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Lectures Prevention of Mental Health Problems 22/23
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Elaborations of the Prevention of Mental Health Problems lectures for the Master in Health Sciences at the Vrije Universiteit Amsterdam 2022/2023
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InhoudsopgaveLecture 1: Introduction ................................................................................................................................... 3
Global burden of disease .................................................................................................................................... 3
Treatment .......................................................................................................................................................... 4
Who is at risk? .................................................................................................................................................... 6
Prevention in practice ........................................................................................................................................ 6
In summary ........................................................................................................................................................ 8
Lecture 2: Prevention of depressive disorders ................................................................................................ 9
Introduction........................................................................................................................................................ 9
The disease burden of depression .................................................................................................................... 11
What is prevention? ......................................................................................................................................... 12
Universal prevention ........................................................................................................................................ 12
Selective prevention ......................................................................................................................................... 13
Indicated prevention ........................................................................................................................................ 13
Next steps: How to increase the impact of prevention?................................................................................... 14
Lecture 3: Prevention in children and adolescents ........................................................................................ 16
Developmental issues ....................................................................................................................................... 16
Family: relational interventions ....................................................................................................................... 18
Specific topics for children (≤ 12 years) ............................................................................................................ 19
Specific topics for youth (>12 years)................................................................................................................. 20
Wrap-up ........................................................................................................................................................... 20
Lecture 4: an environmental perspective on prevention ............................................................................... 21
Urban living and mental health ....................................................................................................................... 21
Environment and mental health ...................................................................................................................... 21
Environmental interventions to prevent mental health problems ................................................................... 22
Natural spaces and mental health ................................................................................................................... 24
Nature-based interventions to prevent mental health..................................................................................... 25
Lecture 5: Prevention of suicide ................................................................................................................... 27
Lecture 6: Prevention of psychosis ............................................................................................................... 34
What is psychosis? ........................................................................................................................................... 34
Does psychosis exist? ....................................................................................................................................... 34
What is the difference between psychotic symptoms, psychosis, and schizophrenia? .................................... 34
What causes psychosis? ................................................................................................................................... 34
Early detection ................................................................................................................................................. 36
Early intervention ............................................................................................................................................. 38
,Lecture 7: Prevention of addiction ................................................................................................................ 41
Drugs, drug use and addiction ......................................................................................................................... 41
Prevention part 1 ............................................................................................................................................. 43
Prevention part 2 ............................................................................................................................................. 45
Example study: Boozebuster ............................................................................................................................ 46
Lecture 8: Prevention of Posttraumatic Stress Disorder (PTSD) ..................................................................... 48
What happens after trauma? .......................................................................................................................... 48
What mechanisms play a role in PTSD development? ..................................................................................... 48
Risk factors and targets for prevention ............................................................................................................ 50
Avenues to trauma care and prevention .......................................................................................................... 51
Comparing Screening Instrument to Predict PTSD ...................................................................................... 53
Promoting Mental Health Following the London Bombings: A screen and Treat approach ....................... 53
Online mental health screening and early intervention for emergency department patients: pilot
implementation and cost-utility analysis .................................................................................................... 54
Help in hand after traumatic event: A RCT in health care professional on the efficacy, usability, and user
satisfaction of a self-help app to reduce trauma-related symptoms .......................................................... 55
Opportunities for the future ............................................................................................................................. 55
So, what can we do? ........................................................................................................................................ 56
,Lecture 1: Introduction
Global burden of disease
- Burden of disease is a concept that you have in each physical and mental health
disorder. It is a way that you compare across disorders both psychical and mental
health disorders.
What do we mean by disease burden?
- Burden of disease is express in Daily Adjusted Life Years (DALYs)
- ‘The amount of ‘health loss’ in a population caused by
illness, disability, or early death’.
- 1 DALY is 1 year of ‘healthy’ life lost to illness, disability, or
early death.
- 0 DALY means ‘perfect health’ means that you have good QoL and no premature
health
- 5 years with half the quality of life then your DALY is 2.5 years.
Disease burden
- 16% affected by mental health disorders (point prevalence)
- 7% of total disease burden (DALYs)
- 1/5 of all QoL lost (YLD)
- Worldwide stats
o Depression ranked 2nd after HIV/AIDS
o Depression: 150 million (at each point in time)
o 1 million suicides a year
o 90 million addictions
High prevalence mental disorders (prevalence is 5-10/15%) and 2/3 of all DALY’s within
mental health
- Anxiety
- Depression
- Addiction
Low prevalence mental disorders (prevalence is less than 1%) and 1/3 of all DALY’s within
mental health
- Bipolar disease
- Schizophrenia
- Eating disorders
- Autism
Why is the burden of disease of mental disorders such as anxiety and depression so high?
- High incidence
- Recurrence rates are high (high prevalence)
- The onset of mental health disorders is generally at an early age
- Mental health disorders affect the working population, and private life.
Worldwide variations addiction and mental disorders
- Western country has a lot of mental health, addiction, and emotional disorders
compare to other countries, because of better measuring.
, - Higher mental health burden in wealthier countries and countries with high income
inequality.
- In LMIC (low- and middle-income countries): poverty was related to more MH
burden.
However:
- Empirical evidence from LMIC is scared and based on population surveys
- Despite efforts to scale up, treatments in LMIC are still lacking so the impact is more
devastating.
The global burden of disease of mental health disorders is underestimated!
- People with personality disorders are not included
- Indirect contributions of mental health disorders to mortality.
- Suicide and self-harm are grouped under injuries (in some countries)
- Overlap with other (neurological) disorders
- People with chronic pain disorders are not included
Treatment
- Good treatment for mental health problems
- Pharmacotherapy, psychotherapy
- Not everyone has access or wants the treatment
- With any mood disorder get 15% better with treatment. With alcohol problems get
2% better with treatment. Evidence based treatment then that number goes up a
little bit and we can cure 23% instead of 15% of people with any mood disorder. Final
estimation that Andrews did, if we reach everyone and we use the best evidence
treatment we can still not reach everyone. And then prevention comes in. Max: if we
could everyone give evidence-based treatment then 34% gets solved.
Lifting the burden
- Prevention of treatment?
- 11-27% reduction of disease burden possible by prevention
- Prevention offers new and cheaper options (Problems are not that big and easier to
treat)
Health promotion (HP) vs prevention
- Promotion of positive health by increasing well-being, competence, resilience and
creating supportive living conditions and environments. focus on increasing
people’s well-being, improving mental health. Aim: improving well-being, people feel
better, functioning better.
- Prevention: reduction of incidence, prevalence, recurrence of disorder (prevent
onset) focus on prevention of a mental health disorders, preventing the onset of a
disorder. Aim: to reduce the number of people with a mental health disorder.
- Different outcomes but the actions can be the same (e.g., mindfulness training it can
promote health and can prevent disorder).
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