Prevention of Psychological Disorders
Senior 6 · Psychology
Prevention of Psychological Disorders
Lesson 1 of 4
25 min
A well-known public health story tells of villagers who keep pulling drowning people out of a river. They become very skilled rescuers, but more and more people come floating down. At last someone walks upstream to find out why so many people are falling in, and mends a broken bridge. Treating psychological disorders is like the rescue: vital, skilled work. Prevention is the walk upstream. This unit asks how disorders can be prevented, for whom, and with what evidence.
Definition
Prevention: action taken to stop a disorder from starting, to detect and treat it early, or to reduce its harm and stop it returning.
Risk factor: a characteristic or experience that makes a disorder more likely, for example childhood abuse. Protective factor: one that makes it less likely, even when risk is present, for example a caring adult.
Mental health promotion: strengthening well-being and the conditions for it in everyone, whether or not they are at risk.
Incidence: the number of new cases in a period. Prevalence: the total number of people with the disorder at a given time.
The psychiatrist Gerald Caplan (1964) borrowed the public health levels of prevention for mental health.
| Level | Aim | Example for depression |
|---|---|---|
| Primary | Stop new cases starting: reduce incidence | Teaching coping and problem-solving skills to all S4 students |
| Secondary | Detect and treat early, to shorten the disorder: reduce prevalence | Training teachers and community health workers to recognise warning signs and refer students to the health centre |
| Tertiary | Reduce disability, prevent relapse and help recovery in people who already have the disorder | Continuing therapy after recovery, support to return to school, family support |
Robert Gordon (1983) and then the US Institute of Medicine (Patricia Mrazek and Robert Haggerty, 1994) classified prevention by who receives it (Figure 1):
Figure 1. The mental health intervention spectrum (after Mrazek and Haggerty, 1994), with Caplan's three levels of prevention (1964) shown underneath.
Prevention works by reducing risk factors and strengthening protective factors. Many factors raise the risk of many disorders at once, which is why one good programme can prevent several problems.
The Adverse Childhood Experiences (ACE) study (Vincent Felitti and colleagues, 1998) asked more than 9,000 adults in the United States about seven kinds of childhood adversity, such as abuse, violence at home and living with a family member with mental illness or substance misuse. The more ACEs a person reported, the higher the risk of depression, suicide attempts, alcohol and drug problems and physical illness in adulthood: a dose–response relationship. People with four or more ACEs had roughly four to twelve times the risk of several of these outcomes. Evaluate: the data were remembered by adults, not recorded in childhood; the score counts types of adversity but ignores their severity and timing; and many people with high scores do well. The researchers themselves warn that an ACE score should not be used to predict any one individual's future.
| Level | Risk factors (examples) | Protective factors (examples) |
|---|---|---|
| Individual | Genetic vulnerability, chronic illness, substance use, negative thinking style | Problem-solving skills, self-esteem, physical activity, sense of purpose |
| Family | Abuse and neglect, violence at home, harsh or inconsistent parenting, parental mental illness | Warm, consistent parenting; at least one caring adult |
| School and peers | Bullying, academic failure, deviant peers | Feeling connected to school, supportive teachers and friends |
| Community and society | Poverty, unemployment, violence, discrimination, easy access to alcohol and drugs | Safe neighbourhoods, social support, access to health care |
The Rwanda Biomedical Centre's Mental Health Division lists, among its national activities, training community health workers remotely by mobile phone, mentorship for health facilities, and managing mental health during the annual commemoration of the 1994 Genocide against the Tutsi, including follow-up of trauma cases and helplines. All district hospitals diagnose and treat mental disorders and mentor the health centres in their area, specialised care is available at Ndera Neuropsychiatric Hospital, and the Huye Isange Rehabilitation Center treats drug addiction. Community-Based Health Insurance is accepted. Each of these is an example of secondary or tertiary prevention; the next lessons look at what primary prevention can add.
TED: "How childhood trauma affects health across a lifetime", Nadine Burke Harris (about 16 minutes). A paediatrician explains the ACE study and how chronic stress in childhood affects the body. She argues for screening children for ACEs; note that the ACE researchers themselves warn against using scores to predict individuals. Which view do you find more convincing?
Important
Where to get help in Rwanda. If you, or someone you know, is struggling, talk to a trusted adult (a parent, teacher or school counsellor) and visit your local health centre. The Rwanda Biomedical Centre asks people to call its toll-free number 114 with questions about its services or in an emergency. Asking for help is a sign of strength, not weakness.
Warning
Prevention is not blame. Knowing risk factors helps communities act, but nobody chooses to have a mental disorder, and having risk factors does not mean a person will become ill. Never tell someone that their illness is their own or their family's fault.
Tip
Primary = Prevent it; Secondary = Spot it; Tertiary = Treat and support. For universal, selective and indicated, ask: "Everyone? A risky group? Or a person with early signs?"
Practice
Sources and credits
Written by Ganzaa: the text, the diagram (Figure 1), the tables and the exercises.
