Although scientists have long demonstrated that various medical illnesses
can be prevented by vaccines, early-screening tools, or particular behaviors,
they have only recently started conducting studies to see whether mental
illnesses can be prevented by specific tactics.
In the past decade, for example, trials have been launched to see whether
improved childhood nutrition prevents antisocial behavior, whether drug
treatment prevents schizophrenia or bipolar disorder in young people at high
risk, and whether an Air Force suicide prevention program is effective. The
latter, in fact, has already produced positive results (Psychiatric
News, December 17, 2004). And now three more studies on preventing mental
illness have produced positive findings as well.
Postcard illustrations by Lasse Skarboevik, Dybvig Communication
A postcard from the early-schizophrenia-detection campaign illustrates
this theme: "The school of life can put you to harder tests than any
The purpose of the first study, conducted by Filip Smit and other
prevention researchers at Trimbos Institute in Utrecht, the Netherlands, was
to see whether a brief intervention could keep primary care patients on the
brink of a clinical depression from developing the disorder.
Some 200 primary care patients with subthreshold depression were randomly
assigned to receive either care as usual by a general practitioner or care as
usual by a general practitioner plus an experimental intervention. The
intervention consisted of giving a patient a self-help manual on how to manage
moods as well as six brief phone conversations with a "prevention"
worker on how to apply techniques described in the manual.
A year later, 18 percent of the control group had developed a
DSM-IV Axis I depression, compared with only 12 percent of the
experimental group—a statistically significant difference, the
researchers reported in the April British Journal of Psychiatry.
"This represents reduction in the incidence by a third," they
wrote, "and indicates superior effectivenss of adjunctive
minimal-contact psychotherapy compared with care as usual."
Moreover, "not only is the intervention more effective," but
economic evaluation indicated that "choosing it over usual care alone is
likely to be the best treatment option...," the investigators pointed
The second study was conducted by Mark Greenberg, Ph.D., director of the
Prevention Research Center at the Pennsylvania State University, and
co-workers to see whether a school-based learning program called the PATHS
Curriculum could prevent internalizing or externalizing behavior problems. The
PATHS Curriculum is designed to help children aged 4 to 11 acquire social and
emotional competence by practicing various self-control strategies.
More than 300 second- and third-grade children were randomized to receive
either regular school instruction or regular school instruction plus the PATHS
Curriculum. They were assessed at the start of the study, seven months after
the curriculum had ended, and a year after the curriculum had ended.
At seven months after the assessment, there were significantly greater
improvements in both inhibitory control and in verbal fluency among the
intervention children than among controls, the researchers found. A year after
the assessment, the intervention children were found to have fewer
internalizing-behavior and externalizing-behavior problems than the control
children. Moreover, improvements in externalizing problems were found to be
mediated via greater inhibitory control, and improvements in internalizing
problems were found to be mediated via both greater inhibitory control and
greater verbal fluency.
Greenberg reported these results at a recent child-resiliency conference
sponsored by the New York Academy of Sciences and held in Arlington, Va.
The third study, headed by Ingrid Melle, M.D., Ph.D., of Ulleval University
Hospital in Oslo, Norway, focused on preventing suicide in individuals in the
early stages of schizophrenia since suicide risk in such persons has been
found to be quite high.
Melle and her coworkers designed their investigation to test this
hypothesis: If the public were made more aware of the symptoms of early
schizophrenia through a media/education campaign and of the value of treating
it at an early stage, would it bring people in the early stages of
schizophrenia into treatment sooner and thereby reduce their risk of
Such an educational campaign was then conducted in two communities, while
two other communities served as controls. Individuals in the four communities
who sought first-time treatment for schizophrenia during the campaign as well
as during the next four years were then identified, and 281 of them were
enrolled in the study. Half came from the communities that had conducted the
campaign, the other half from the communities that had not.
Melle and her colleagues then assessed the number of suicidal thoughts and
behaviors occurring in the month before seeking treatment in both groups. The
exposure group had experienced significantly fewer suicidal thoughts and
behaviors in the month before seeking treatment than the nonexposure group
had, the researchers found. By getting treatment earlier, they reduced their
risk of suicide, Melle and her team concluded in the May American Journal
An abstract of "Cost-Effectiveness of Preventing Depression in
Primary Care Patients" is posted at<http://bjp.rcpsych.org/cgi/content/abstract/188/4/330>."
Early Detection of the First Episode of Schizophrenia and Suicidal
Behavior" is posted at<http://ajp.psychiatryonline.org/cgi/content/full/163/5/800>.▪