Samenvatting, articles en exam tips - Prevention of Mental Health Problems (AM_470840)
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Course
Prevention of Mental Health Problems (AM_470840)
Institution
Vrije Universiteit Amsterdam (VU)
This is the summary of all lectures (9 total), the articles and exam tips for the Prevention of Mental Health course. All models are in it + an elaboration of them, the articles have been named and tips for the exam have been given!
Lecture 1: Introduction 2
Lecture 2: Prevention & Depression 6
Lecture 3: Prevention of PTSD 12
Lecture 4: Early detection and prevention of psychosis 21
Lecture 5: An environmental perspective on prevention 27
Lecture 6: Prevention of addiction 33
Lecture 7: Suicide prevention 39
Lecture 8: Prevention in Children and Adolescents (C&A) 46
Lecture 9: New Stressors 51
Exam tips 54
1
,Lecture 1: Introduction
Goals = important to know of exam:
- Explain most important theoretical & scientific concepts in field of PMHP
- Basic understanding of methods to identify who is at risk
- Discuss relevance of different risk & protective factors
- Describe prevention programs for different MHP & evidence for its effectiveness
- Conduct systematic & critical review of scientific literature in the field & report on it
- Integrate gained knowledge on prevention to make recommendations for further
research & practice
Global burden of disease (BoD) = Disability Adjusted Life Years (DALYs)
- Amount of ‘health loss’ in a population caused by illness, disability, or early death
- 1 DALY = 1 healthy life year lost & 0 DALY = perfect health, no premature death.
DALY = YLL + YLD
- YLL = years life lost due to early death, YLD = years lost due to disability
- YLD based on generic measures of QoL & for burden of MHD
- YLD is an estimate of reduction QoL & more common in MHD, except suicide.
Top 10 causes of DALY in NL → most non-communicable diseases:
1. Ischaemic heart disease
2. Chronic obstructive pulmonary disease
3. Trachea, bronchus, lung cancers
4. Alzheimer disease & other dementias
5. Back & neck pain
6. Stroke
7. Falls
8. Diabetes mellitus
9. Depressive disorder
10. Anxiety disorder
From all disease burdens:16% affected by MHD, 7% of total BoD, ⅕ of all QoL lost (YLD)
Worldwide statistics: Depression = 2nd (150 mil), 1 mil suicides/year, 90 mil addictions
World Health Organization (WHO) = institute monitors prevalence & incidence of MHD:
- High prevalence mental disorder (⅔ all DALY’s) = anxiety, depression, addiction
- Low prevalence mental disorder (⅓ all DALY’s) = bipolar, schizophrenia, eating, ASD
Why is BoD of MHD as anxiety & depression so high?
- Onset of MHD is generally at early age
- High incidence = new cases
- High prevalence = recurrence rates are high
- MHD affects the working population
Worldwide variations: depend on diagnosis, most
West, some cultures MHD is not accepted.
- More MH burden in wealthier countries &
high income inequality
2
, - LMIC: poverty related to MH burden. Something about SES & MHD.
However:
- Empirical evidence from LMIC countries is scarce & based on population surveys
- Despite efforts to scale up, treatments in LMIC countries are still lacking so the
impact is more devastating.
Global BoD of MHD is underestimated:
- Chronic pain disorders & personality disorders are not included.
- Indirect contribution of MHD to mortality → depression + heart failure.
- Self harm & suicide fall under injury instead of
mental health.
- Overlap with other neurological disorders
Treatment
In general: good treatments for MHD.
2004: researcher estimated how much MHD we could
reduce with the current treatment, evidence-based & if we
could treat more (100%) → total of 40%, but still 60% with
MHD…
Prevention
- 11-27% reduction of disease burden possible by prevention
- Prevention offers new + cheaper options → money plays an important role!
- ‘An ounce of prevention is worth a pound of cure’ - Benjamin Franklin.
Health promotion vs prevention
- Promotion: of positive health by increasing well-being, competence, resilience &
creating supportive living conditions & environments → providing advice
- Prevention: reducing indicende, prevalence & recurrence of disorder (prevent onset)
- Difference = outcome → promotion:promote
well-being. Prevention: preventing MHD.
Mental health condition vs positive mental health
- Mental health condition: outcome prevention
- Positive mental health: outcome promotion
→ These concepts are theoretical in practice, they overlap
& are hard to distinguish.
Mental health/well-being = positive emotional well-being,
psychological & social functioning.
Prevention spectrum: important for prevention,
where are we? Universal, selective or indicated.
3
, Classification of prevention
Traditional medicine:
- Primary = prevent onset of a disorder
- Secondary = early identification & treatment in those diagnosed
- Tertiary = prevent recurrence, relapse, or worseling (disability)
Mental health primary prevention:
- Universal = targeting the population
- Selective = target subgroups that are at risks → behavioral intervention for people
with cancer after treatment.
- Indicated = target people in the early stages who experience symptoms (screen
people, close to secondary) → online mindfulness training to people with mild
symptoms of depression
Challenges in prevention
1. Complexity
- Often unknown who will develop disorder & what disorder
- Efforts may be a waste of time for some people
- Intention to treat: 20 - 30 individuals to treat to prevent one case
2. Low uptake of preventive interventions
- People often experience less urgency, no motivation → solve their own problems.
- Stigma against treatment.
3. Prevention interventions studies need large sample size
- High Number needed to Treat (NNT)
- Multiple programs & risk factors are genetic
- Takes a long time before people develop MHD, study
requires long follow-up
- Include people through school, work.
Who is at risk?
Diathesis-stress model
- Diathesis = predisposition/vulnerability to a disorder
- Stress = occurrence of severe environmental or life event
- Both are necessary for a disorder to develop!
Risk factors: psychopathology
1. Stressful environment or life event
2. Temperamental & personality traits
3. Neurobiological factors
4. Cognitive processes & biases
5. Genetic make-up
→ They interact (in a complex way) to have direct or indirect effects on the development of
psychopathology, causal pathways are difficult to determine.
4
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