What should a nation do to prevent common mental disorders? Meet seven conditions for effective prevention

Abstract

The global burden of Common Mental Disorders (CMDs), including depressive, anxiety and substance use disorders, is substantial. Since increased treatment has not reduced CMD prevalence, prevention is a logical approach to reduce CMD burden. However, CMD prevention as currently delivered has not reduced prevalence. Seven conditions need to be met to maximize the long-term effectiveness of CMD prevention: 1. Target young persons early in life and families. 2. Modify major CMD risk and protective factors. 3. Embed in social institutions and culture. 4. Implement via synergistic programs of proven effectiveness in multiple community settings (pre-school and kindergarten, elementary and secondary schools, child and health care, social welfare/family support). 5. Secure long-term funding with permanent, structural integration into community organizations. 6. Address socio-economic disadvantage and attendant risk factors. 7. Use the power of policy. We consider how these conditions might be achieved in large populations. A dilemma is that compelling evidence regarding the benefits of CMD prevention may be needed to motivate large, long-term investments, but until society has made and sustained these investments for 10 to 20 years, full benefits of CMD prevention may not be realized. Therefore, we propose regional implementation and evaluation focused initially on proximal benefits for child development. Developmental determinants important to educators, parents and other stakeholders should be evaluated initially to establish short-term pay-offs for educational and behavioral outcomes. Long-term CMD prevention initiatives may not only prevent CMDs, but also develop resourceful, resilient, and well-educated children and adults.