Effective childhood prevention of mental health problems

A short overview of effective childhood interventions to prevent mental health problems and disorders in adulthood. The focus is on public mental health interventions, especially parental support and school mental health interventions. The presentation concludes that cost-effective interventions exist and that they need to be taken to scale.
Presentation in Nice, France March 6, 2018, at the European Psychiatry Association Congress

1. Effective prevention programmes in childhood Kristian Wahlbeck

2. Conflicts of interest : None

3. 05/03/2018 Prevention programmes in childhood 3

4. Cumulative incidence of first DSM-IV disorder by comorbidity and severity “ Generalized “ psychopathology already present at age 13 Ormel et al., 2014

5. 05/03/2018 Prevention programmes in childhood Children who have been maltreated o r bullied are much more likely to have mental health problems in adulthood G reat Smoky Mountains Study, Lereya et al Lancet 2015 Risk of mental health problems in adulthood 5 Odds ratio

6. Psychopathology may affect the brain Usually , childhood behavioral problems are seen as function of underlying brain psychopathology . A Dutch cohort study of 845 children with MRI data at ages 8 and 10 indicates that symptom ratings predict neurodevelopment but not vice versa . Muetzel et al , AJP 2018 It is thus plausible , that childhood preventive interventions will have an effect not only on adult mental health but also on its underlying biological substrate . 05/03/2018 Prevention programmes in childhood 6

7. 05/03/2018 Prevention programmes in childhood 7 Effective prevention interventions in childhood Parenting support interventions have been shown to promote life-long mental health and well-being of the offspring in a variety of cultures and countries School programmes have consistently been shown to have positive moderate to strong effects on social and emotional skills and competences

8. Intergenerational transmission of mental health problems can be stopped Risk of mental disorders in the offspring of parents with mental disorders is reduced by 40% by preventive interventions Siegenthaler et al. JAACAP 2012

9. 40 % of mental disorders can be prevented in high-risk families 05/03/2018 Effect of interventions on the risk in the child of the mental disorder diagnosed in the parent. Siegenthaler et al. JAACAP 2012 Prevention programmes in childhood 9

10. Let’s Talk About Children Brief talking intervention to e mpower people with mental disorders to be good parents S upporting parents to talk about their mental illness to their children Promoting recovery - RCTs in Finland (Solantaus 2010) and Australia (Goodyear, submitted ) 05/03/2018 Prevention programmes in childhood 10

11. Evidence-based parenting support programmes for behavioral problems Incredible Years RCTs in Ireland , Norway , Sweden , UK Triple P RCT in UK PCIT ( Parent –Child InteractionTherapy ) PMTO ( Parent Management Training Oregon) RCT in Iceland 05/03/2018 Prevention programmes in childhood 11

12. Parenting support programmes : Effectiveness in n on -US RCTs ( Eyberg Child Behavior Inventory scores ) 05/03/2018 Prevention programmes in childhood 12 G ardner al. 2015

13. Parenting support enables financial contribution to society 05/03/2018 Ministry of social affairs and integration , Denmark 2012 Normal life course IY Conduct disorder Net cost / year (DKR) Prevention programmes in childhood 13

14. Evidence-based school interventions 05/03/2018 Whole-school approach Anti- bullying programmes Teacher training programmes ( e.g . Incredible Years Classroom ) Suicide prevention programmes ( e.g . SEYLE) Prevention programmes in childhood 14

15. School- based mental health promotion a .k.a . ” socio-emotional learning , “emotional literacy ”, “ emotional intelligence”, “resilience ”, “ life skills” and “character education ”, targeting skills c urriculum teacher education, peer support whole school approach Strong evidence of effectiveness Strong effects on socio-emotional skills Small to medium effects on emotional well-being Evidence of reduction of depression, aggression, impulsiveness and antisocial behavior 05/03/2018 Prevention programmes in childhood 15

16. S uccessful prevention of mental disorders build on intersectoral collaboration

17. Respecting the UN Convention on the Rights of the Child lays the basis for prevention 05/03/2018 Prevention programmes in childhood 17