Can Mental Illness Be Prevented?

February 15, 2008

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Editor's note: This is the second in a series of articles that look at the promise of taking a public health approach to mental health. The series starts with Creating an Ounce of Prevention.

First, the easy part. The principles of prevention in sustaining better physical health are well-known and simple:

Screen regularly for cancer and catch it early – recovery odds improve
Exercise and maintain a proper diet – risk of heart disease shrinks
If people all around you are catching colds, take vitamin C – you might not get a cold

Now the hard question. Do the same principles apply to conditions such as depression or anxiety?

"We have seen very strong evidence that childhood experience of trauma affects emotional health," says Wendy Janis of the Washington State Board of Health. Janis co-authored the recent report Mental Health–A Public Health Approach: Developing a Prevention-Oriented Mental Health System in Washington State [ Portable Document Format 771KB].

What's more, trauma does not equate simply to overt abuse. It comes in much more subtle forms.

Understanding Development of the Brain

Recent studies of rats show how trauma may not be obvious to untrained eyes. The studies compared infant rats that received a high level of licking and grooming with infant rats that did not. Infant rats receiving this attention in the first six days of life exhibited genetic-based behavior that allowed for greater tolerance of stress.

Here we can see how social experience, both present and absent, alters brain function in ways that affect long-term emotional health. Infant rats that received this attention early in their lives showed a greater tolerance for stress later. It seems to be an example of how social experience can shape brain function and affect long-term emotional health.

The human brain operates similarly. Sexual, physical, and verbal abuse produce comparable effects on the development of children's brains. Even witnessing the abuse of others can cause long-lasting harm.

Another study showing similar results compared self-reported adverse childhood experiences with health outcomes later in life. More than 17,000 members of a San Diego HMO were surveyed for the study; the average age of each member was 56.

Adverse childhood experiences were defined as:

Emotional abuse
Physical abuse
Sexual abuse
Emotional neglect
Physical neglect
Divorced or separated parents
Witnessing domestic violence against a female caretaker
Living with an alcoholic or drug addict
Living with someone with depression or a mental illness
Living with someone convicted of a felony crime and sent to prison

The study found that more than half of the participants experienced at least one of these traumas, and 25% experienced two or more.

Even more significant, the study found critical dose-response relationships between those experiences and poorer outcomes related to physical, emotional, and behavioral health, which surfaced later in life:

Depressive disorders
Panic reactions and anxiety
Obesity
Smoking
Alcoholism
Injected drug use
Promiscuity
Ischemic heart disease
Cancer
Chronic bronchitis or emphysema
History of hepatitis or jaundice
Skeletal fractures

Effective Prevention

If the harmful effects of trauma occur more easily than most people may understand, the good news is that effective preventive programs have been developed and implemented.

For example, one promising avenue is the Nurse-Family Partnership strategy, which targets first-time mothers living at or below the federal poverty line. Nurses visit the women in their homes when they are still pregnant and provide encouragement and education to improve health-related behaviors.

Then, for two years after the baby is born, nurses continue to mentor the mothers and teach them effective parenting and caretaking skills to reduce abuse and neglect. Finally, nurses help mothers become economically self-sufficient by helping to plan future pregnancies, complete their education, or find work.

Results include:

79% reduction in child abuse and neglect
44% reduction in maternal behavior problems due to substance abuse
69% reduction in maternal arrest rates
54% fewer arrests, and 69% fewer convictions, among children
58% fewer sexual partners among adolescent children
28% reduction in cigarette smoking among adolescent children

Prevention is for Everyone

Preventive approaches don’t just apply to children. A good deal of help can be offered at any age to promote mental health, intervene early to address emerging mental health problems, and reduce the devastating impacts of mental illness. Help can be especially effective when it is targeted to key transition points such as divorce, job loss, sickness, death of a loved one, or placement in a nursing home.

Can mental illness be prevented? The short answer is yes.

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