Table 1.
Summary of selected findings for mental disorder prevention and mental health promotion interventions
| Intervention Category | Intervention Components | Exemplary Outcome Measures (List) | Global Distribution of Research (Yes or No) | Main Findings | Research Gaps |
|---|---|---|---|---|---|
| Child abuse prevention | ECHV (provide support, education, improve child health & caregiving) PE (provide education, improve child-rearing skills) School-based CSA programs (education) MCT (family support, parenting skills, preschool education) |
Child maltreatment (hospital visits, parental report, referrals to protective services) Parenting skills Parental employment & reliance on social services |
No 0.6% of research from LMICs Reviewed in Skeen and Tomlinson,46 2013 and Mikton and Butchart,89 2009 |
ECHV: reduced risk factors for child maltreatment Only clear evidence of reduced actual maltreatment: Nurse-family partnership (USA) PE: some small to medium effects for reduction in risk factors and actual maltreatment, others only on reduced risk factors CSA: mixed—increased knowledge, no clear evidence of reduced abuse MCT: moderate effects in some studies, mixed evidence regarding reduction of risk factors in others |
Improve methodological quality in HIC studies (use of control groups, internal validity, randomized controlled designs) Overall prevention interventions in LMICs |
| Early childhood education | Parent training: 1.Improving parenting practices (eg, increased sensitive responsive interactions and early stimulation) 2.Emotional support for parents Center based: 1. Training teachers/caregivers in behavior management and greater social, emotional, and coping skills |
Observation of child behavior Assessment of child attachment Assessment of child mental health Assessment of caregiver practices (eg, measures of parenting) Assessment of caregiver mental health |
Yes Reviewed in Baker-Henningham,90 2014 |
Overall improvements in child mental health outcomes, and behavioral outcomes (both in short term [12/16 studies] and long term [6/6 studies]) Benefits in caregiver practices (21/25 studies) and caregiver mental health (6/9 studies) |
Need more long-term follow-up studies Discern optimal timing and duration Assess benefit to other children in the family Effect of booster interventions during later part of childhood |
| Mental health promotion interventions | Cognitive behavioral frameworks to structure building socioemotional skills, problem solving, and increased positive behaviors Physical, reproductive, and psychological health education Stress reduction techniques |
Emotional and behavioral well-being (eg, self-esteem, self-efficacy, coping skills, prosocial behaviors) Mental health assessment (anxiety, depression, PTSD, anger, hyperactivity symptoms) |
Yes Reviewed in Barry et al,70 2013 |
Positive effects for children living in conflict areas Mixed results in other interventions with differential gender and age group effects Positive effects in life skill and resilience-building programs |
Discern optimal components of intervention (age, individual/group, timing, duration) Need more research in low-income countries and in younger age groups (5-10 y) Assess cost-effectiveness |
| School-based mental health interventions | Health promotion: see mental health promotion intervention components and outcome measures described above Prevention and treatment (can be universal, selective and indicated): Cognitive behavioral techniques Creative arts and relaxation techniques Multimodal (including family and community components) |
Health promotion: see mental health promotion intervention components and outcomes described above Prevention and treatment: mental health assessment (anxiety, depression, PTSD, anger, hyperactivity symptoms) |
Yes Reviewed in Barry et al,70 2013 and Fazel et al,69 2014 |
In LMICs: most positive effects on PTSD symptoms Mixed effects on depression, grief, behaviors, and conduct symptoms Differential sex effects as well as differential effects depending on symptom severity |
Discern optimal components of intervention Develop outcome measures that integrate mental health and academic outcomes Assessment fidelity of interventions Need more long-term follow-up studies |
| Early intervention for psychosis | Prodromal symptoms: CBT Specialized teama Medications Omega-3 fatty acids Transition to psychosis: CBT vs supportive counseling Omega-3 fatty acids Improving outcome of first-episode psychosis: Medications CBT Family therapy Specialized team Vocational training |
Transition to psychosis Adherence to treatment Number of hospitalizations and number of days hospitalized Living independently Working or studying |
No (1 study in China, the rest in HICs) Reviewed in Marshal and Rathbone,92 2011; Stafford et al,93 2013 |
Prodromal symptoms: No effects of antipsychotics or CBT alone. Short-term effects of combination of all 3 over specialized team alone. Not sustained at 1 year Possible benefit of Omega-3 fatty acids Reduced transition to psychosis: Moderate-quality evidence in favor of CBT vs supportive counseling Low-quality evidence in favor of omega-3 fatty acids vs placebo Improving outcome of first-episode psychosis: Some support for vocational training and family therapy in addition to medications |
Rigorous randomized controlled trials Studies in LMICs Improved characterization of the role of a specialized team and the intervention components |
Abbreviations: CBT, cognitive behavioral therapy; CSA, child sexual abuse; ECHV, early childhood home visitation; MCT, multicomponent; PE, parent education; PTSD, posttraumatic stress disorder.
a
Specialized team is a multidisciplinary psychiatric team specializing in the treatment of patients with first-episode psychosis.