone.
Rate and hazard ratio (HR) of a probable or definite depressive episode (ie, depressive symptom rating score of > or = 4) for at least 2 weeks as diagnosed by clinical interviewers.
Through the postcontinuation session follow-up, the rate and HR of incident depressive episodes were lower for those in the CB prevention program than for those in usual care (21.4% vs 32.7%; HR, 0.63; 95% confidence interval [CI], 0.40-0.98). Adolescents in the CB prevention program also showed significantly greater improvement in self-reported depressive symptoms than those in usual care (coefficient, -1.1; z = -2.2; P = .03). Current parental depression at baseline moderated intervention effects (HR, 5.98; 95% CI, 2.29-15.58; P = .001). Among adolescents whose parents were not depressed at baseline, the CB prevention program was more effective in preventing onset of depression than usual care (11.7% vs 40.5%; HR, 0.24; 95% CI, 0.11-0.50), whereas for adolescents with a currently depressed parent, the CB prevention program was not more effective than usual care in preventing incident depression (31.2% vs 24.3%; HR, 1.43; 95% CI, 0.76-2.67).
The CB prevention program had a significant prevention effect through the 9-month follow-up period based on both clinical diagnoses and self-reported depressive symptoms, but this effect was not evident for adolescents with a currently depressed parent.
clinicaltrials.gov Identifier: NCT00073671.
The authors suggest that the most promising route to effective strategies for the prevention of adolescent alcohol and other drug problems is through a risk-focused approach. This approach requires the identification of risk factors for drug abuse, identification of methods by which risk factors have been effectively addressed, and application of these methods to appropriate high-risk and general population samples in controlled studies. The authors review risk and protective factors for drug abuse, assess a number of approaches for drug abuse prevention potential with high-risk groups, and make recommendations for research and practice.
Drawing on coping resources theory, we evaluate the impact of a job search intervention on depressive symptoms in a randomized field experiment at three follow-up periods covering two and one-half years. Baseline depressive symptoms, low social assertiveness, and financial hardship were identified as significant risk variables predicting depressive symptoms at follow-up. These variables then were used to identify high- and low-risk individuals in both experimental and control groups. Results indicated that the job search intervention had its primary impact on persons identified as being at higher risk for depression. Furthermore, the intervention had an impact on both the incidence and prevalence of more severe depressive symptoms among high-risk individuals.
The experience of staff members of a children's hospital, as presented in ward or staff groups, is considered. Staff meetings were initiated to share work-related concerns and feelings engendered by caring for hospitalized children. Significant stresses experienced by staff are described, and successful coping patterns are identified. The role of the staff group in the coping pattern deserves attention. Certainly, sharing of feelings engendered by working occurs in other places and in other ways than in a staff group. The authors are convinced that such sharing is essential to counteract the stresses of the work, that it can and does occur in staff groups such as have been described, and that the presence of such groups increases the likelihood of the staff's successful coping and resultant enhancement of patient care.
The prevention of major depression is an important research goal which deserves increased attention. Depressive symptoms and disorders are particularly common in primary care patients and have a negative impact on functioning and well-being comparable with other major chronic medical conditions. The San Francisco Depression Prevention Research project conducted a randomized, controlled, prevention trial to demonstrate the feasibility of implementing such research in a public sector setting serving low-income, predominantly minority individuals: 150 primary care patients free from depression or other major mental disorders were randomized to an experimental cognitive-behavioral intervention or to a control condition. The experimental intervention group reported a significantly greater reduction in depressive levels. Decline in depressive levels was significantly mediated by decline in the frequency of negative conditions. Group differences in the number of new episodes (incidence) of major depression did not reach significance during the 1-year trial. We conclude that depression prevention trials in public sector primary care settings are feasible, and that depressive symptoms can be reduced even in low-income, minority populations. To conduct randomized prevention trials that can test effects on incidence with sufficient statistical power, subgroups at greater imminent risk have to be identified.
The purpose of this paper is to review studies of burnout relating to mental health workers and to propose directions for future research. It will summarize findings with regard to established norms, demographic variables, possible antecedents and consequences of burnout, and burnout models tested with mental health workers. Comparison of group perceptions of burnout is facilitated by the fact that all the papers but one have used the Maslach Burnout Inventory (Maslach & Jackson, 1981, 1986). Strengths and weaknesses of the research will be analyzed and suggestions offered for extending research in this area.
