Establishing a Theory-Based Multi-Level Approach for Primary Prevention of Mental Disorders in Young People

Giuseppina Lo Moro, Emma Soneson, Peter B Jones, Julieta Galante, Giuseppina Lo Moro, Emma Soneson, Peter B Jones, Julieta Galante

Abstract

The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14-24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.

Keywords: adolescents; children; common mental distress; interventions; mental health; mental health disorders; prevention; public health.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the concept, the design of any study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish.

Figures

Figure 1
Figure 1
Dose-response effect of common mental distress on non- suicidal self- injury (NSSI) and suicidal thought (ST) in cohort 1 and cohort 2. The normal population distribution of CMD, which was strikingly similar, but not identical, in cohorts 1 and 2, is shown by the purple line. CMD, common mental distress. (Reproduced from Polek 2020 [69] with permission).
Figure 2
Figure 2
Density plot illustrating the CORE-OM psychological distress scores for each trial arm as students progressed from the moment they signed up for the study (baseline), 2 months later (post-intervention), and during the examination period (4–6 months later). CORE-OM total mean scores range from 0 (no distress) to 4 (maximum distress) (reproduced from Galante 2018 [73] with permission).

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