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

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.

Narrative review: COVID-19 and pediatric anxiety

“…More adverse childhood experiences were predictive of more PTSD and anxiety ( Guo et al, 2020 ). Fear and anxiety provocation has been addressed in several studies ( Kılınçel et al, 2020 ; Ferrando et al, 2020 ; Duan et al, 2020 ; Palacio-Ortiz et al, 2020 ; Masuyama et al, 2020 ; Lo Moro et al, 2020 ; Jefsen et al, 2020 ; Liu et al, 2020 ; Panda et al, 2020 ; Ravaldi et al, 2020 ; Oosterhoff et al, 2020 ). Fear of COVID is common in anxious children ( Ferrando et al, 2020 ; Palacio-Ortiz et al, 2020 ; Jefsen et al, 2020 ; Panda et al, 2020 ).…”

“…Confinement to home can also expose children to maltreatment and abuse in conflict-ridden families. The lockdown has exposed more women to intimate partner violence, which can traumatize children and produce anxiety ( Haleemunnissa et al, 2021 ; Guo et al, 2020 ; Palacio-Ortiz et al, 2020 ; Lo Moro et al, 2020 ; Marques de Miranda et al, 2020 ; Singh et al, 2020 ; Chardavoyne and Olympia, 2020 ).…”

“…Anxiety is linked to excessive exposure to media related to COVID in children, but not in parents ( Mahajan et al, 2020 ; Haleemunnissa et al, 2021 ; Lo Moro et al, 2020 ; Jefsen et al, 2020 ; Singh et al, 2020 ). Overexposure to the internet in general is linked to greater anxiety ( Singh et al, 2020 ) and this same pattern was observed during COVID-19 ( Dong et al, 2020 ).…”

“…COVID-19 acts as a universal stressor that increases common mental distress (CMD, or the p factor) across the entire pediatric population. CMD is a conglomerate of symptoms common to multiple diseases, including depression and anxiety ( Lo Moro et al, 2020 ).…”

Prevalence of Mental Health Disorders Among Immigrant, Refugee, and Nonimmigrant Children and Youth in British Columbia, Canada

“…4 Despite this knowledge, there remains a need for mental health interventions to take into account the contexts in which they are implemented. 5 In the Canadian context, child and adolescent mental health strategies need to consider the large and growing immigrant and refugee population. 6 As of 2016, 37.5% of children in Canada aged 14 years and younger were born outside of Canada or had at least 1 parent who was born outside of Canada (almost 2.2 million), a proportion projected to reach 50% by 2036.…”