The purpose of this study was to compare the sustained effects of two cognitive, psychoeducational preventive interventions for families in which a parent had an affective disorder.
Thirty-seven families, in which there was a child between the ages of 8 and 15 years (mean = 11.5 years) and at least one parent who had experienced a recent episode of affective disorder according to the Research Diagnostic Criteria, were studied 1.5 years after enrollment in the study. The families were randomly assigned to one of two interventions, clinician-facilitated or lecture. The two interventions were similar in content but differed in the degree of involvement of the children and the linking of information to the families' life experiences. Nineteen families participated in the clinician-facilitated intervention, which consisted of six to 10 sessions. Eighteen families were assigned to the lecture condition, which consisted of two lectures attended only by parents. Family members were interviewed both before and after the interventions with diagnostic interviews and semistructured measures designed to assess response to the interventions.
Sustained effects of the interventions were reported 1.5 years after enrollment. The clinician-facilitated intervention was associated with more positive self-reported and assessor-rated changes than the lecture intervention.
These short-term preventive interventions, particularly the clinician-facilitated one, have long-term benefits for families with parental affective disorder.
Adolescent offspring of depressed parents are at high risk for development of depression. Cognitive restructuring therapy holds promise for preventing progression to depressive episodes.
A randomized, controlled trial was conducted to prevent depressive episodes in at-risk offspring (aged 13-18 years) of adults treated for depression in a health maintenance organization (HMO). Potential adult cases were found by reviewing the HMO pharmacy records for dispensation of antidepressant medication and the mental health appointment system. Medical charts were reviewed for a depression diagnosis. Recruitment letters signed by treating physicians were mailed to adults. Eligible offspring had subdiagnostic depressive symptoms insufficient to meet full DSM-III-R criteria for affective disorder and/or a past mood disorder. These youth were randomized to usual HMO care (n = 49) or usual care plus a 15-session group cognitive therapy prevention program (n = 45).
We detected significant treatment-by-time (program) effects for the Center for Epidemiological Studies Depression Scale (P=.005) and the Global Assessment of Functioning scores (P =.04). Survival analysis of incident major depressive episodes during a median 15-month follow-up found a significant advantage (P =.003) for the experimental condition (9.3% cumulative major depression incidence) compared with the usual-care control condition (28.8%).
A brief, group cognitive therapy prevention program can reduce the risk for depression in the adolescent offspring of parents with a history of depression.
The authors tested hypotheses concerning risk mechanisms that follow involuntary job loss resulting in depression and the link between depression and poor health and functioning. A 2-year longitudinal study of 756 people experiencing job loss indicates that the critical mediating mechanisms in the chain of adversity from job loss to poor health and functioning are financial strain (FS) and a reduction in personal control (PC). FS mediates the relationship of job loss with depression and PC, whereas reduced PC mediates the adverse impacts of FS and depression on poor functioning and self-reports of poor health. Results suggest that loss of PC is a pathway through which economic adversity is transformed into chronic problems of poor health and impaired role and emotional functioning.
Objective:
Depression in parents is a prevalent and impairing illness that is encountered frequently in medical practice. Children of depressed parents are at risk for psychopathology and other difficulties. A series of recent national reports have recommended the development of prevention efforts targeting children of depressed parents. Yet, to date, few controlled prevention studies of depression in children and adolescents have been conducted. In this study, we report the evaluation of 2 preventive intervention strategies that target children living in homes with depressed parents. Both are public health approaches that were designed to be used by a wide range of practitioners from a variety of disciplines, including pediatricians, internists, school counselors, nurses, and mental health practitioners. We adopted a developmental perspective and intervened with families when children were entering the age of highest risk for depression onset (ie, adolescence). We chose a family-based approach to prevention and sought to reduce risk factors and enhance protective factors for early adolescents by increasing positive interactions between parents and children, and by increasing understanding of the illness for everyone in the family. Our prevention approaches were designed to provide information about mood disorders to parents, to equip parents with the skills they need to communicate information to their children, and to open a dialogue with their children about the effects of parental depression. We hypothesized that participation in these prevention programs would result in parental change in child-related behaviors and attitudes about depression and its impact on the family. In addition, we hypothesized that this parental change would produce change in children's self-understanding, and in children's depressive symptomatology.
