Preventing Mental, Emotional, and Behavioral Disorders Among Young People Progress and Possibilities (2009) / Chapter Skim
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7 Prevention of Specific Disorders and Promotion of Mental Health
7 Prevention of Specific Disorders and Promotion of Mental Health
Pages 191-220
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From page 191... ...
Similarly, other lowfrequency disorders for which little preventive literature is available, such as bipolar disorder, autism spectrum disorder, and pervasive developmental disorders, are not discussed. The chapter also includes interventions targeted at mental health promotion, including strategies related to fostering positive development among 191
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The chapter closes with conclusions and recommendations based on the evidence presented in both Chapter 6 and Chapter 7. PREVENTION OF SPECIFIC DISORDERS Prevention of Anxiety Anxiety symptoms and disorders typically emerge in childhood (see Chapter 2)
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Intervention participants were also significantly more comfortable than control participants when exposed to a CO2 challenge that elicits anxiety, and significantly fewer had developed anxiety disorders one to two years after the intervention. Seligman, Schulman, and colleagues (1999)
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Although the preventive interventions for anxiety disorders evaluated to date are all based on CBT approaches, recent research suggests that these approaches may not be optimal (Biglan, Hayes, and Pistorello, 2008)
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Both meta-analyses showed slightly higher effect sizes for selective and indicated interventions, although the number of universal interventions was very small. Significant benefit has been reported for preventive interventions for reducing depressive symptoms in children and adolescents, with small to modest effect sizes (Horowitz and Garber, 2006; Jané-Llopis, Hosman, et al., 2003)
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specifically aimed at providing information and assistance in parenting to children of depressed parents, both of which have shown positive results in multiple randomized trials.
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Cuijpers (2002) reviewed three meta-analyses of classroom-based substance abuse prevention programs (Rooney and Murray, 1996; Tobler, Roona, et al., 2000; White and Pitts, 1998)
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Positive results of PRP in preventing depressive symptoms have likewise been reported by Cutuli, Chaplin, and colleagues (2006) and Gillham, Hamilton, and colleagues (2006)
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. Additionally, the principles of the Family Talk intervention have been applied in a program to help teachers develop skills to deal with depressed parents in Head Start and Early Head Start (Beardslee, Hosman, et al., 2005; Beardslee, Ayoub, et al., in press)
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Derzon, Sale, and colleagues (2005) report on an analysis of a 46-site, five-year evaluation of school- and community-based substance abuse prevention programs that included behavioral skills programs, informationfocused programs, recreation-focused programs, and affective programs.
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. The program is among the substance abuse prevention programs for which Aos, Lieb, and colleagues report that benefits exceed costs (2004)
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They found that the TLFB by itself reduced alcohol consumption compared with the no-intervention control. The standard MI produced significantly greater reductions in alcohol use and alcohol problems than did the TLFB; those who received the enhanced MI did not improve as much.
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Some interventions, including three family interventions, MI, and two interventions with both community and school components, showed potential benefit in reducing marijuana use. Compared with the more robust data on school-based substance abuse prevention programs, existing research is insufficient to determine the effectiveness of efforts to prevent substance abuse through interventions in other settings.
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training of community leaders in development of a drug abuse prevention task force, and (4) media promotion of prevention policies and norms (Pentz, MacKinnon, et al., 1989b)
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reviewed 72 studies evaluating the effects of a broad range of media interventions on substance use behavior, attitudes, or knowledge. Using pre-post gain effect size statistics, they found positive effects for those receiving media interventions compared with controls, including smaller increases in substance use, greater improvement in substance use attitudes, and larger gains in substance use knowledge.
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Some effects were detectable as much as two years after the intervention. The effect sizes were smaller for universal interventions, which included many participants not at risk for eating disorders.
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. The published studies of these preventive interventions indicate a substantial reduction in rates of development of frank psychosis and in p rodromal and psychotic symptoms, although one study did not show statistical significance.
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MENTAL HEALTH PROMOTION Mental health promotion programs aim to improve positive outcomes among young people. Some programs share elements with universal prevention programs when they attempt to reduce negative emotional and behavioral outcomes as well as to improve positive mental health outcomes.
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reviewed 177 interventions targeted at reducing behavioral and social problems in children and adolescents, including both prevention and mental health promotion interventions. They found significant mean effects for programs that modified the school environment, helped children negotiate stressful transitions, and provided individually focused mental health promotion.
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, as well as the Big Brothers Big Sisters Program (see Box 7-6) are frequently cited as successful promotion and prevention
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Lifestyle Factors That Promote Mental Health and Prevent Mental, Emotional, and Behavioral Disorders Evidence from a small but growing set of observational and interventional studies indicates that modifications in a number of lifestyle factors, including sleep, diet, activity and physical fitness, sunshine and light, and television viewing, can promote mental health. Of these factors, the opportunity is perhaps strongest for the salutary effects of adequate sleep and certain nutritional elements, such as adequate iron content in the diet.
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. Given that 20 percent or more of children have sleep problems, the contribution of SBD and other sleep problems to behavioral disorders is potentially enormous, though largely underrecognized.
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. While the IQ effect is modest in most studies, intelligence is a protective factor for MEB disorders and related problems.
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. While not yet conclusive, however, the available evidence warrants well-designed experimental trials of the impact of omega-3 in preventing depression and behavioral disorders involving aggression.
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. A meta-analysis of exercise interventions targeting depression and anxiety, primarily in college students, showed significant positive effects related to depression and positive but not significant effects related to anxiety (Larun, Nordheim, et al., 2006)
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Parenting and family-based interventions have demonstrated positive effects on reducing risk for specific externalizing disorders, for multiple problem outcomes in adolescence, for reducing prevalence of diagnosed MEB disorders, and for reducing parenting and family risk factors. Conclusion: Interventions that strengthen families, individuals, schools, and other community organizations and structures have been shown to
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Future research must determine the full impact of these interventions on MEB disorders. Preventive interventions have increasingly demonstrated positive effects on multiple outcomes, but the range of outcomes assessed is also limited.
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. Conclusion: Although evidence-based interventions are now available for broad implementation in some communities, there is a need to increase the effectiveness of prevention programs and to develop inter ventions that reach a larger portion of at-risk populations.
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and in primary care settings; interven tions to address poverty; approaches that combine interventions at mul tiple developmental phases; and approaches that integrate individual, family, school, and community-level interventions. In addition, as discussed in the chapters that follow, achieving the widespread benefits of evidence-based preventive interventions will also require further research on how to train those who implement interventions, how to influence organizations to adopt evidence-based interventions and to implement them with fidelity, and establishing an infrastructure with the capacity to implement and evaluate proven approaches.
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