Preventing mental illness

In the research focus “Prevention” the PROTECT Lab deals with

  • the development of psychological interventions for the prevention of mental illness, with a focus on the prevention of depression
  • the evaluation of the effectiveness of interventions for the prevention of mental disorders (randomized controlled trials, meta-analyses, individual patient data meta-analyses)
  • the cost-effectiveness of prevention
  • the identification of mechanisms of action of preventive psychological interventions
  • Questions of indication: for whom are preventive psychological interventions effective, for whom not?
  • the question of how to increase the use of preventive interventions in populations at risk

 

Why bother with prevention?

Mental disorders are widespread with estimated lifetime and 12-month prevalence rates of between 18.1-36.1% and 9.8-19.1% respectively ( Kessler et al., 2009). Mental disorders are not only one of the leading causes of disability ( Whiteford et al., 2013), but are also associated with a high burden of disease and an increased risk of developing chronic physical conditions and premature death ( Saarni et al., 2007; Üstün, Ayuso-Mateos, Chatterji, Mathers, & Murray, 2004). The economic consequences are also substantial, due to medical costs, disability at work, and reduction in work participation and productivity ( Berto, D’Ilario, Ruffo, Virgilio, & Rizzo, 2000; Greenberg & Birnbaum, 2005; Smit et al., 2006.

Over the past decades, a large number of interventions for the treatment of mental disorders have been developed, for which efficacy has been demonstrated in a large number of randomised controlled trials ( Cuijpers, van Straten, Andersson, & van Oppen, 2008; Hofmann & Smits, 2008). However, even assuming a hypothetical scenario of 100% treatment coverage using evidence-based interventions only, the burden of disease attributable to mental disorders can only be reduced by about 1/3 ( Andrews, Issakidis, Sanderson, Corry, & Lapsley, 2004). In fact, however, less than half of those with mental disorders are identified and treated as such ( Kohn, Saxena, Levav, & Saraceno, 2004). For this reason, attention is currently being increasingly focused on the prevention of mental disorders.

 

What is prevention ?

Most researchers define prevention as those interventions that are carried out before individuals meet the formal criteria of a mental disorder according to DSM-5. There are three types: universal, selective, and indicated prevention.

  • Universal prevention targets the whole population or parts of the whole population, regardless of whether individuals are at greater risk of developing a disorder (e.g. school program, media campaigns);

  • Selective prevention targets high-risk groups (e.g. with specific risk factors for the development of mental disorders); and

  • Indicated prevention on individuals who already show the first symptoms of a mental disorder but do not yet meet the diagnostic criteria.

By comparison, acute and maintenance treatment is tailored to individuals who already meet or have met the criteria for a disorder.

 

Why prevention?

According to forecasts, mental disorders will be the diseases with the greatest burden of disease on our health system in industrialized countries by 2030 at the latest. In addition, mental disorders are associated with a huge loss of quality of life, increased mortality, and enormous social costs.

According to Australian model studies, for example, only 16% of the burden of disease can be prevented from depression by current psychotherapeutic care. But even if all patients received evidence-based treatment, only 34% of the burden of disease could be prevented.

While there is a great deal of research and treatment available in the field of mental health care, the focus on preventive research has only recently shifted to the treatment of mental disorders.

 

Is it possible to prevent mental disorders?

Numerous empirical findings prove the potential of psychological interventions for the prevention of mental disorders. For example, a recent meta-analysis showed that psychological interventions aimed at preventing depressive disorders could reduce the incidence by about 22% ( van Zoonen et al., 2014).

Results from another review show that cognitive-behavioural-therapeutic, preventive interventions reduce transmission to psychotic disorders with a risk ratio of 0.54 (95%CI: 0.34-0.86) ( Hutton & Taylor, 2014).

Encouraging evidence on the basis of a limited number of randomised controlled trials is also available on the prevention of eating disorders ( Harrer et al., 2020) and tobacco consumption ( Hwang, Yeagley, & Petosa, 2004), among other things.