Reducing Risks for Mental Disorders Frontiers for Preventive Intervention Research (1994) / Chapter Skim
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4 THE CORE SCIENCES: CONTRIBUTIONS AND FRONTIERS
4 THE CORE SCIENCES: CONTRIBUTIONS AND FRONTIERS
Pages 53-72
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From page 53... ...
In the sections that follow, this chapter presents four of these integrative core sciences as illustrations-neuroscience, genetics, epidemiology, and developmental psychopathology to highlight how they have contributed and will continue to contribute to preventive intervention research. NEUROSCIENCE Neuroscience research encompasses the acquisition of knowledge about fundamental biological processes of the brain and nervous system 53
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From page 54... ...
Such understanding also can be important in framing and implementing a rational prevention strategy. The more that is known about etiology, the more possible it becomes to target preventive interventions to intervene in causal chains.
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Genetic influences are quite relevant to prevention research. First, the accumulated results in genetic research have provided convincing evidence of the role of genetic factors both in normal variations in Portions of this section were based on a commissioned paper by M
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Some of these indicated preventive interventions may be pharmacological, but rich opportunities also exist for psychosocial interventions. An example of such an opportunity may exist with infantile autism, a severe developmental disorder that strikes in infancy and leads to profound cognitive and social impairment.
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to thinking about how we may elucidate possible risk mechanisms. Examples relevant to mental disorders include the role genetic factors play in alcohol dependence, depressive disorders, physiological reactivity, temperamental characteristics, and emotional and conduct disturbances.
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From page 58... ...
Shared risk factors that apply to the family as a whole, such as family discord or poverty, are indeed relevant, but they are likely to impinge on different children in the same family to varying degrees or in different ways, that is, to have nonshared effects. If we are to understand how such environmental risk factors operate, we must investigate the processes on a personspecific basis and not simply assume a uniform impact.
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From page 59... ...
Nevertheless, there is still a tendency to treat obstetric complications as though they were only environmental risk factors. Recent evidence suggests that the process may also work the other way around: genetic or chromosomal abnormalities in the fetus may predispose to obstetric complications.
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Genetic counseling is no longer confined to advising people about the risks involved if they have children or the risk involved in a particular pregnancy. It may now involve decisions on whether to take preventive action with people who are known to be at genetic risk through mechanisms involving susceptibility to environmental factors.
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From page 61... ...
Epidemiological research has produced data on differential incidence and prevalence by demographic factors such as age, gender, educational level, employment status, ethnicity, and socioeconomic level; environmental factors such as hazardous conditions, toxic substances, stressful environments, availability of resources or supports, and ease of availability of drugs, alcohol, guns, and cars; personal attributes such as temperament, attractiveness, intelligence, and prior individual experience; and biological attributes such as genetics, health status, and other biological vulnerability. Throughout Epidemiological research, there is a common goal of c~enury~ng risk factors.
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From page 62... ...
If the relative risk of lung cancer for smokers versus nonsmokers is 15, as above, and the prevalence of smoking is about 50 percent, then the proportion of cases of lung cancer attributable to smoking, that is, the attributable risk, is approximately 88 percent. Data on prevalence and on attributable risk are especially germane to research on the prevention of mental disorders.
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From page 63... ...
Data from these studies strongly suggest that the delivery of health care services for the general population could be greatly improved by subsidizing expanded preventive interventions for people at risk for certain health disorders, although the economic and social consequences of such targeted practices have yet to be determined (CBASSE, 1988)
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From page 64... ...
They also study children who appear emotionally healthy early in life, but develop mental disorders in adulthood. Prospective longitudinal risk research is at the heart of this new discipline; prospective designs help define etiologies and pathways for illness, illuminating changes in risk and protective factors for individuals over time.
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Two examples highlight the research developments in developmental psychopathology. First, low birthweight and premature birth have long been thought to be risk factors associated with increased rates of behavioral and emotional symptoms.
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From page 66... ...
For example, other forms of parental psychopathology and child maltreatment, and especially the interactive effects when both risk factors are present, also significantly increase the likelihood that a child will become depressed in middle childhood (Downey and Walker, 1992; Toth, Manly, and Cicchetti, 1992~. The rate of depression rises overall between childhood and adolescence.
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From this developmental focus has arisen the concept of sensitive periods. · Eventually, it may become possible to determine the precise mechanisms by which environmental risk factors operate.
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From page 68... ...
· Contributions from areas of investigation rooted in the behavioral sciences offer substantial leads for research on the prevention of mental disorders. These include the impact of psychological stress on health; the role of social support mechanisms in decreasing risk factors and enhancing protective factors; usage of health care delivery systems; the relationship between theoretical concepts such as attachment, selfesteem, and self-efficacy and later social relationships and health behaviors; and the importance of social frames of reference, including race, culture, gender, and community context.
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From page 69... ...
(1992) Deletion polymorphism in the gene for angiotensin-converting enzyme is a potent risk factor for myocardial infarction.
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(1990) Genetic factors in child psychiatric disorders.
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From page 71... ...
(1992) Developmental theories for the 1990's: Development and individual differences.
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