Methods:
We conducted a large-scale efficacy trial of 2 manual-based preventive intervention programs that were designed to be used widely in public health settings. These interventions target the relatively healthy children (ages 8-15) of parents with mood disorder. Ninety-three families (88.5% of our initial sample), including 121 children, participated in this study through the fourth assessment point. These families were assigned randomly to either a lecture or a clinician-facilitated intervention. Both interventions were specified in manuals. The lecture condition consisted of 2 separate meetings delivered in a group format without children present. The clinician-facilitated condition consisted of 6 to 11 sessions, including separate meetings with parents and children, and a family meeting in which the parents led a discussion of the illness and of positive steps that can be taken to promote healthy functioning in the children. In addition, telephone contacts or refresher meetings were conducted at 6- to 9-month intervals. In both conditions, psychoeducational material about mood disorders, risk, and resilience was presented and efforts were made to decrease feelings of guilt and blame in children. Parents were helped to build resilience in their children through encouraging their friendships, their success outside of the home, and their understanding of parental illness and of themselves. In addition, in the clinician-facilitated condition, efforts were made to link the psychoeducational material presented to the family's own unique illness experience. To address directly how their lives had changed, all family members in both conditions were assessed for psychopathology and for overall functioning at intake, and for psychopathology, functioning, and response to intervention immediately postintervention, approximately 1 year postintervention, and again approximately 2.5 years postintervention.
Results:
We examined the outcomes of child understanding and internalizing symptomatology, and a number of predictor variables, using repeated measures analyses with generalized estimating equations. We found that parents in both conditions reported significant change in child-related behaviors and and attitudes, and that the amount of change reported increased over time from time 3 to time 4 (chi2(1) = 18.1). Moreover, relative to parents in the lecture program (mean number of changes = 6.3), parents in the clinician-facilitated program reported more change in child-related behaviors and attitudes (mean number of changes = 9.8). Children in both conditions reported increased understanding of parental illness attributable to participation in our intervention programs. There was a positive association between the amount of change children reported in their understanding of parental illness and the number of changes couples reported in child-related behaviors/attitudes (chi2(1) = 37.3; ie, parents who had changed the most in response to intervention had children who also changed the most). Finally, internalizing scores for all children decreased with increased time since intervention (chi2(1) = 7.3). In addition, females had higher internalizing scores than males (chi2(1) = 5.3). There was no significant effect of group on children's change in internalizing symptomatology (chi2(1) = 0.2).
Conclusions:
We enrolled families with relatively healthy children, administered carefully designed preventive interventions that are manual-based and relatively brief, and found that these programs do have long-standing positive effects in how families problem solve around parental illness. Our results show significant benefits from both interventions. Moreover, changes in parents' perceptions translated directly into changes in children's own understanding of parental illness. Parental behavior and attitude changes and their connection to child changes in understanding identify an important mediating variable: family change. By increasing children's understanding of parental mood disorder, our interventions were found to promote resilience-related qualities in these children at risk. This presentation represents the first and only longitudinal primary prevention study of relatively healthy children at risk for psychopathology attributable to parental mood disorder and demonstrates a significant reduction in risk factors and increase in protective factors in these families over a long time interval--2(1/2) years. Our results provide support for a family-based approach to preventive intervention.
Programs for parents of young children hold considerable promise for improving children's life-course trajectories and for reducing health and development problems and associated costs to government and society. To date, this promise has not been achieved. Fulfilling the potential of parenting interventions will require substantial improvements in current practice for developing and testing such programs. Intervention development will be improved if clinicians and investigators ground parenting interventions in theory and epidemiology; and carefully pilot them to ascertain program feasibility, participant engagement, and behavioral change prior to testing them in randomized trials. Studies of parenting interventions will be improved if they adhere to the highest standards for randomization; if they examine objectively measured outcomes with clear public health relevance; and if they minimize selection factors known to compromise the analysis of data. Policy and practice recommendations for parenting interventions will be improved if they are based upon replicated randomized controlled trials, if the interventions are tested with different populations living in different contexts, and if they are examined in dissemination studies before public investments are made in such programs. Procedures need to be developed to ensure that the essential elements of evidence-based parenting programs can be implemented reliably in a variety of practice settings so that they will produce their intended effects. To date, few programs have met these high programmatic and evidentiary standards, with the result that many large-scale policy initiatives for at-risk parents have failed. Evidence is accumulating, however, that some programs delivered by professionals, especially nurse home visiting programs for pregnant women and parents of young children, produce replicable effects on children's health and development, and that these programs can be reliably reproduced with different populations living in a variety of community settings.
