One of the biggest problems in the treatment of mental health disorders is getting them diagnosed quickly enough. A large body of evidence corroborates that the earlier the interventions, the better the outcomes for most mental health disorders — even for genetic disorders.

Wouldn’t it be nice if we could take what we know about mental health and devise interventions that reduce or prevent disorders from arising? That is the subject of a lengthy review in World Psychology, the official journal of the World Psychological Association.

The review is the product of an international team of neuroscientists, psychiatrists and biomedical researchers led by Dr. Paolo Fusar-Poli of King’s College, London, U.K.  The researchers are hunting for “evidence-based preventive interventions” for mental health disorders, including bipolar disorder, psychosis, anxiety, and depression. They begin with a summary of statistics from the World Health Organization (WHO):

• Approximately a billion people worldwide suffer from a mental health disorder.

• That’s one out of every eight people, globally.

• Half of those suffering from mental health disorders are diagnosed by age 14.

• Three quarters of those suffering from mental health disorders are diagnosed by age 24.

• About 8% of adults age 24 self-report having had a “psychotic experience.”

These disorders disrupt the lives of young people, often reducing their educational and employment opportunities. The disorders will also shorten their lives, on average, leading to more than a decade of reduced life expectancy. So the first question is, will screening reveal those with a likelihood of mental health disorders?

Yes and no. Surveys can identify those with a clinically high risk of psychosis, but cannot identify those with a high risk of bipolar, anxiety or depression. It is partly due to the inability to adequately screen for these disorders that the researchers are keen to find universal interventions for the whole population that reduce the rates of mental health disorders for everyone, not just those with high risk.

For bipolar disorder, there is no diagnostic common ingredient other than sub-threshold levels of anxiety or depressive disorders in the patient’s history. Interestingly, the researchers say that for those presenting with psychosis, “attenuated psychotic symptoms” last on average two years, and for those presenting with bipolar, “attenuated bipolar-risk features” last on average eight years.

The ability to predict anxiety and depressive disorders is even lower than bipolar. Screenings of large populations have been unable to determine those at high risk of developing a disorder. Once the anxiety or depression becomes apparent, there is a higher risk of it becoming a disorder. So a history of sub-threshold episodes is a good predictor of someone with an elevated risk for a disorder.

Even though it is not easy to predict which children will develop mental health disorders, there are programs that, when administered to everyone, reduce the incidence of mental health disorders. The researchers describe such a study:

Early meta-analyses not focusing on young individuals showed that indicated psychological interventions, generally based on cognitive behavioural therapy, can reduce the incidence of depression, and that these interventions can be effectively delivered digitally in middle-aged adults.

One risk factor for psychosis, bipolar, anxiety and depression is “the initiation of illicit and non-medical drug use among adolescents and young adults.” Yet the researchers found “no evidence to favour [universal] behavioral counseling.” In a recent article on AddictionNews, we pointed out the lack of success for the D.A.R.E. program in reducing rates of adolescent drug use.

Similarly, the researchers say there’s “little evidence that [universal] school-based educational interventions are effective for the prevention of common mental disorders in young people.” There is evidence that interventions such as an exercise program are effective with students identified as at-risk of developing a mental health disorder.

Mental health disorders do correlate with social welfare issues and “are key-risk determinants of psychotic disorders.” Interventions that could yield high benefits for young people include:

[R]eduction of gender-based violence, child maltreatment, racial discrimination and xenophobia, basic income grants and improved employment, safe neighbourhoods, reductions in violence, early response to environmental events, action on protecting vulnerable ecosystems, and improved education.

Of all the school-wide interventions, the best results so far have been physical exercise programs. Other efforts to promote good mental health among the universal population have not proven to reduce the incidence of mental health disorders. However, they have improved a variety of scores that indicate better mental health, including self-perception, quality of life, cognitive skills, social skills, physical health, and academic performance.

In the end, the authors lament that “economic evaluations of preventive approaches in young people remain relatively neglected.” The societal costs of mental health disorders in young people are staggering: the authors estimate it at $16.3 trillion in 2030. Including substance use disorders, it will consume an enormous portion of the global healthcare budget, yet receives less than 2% of government healthcare expenditure today.

Written by Steve O’Keefe. First published December 26, 2024.

Sources:

“Preventive psychiatry: a blueprint for improving the mental health of young people,” World Psychiatry, June 2021.

Image Copyright: serrnovik.