The 2004 WHO report Prevention of Mental Disorders stated that "prevention of these disorders is obviously one of the most effective ways to reduce the [disease] burden. " Prevention of mental disorders is beneficial for a number of reasons, ranging from individual well-being to economic and social factors. Financially, the cost of implementing primary prevention programs is often much less than the cost of caring for individuals after being diagnosed with the disorder or disease. The 2011 European Psychiatric Association (EPA) guidance on prevention of mental disorders states, "There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions. " A considerable amount of research on prevention programs has demonstrated the effectiveness of these programs.
Screening questionnaires for assessing the risks of developing a mental disorder face the problem of low specificity, which means that the majority of the people with an increased risk will not develop the disorder. However a combination of risk factors gives higher estimated risk for the development of mental disorders. For instance, risk of depression is higher for a widow who also has an illness and lives alone.
Risk factors for mental illness include both genetic and environmental influences. Some environmental influences include parenting style, poverty, and major life stressors such as divorce or death. Risk factors associated with parenting include parental rejection, lack of parental warmth, high hostility, harsh discipline, high negative affect, parental favoritism, anxious childrearing, modeling of dysfunctional and drug-abusing behavior, and child abuse (emotional, physical and sexual). Other risk factors may include family history (e.g. of anxiety), temperament, and attitudes (e.g. pessimism). Some mental disorders have a genetic link. Usually, this link is a predisposition to developing the disorder, which means that an individual may be more likely than other individuals to develop it, but there is no guarantee that the individual will develop the disorder. Primary prevention (discussed below) can help reduce the likelihood that a genetically predisposed individual will develop the disorder.
Three Levels of Prevention
Prevention falls into three levels: primary, secondary, and tertiary. Primary prevention targets individuals who are at a high risk for developing a disorder. Secondary prevention targets those who are in the early stages of a disorder. Tertiary prevention targets individuals who already have the disorder and by seeking to reduce or eliminate the negative impact of the disorder.
These are methods to avoid the occurrence of a disorder or disease. Most population-based health promotion efforts are of this type. This method targets individuals and groups who have a high risk of developing a mental illness based upon biological, social, or psychological risk factors. Primary prevention programs might include teaching parents effective parenting skills, distributing condoms to students who are at high risk for teen pregnancy, or providing social support to children of divorce.
One particularly well-known primary prevention initiative is the international D.A.R.E (Drug Abuse Resistance Education) program, which aims to reduce substance abuse in youth. At its start, the program attempted to achieve this through simply educating youth about the dangers involved in using drugs, but this approach drew criticism—in 1999 the American Psychological Association found the program to have no impact on drug use, and in 2001 the US Surgeon General categorized D.A.R.E. as an "Ineffective Primary Prevention Program. " Since then, D.A.R.E. has adopted a new and more effective evidence-based curriculum grounded in cultural context and communication skills.
These are methods to diagnose and treat the disorder or disease in early stages before it causes significant morbidity, as well as to lower the rate of established cases. An example of a secondary prevention program is rape crisis counseling. Following a rape, an individual may develop or be in the early stages of developing a number of disorders such as depression, anxiety, or post-traumatic stress disorder. Early intervention through counseling can help minimize the progression of one of these mental health issues.
These are methods to reduce the negative impact of existent disorders or diseases by restoring function and reducing complications. These methods include interventions that prevent relapse, promote rehabilitation, and reduce the nature of the disorder. Examples of tertiary prevention programs include Alcoholics Anonymous, diabetes control programs, and home visits to those who are chronically ill.