This article presents long-term effects of a randomized trial evaluating 2 standardized, manual-based prevention strategies for families with parental mood disorder: informational lectures and a brief, clinician-based approach including child assessment and a family meeting. A sample of 105 families, in which at least 1 parent suffered from a mood disorder and at least 1 nondepressed child was within the 8- to 15-year age range, was recruited. Parents and children were assessed separately at baseline and every 9 to 12 months thereafter on behavioral functioning, psychopathology, and response to intervention. Both interventions produced sustained effects through the 6th assessment point, approximately 4.5 years after enrollment, with relatively small sample loss of families (<14%). Clinician-based families had significantly more gains in parental child-related behaviors and attitudes and in child-reported understanding of parental disorder. Child and parent family functioning increased for both groups and internalizing symptoms decreased for both groups, with no significant group differences. These findings demonstrate that brief, family-centered preventive interventions for parental depression may contribute to long-term, sustained improvements in family functioning.
The understanding of risks and outcome for psychopathology in children and adolescents has advanced dramatically over the past 20 years. Correspondingly, so has the understanding of protective factors. The development and evaluation of preventive intervention programs are informed by such advances. Indeed, in some ways, the scientific basis for the development of preventive interventions is the understanding of normal development and its vicissitudes. The purpose of this chapter is to discuss some recent developments in our understanding of risk and protective factors in youth, and to illustrate how such understanding has been used in the design of preventive interventions. We will use the example of empirical prevention approaches for adolescent depression, as a discussion of prevention programs for other diagnoses is beyond the scope of this chapter.
This report examines the effects of the Perry Preschool Project, an early intervention program for disadvantaged students, on youths through age 15. The report provides a framework for the study of the effects of early childhood intervention and information on the design of the project. Data are then presented regarding the preschool effects on school performance and experience, and on deviance and social patterns. Also discussed are the economic implications of the study. The report concludes with an analysis of the Perry Preschool Project in the larger educational context. Commentaries by Asa Hilliard and Paul N. Ylvisaker are also included. (APM)
Describes a conceptual framework for identifying and targeting developmental antecedents in early childhood that have been shown in previous work to predict delinquency and violent behavior, heavy drug use, depression, and other psychiatric symptoms and possibly disorders in late adolescence and into adulthood. Criteria are described that guided choices of targets for two epidemiologically based, randomized preventive trials carried out in 19 elementary schools in the eastern half of Baltimore, involving more than 2,400 first-grade children over the course of first and second grades. Baseline models derived from the first of two cohorts show the evolving patterns of concurrence among the target antecedents. The central role of concentration problems emerged. From Fall to Spring in first grade, concentration problems led to shy and aggressive behavior and poor achievement in both genders and to depressive symptoms among girls. There was evidence for reciprocal relationships in girls. For example, depressive symptoms led to poor achievement in both girls and boys, whereas poor achievement led to depressive symptoms in girls but not boys, at least over the first-grade year. These results provide important epidemiological data relevant to the developmental paths leading to the problem outcomes and suggest preventive trials.
Objective:
To examine long-term effects of two forms of preventive intervention designed to increase families' understanding of parental affective disorder and to prevent depression in children.
Method:
Thirty-six families who had a nondepressed child between ages 8 and 15 years and a parent who had experienced affective disorder were enrolled and randomly assigned to either a clinician-facilitated intervention or a lecture discussion group. Each parent and child were assessed prior to randomization, after intervention, and approximately 1 1/2 years after enrollment. Assessments included standard diagnostic interviews, measures of child and family functioning, and interviews about experience of parental affective disorder and intervention effects.
Results:
Children in the clinician-facilitated group reported greater understanding of parental affective disorder, as rated by self-report, rater-generated scales, and parent report, and had better adaptive functioning after intervention. Parents in the clinician-facilitated intervention group reported significantly more change.
Conclusion:
Findings from both interventions support the value of a future-oriented resiliency-based approach. The greater effects of the clinician-facilitated intervention support the need for linking cognitive information to families' life experience and involving children directly in order to achieve long-term effects.
This article provides a conceptual framework for research and outlines several new directions for the same on the prevention of depression in youth and reviews the recent literature on prevention efforts targeting children and adolescents. Prevention efforts should target both specific and nonspecific risk factors, enhance protective factors, use a developmental approach, and target selective and/or indicated samples. A review of the literature indicates that prevention programs using cognitive-behavioral and/or interpersonal approaches and family-based prevention strategies are the most helpful. Overall, it seems that there is reason for hope regarding the role of interventions in preventing depressive disorders in youth.
This paper describes the process for and safety/feasibility of adapting the Beardslee Preventive Intervention Program for Depression for use with predominantly low income, Latino families. Utilizing a Stage I model for protocol development, the adaptation involved literature review, focus groups, pilot testing of the adapted manual, and open trial of the adapted intervention with 9 families experiencing maternal depression. Adaptations included conducting the intervention in either Spanish or English, expanding the intervention to include the contextual experience of Latino families in the United States with special attention to cultural metaphors, and using a strength-based, family-centered approach. The families completed preintervention measures for maternal depression, child behavioral difficulties, global functioning, life stresses, and an interview that included questions about acculturative stressors, resiliency, and family awareness of parental depression. The postintervention interview focused on satisfaction, distress, benefits of the adapted intervention, and therapeutic alliance. The results revealed that the adaptation was nonstressful, perceived as helpful by family members, had effects that seem to be similar to the original intervention, and the preventionists could maintain fidelity to the revised manual. The therapeutic alliance with the preventionists was experienced as quite positive by the mothers. A case example illustrates how the intervention was adapted.
To review the recent literature on the prevention of clinical diagnoses of depression in children and adolescents.
Several preventive intervention programs targeting depressive diagnoses in youth were reviewed. These programs based their prevention strategies on cognitive-behavioural and (or) interpersonal approaches, which have been found to be helpful in the treatment of depression. In addition, family-based prevention strategies were reviewed. Also, nonspecific risk factors for youth depression, including poverty and child maltreatment, were discussed as important considerations in prevention programs targeting youth depression.
In general, successful prevention programs targeting youth depression are based on evidence-based treatment programs for youth depression, structured and outlined in manuals, involve careful training of personnel implementing the protocols, and include assessment of fidelity to the intervention protocols. The programs were consistent with cognitive-behavioural and (or) interpersonal psychotherapy traditions. Overall, it appears that there is reason for hope regarding the role of interventions in preventing depressive disorders in youth.
Several new directions for future research on the prevention of depression in youth were outlined. Future research is needed to establish an empirical base for the prevention of depression in high-risk youth and should: focus on targeted and indicated prevention approaches, attend to moderators of intervention effects, include approaches that aim to enhance the family environment, attend to nonspecific risk factors for disorder, and focus on the dissemination phase of prevention research.
Eighteen young men and women whose parents had major affective disorders, often in combination with other serious psychiatric disorders, were selected from a larger sample on the basis of their good behavioral functioning as adolescents at initial assessment. When they were reassessed an average of 2 1/2 years later, 15 of the 18 were still functioning well. Considerable self-understanding, a deep commitment to relationships, and the ability to think and act separately from their parents characterized these young people. Many of them were taking care of their ill parents. The implications of these findings for preventive and clinical intervention are discussed.
High levels of both burnout and job satisfaction have been found in recent studies of mental health professionals. A qualitative methodology was used in a related study to explore reasons for these findings and to investigate staff's accounts of their strategies for coping with their work, and their views of support provided for them and how their jobs might be made less stressful and still more satisfying.
A semi-structured schedule was used to interview a purposive sample of 30 mental health staff drawn from three South London geographical sectors, selected to include junior and senior members of each profession in both hospital and community settings. Interviews were transcribed and analysed using QSR NUD.IST software.
Informal contacts with colleagues were the most frequently mentioned way of coping with the difficult and demanding aspects of work in both hospital and community settings, closely followed by time management techniques. The main formal sources of support described by staff were individual supervision and staff support groups. Accounts of the former were generally positive, but there was great variation in opinions about whether support groups are useful. Almost all the interviewees believed that their jobs could be improved by further training. For community mental health staff the main training gaps were the development of skills in various forms of clinical intervention, whilst ward staff identified the need for further skills in diffusing potentially confrontational and aggressive situations.
Traditionally, research on childhood mood disorders has focused on clinical trials and longitudinal course and outcome studies, rather than on prevention. Recently, however, advances in the design, methodology, and evaluation of prevention approaches and progress in understanding what factors predispose children to depression have made possible the development of theoretically driven, empirically justified approaches to the prevention of depression in youngsters who are at high risk, either because of elevated symptom levels or parental mood disorder. In this review, we outline recent empirical findings on risk factors for depression in nonreferred samples of youngsters and also in children of depressed parents. Additionally, we review three trials of preventive interventions for childhood depression that yield promising initial findings. We emphasize the need to understand both risks for depression and factors that protect youngsters at risk from succumbing to depression in guiding the development of prevention programs. We also argue that consideration of prevention of depression requires addressing broader social adversity influences that lead to poor mental health outcomes in children, even beyond the effects of parental mood disorder. We conclude with an emphasis on the importance of a developmental-transactional perspective that highlights opportunities for intervention at different points across the lifespan.
To describe essential elements in the adaptation of a prevention approach with a high-risk urban sample, chosen to contrast sharply with the primarily middle-class sample in which it had been originally tested.
Key elements of a preventive intervention for families with parental depression were adapted for use in the new context.
A sequence of alliance-building events was implemented, involving engagement at three levels: community, caregivers, and family. The prevention approach was modified to include an expanded approach to defining depression and resilience; greater flexibility on the part of the clinician; more intensive engagement between clinician and family, with a focus on immediate daily concerns; as well as awareness of cultural issues and responsiveness to the subject's experience of violence.
Core principles of helping family members to discuss the effects of depression and adversity on family life were affirmed.
Communities That Care (CTC) is a prevention system designed to reduce levels of adolescent delinquency and substance use through the selection and use of effective preventive interventions tailored to a community's specific profile of risk and protection. This article describes early findings from the first group-randomized trial of CTC.
A panel of 4407 fifth-grade students was surveyed annually through seventh grade. Analyses were conducted to assess the effects of CTC on reducing levels of targeted risk factors and reducing initiation of delinquent behavior and substance use in seventh grade, 1.67 years after implementing preventive interventions selected through the CTC process.
Mean levels of targeted risks for students in seventh grade were significantly lower in CTC communities compared with controls. Significantly fewer students in CTC communities than in control communities initiated delinquent behavior between grades 5 and 7. No significant intervention effect on substance use initiation by spring of seventh grade was observed.
CTC's theory of change hypothesizes that it takes from 2 to 5 years to observe community-level effects on risk factors and 5 or more years to observe effects on adolescent delinquency or substance use. The early findings indicating hypothesized effects of CTC on targeted risk factors and initiation of delinquent behavior are promising.
Prevention of mental disorders and the study of developmental psychopathology: A natural alliance
- W R Beardslee
- W. R Beardslee
Beardslee, W. R. (2000). Prevention of mental disorders and the study of developmental psychopathology: A natural alliance. In J. Rapoport (Ed.), Childhood onset of "adult" disorder:
What can it tell us? (pp. 233-354). Washington: American Psychiatric Press.
The optimistic child: A proven program to safeguard children against depression and build lifelong resilience
- M E P Seligman
- K Reivich
- L Jaycox
- J Gillham
- M. E. P. Seligman
Seligman, M. E. P., Reivich, K., Jaycox, L., & Gillham, J. (1995). The optimistic child: A proven
program to safeguard children against depression and build lifelong resilience. New York:
HarperPerrenial.
Investing in children, youth, families, and communities: Strengths-based research and policy
- K Maton
- C Schellenbach
- B Leadbeater
- A Solarz
- K. Maton
Prevention of mental disorders: Effective interventions and policy options: Summary report
World Health Organization. (2004). Prevention of mental disorders: Effective interventions and
policy options: Summary report. Geneva: Author.