Prevention of Mental Health Problems PDF

Lecture 1- introduction Disease Burden and DALYs Disease burden: This refers to the impact of a disease on a population, measured in terms of the loss of healthy life. DALYs (Disability-Adjusted Life Years): A key metric for measuring disease burden. o Combines t...

Lecture 1- introduction Disease Burden and DALYs Disease burden: This refers to the impact of a disease on a population, measured in terms of the loss of healthy life. DALYs (Disability-Adjusted Life Years): A key metric for measuring disease burden. o Combines two major components: ▪ YLLs (Years of Life Lost): Years of life lost due to premature mortality (death before the expected lifespan). ▪ YLDs (Years Lived with Disability): Years lived with the health consequences of a disease or injury. Interpretation: o 1 DALY represents the loss of one year of healthy life. o A higher DALY value indicates a greater burden of disease. o A value of 0 DALYs would represent perfect health for the entire population. Top 10 Disease Burden in the Netherlands (2021) Global Disease Burden of Mental Health Disorders Significant Increase: The global burden of mental health disorders has increased substantially between 1990 and 2019. o DALYs attributed to mental health disorders rose from 90 million to 125.3 million. o The proportion of DALYs due to mental health disorders increased from 3.1% to 4.9%. Substantial Impact: o 7th leading cause of DALYs globally in 2019. o Second leading cause of YLDs globally in 2019, highlighting the significant impact of these disorders on quality of life. Global Disease Burden of Mental Disorders by Sex and Age in 2019 Underestimating DALYs for Mental Health Disorders Significant Underestimation: The true burden of mental health disorders is likely underestimated due to several factors: o Exclusion of Personality Disorders: These conditions are not always included in burden of disease estimates. o Indirect Mortality Contributions: Mental health disorders can indirectly contribute to mortality through factors like increased risk of accidents, substance abuse, and chronic diseases. o Suicide and Self-Harm Classification: In some countries, suicide and self-harm may be categorized under injuries rather than mental health disorders, potentially underestimating their impact. o Overlap with Other Disorders: Mental health conditions often co-occur with other disorders, such as neurological conditions, making it difficult to accurately isolate their individual impact. o Exclusion of Chronic Pain: The impact of chronic pain on mental health is not always fully captured in burden of disease estimates. Revised Estimate: When considering these factors, the proportion of global DALYs attributable to mental health disorders may rise to 16%. Global Prevalence of Mental Disorders in 2019 High Prevalence: Mental health disorders are highly prevalent globally: o All mental health disorders: 970 million people (approximately 1 in 8 people). o Anxiety disorders: 301 million. o Depression: 280 million. o Bipolar disorder: 40 million.  o Schizophrenia: 24 million. o Eating disorders: 14 million. Economic Burden of Mental Health Disorders Significant Economic Impact: o Global economic losses due to mental health disorders were estimated at 1.42 trillion USD. o When considering broader impacts, including alcohol and drug use, neurological disorders, chronic pain, suicide, and self-harm, the estimated economic loss rises to 4.74 trillion USD. Limitations of Treatment Alone Partial Reduction of Burden: Treatment can reduce the burden of mental health disorders, but often only partially. Treatment Limitations: o Limited Effectiveness: ▪ Small effect sizes for some psychotherapies and pharmacotherapies. ▪ Not all treatments are equally effective for all individuals. o High Relapse Rates: ▪ Many mental health disorders have high relapse rates, even after successful treatment. ▪ Example: 26% of people with bipolar disorder experience at least one relapse within 5 years of treatment. o Limited Access to Care: ▪ Approximately 70% of people who need mental health care do not have access to it. The Importance of Prevention Significant Potential: Prevention can significantly reduce the burden of mental health disorders. o Estimates suggest a potential reduction of 11-27% in disease burden. Cost-Effectiveness: Prevention strategies can be cost-effective, with economic benefits often outweighing the investment. Reduced Healthcare Burden: By preventing the onset of mental health disorders, prevention can reduce the demand for costly treatment services. Treatment vs. Promotion vs. Prevention Distinct Concepts: o Treatment: Focuses on curing, healing, or repairing existing illnesses or injuries. o Health Promotion: Aims to improve overall well-being, competence, resilience, and create supportive environments.  o Prevention: Focuses on reducing the incidence, prevalence, and recurrence of disorders. Different Aims and Outcomes: Each approach has distinct goals and expected outcomes. Mental Health Disorder vs. Positive Mental Health Mental Health: More Than Just the Absence of Disorder: o Refers to positive emotional well-being, psychological well-being, and social functioning. o Emphasizes overall well-being, not just the absence of mental illness. Classification of Prevention Traditional Classification (Disease-Focused): o Primary Prevention: Prevents the onset of a disorder. o Secondary Prevention: Early identification and treatment of individuals who have been diagnosed. o Tertiary Prevention: Prevents recurrence, relapse, or worsening of a disorder in individuals who have already been diagnosed. Mental Health-Specific Classification (Group-Focused): o Universal Prevention: Targets the entire population. o Selective Prevention: Targets specific subgroups at increased risk for mental health problems.  o Indicated Prevention: Targets individuals who are showing early signs or symptoms of a mental health disorder. Examples of Different Types of Prevention Behavioral intervention for people with cancer after treatment: Selective prevention (targets a specific at-risk group). Mindfulness training for people with mild symptoms of depression: Indicated prevention (targets individuals with early signs of the disorder). Advising the public to stay active to improve well-being: Health promotion (focuses on enhancing overall well-being). School-based program to prevent bullying: Universal prevention (targets the entire school population). Risk and Protective Factors for Mental Health Disorders Risk Factors: Factors that increase the likelihood of developing a mental health disorder. o Genetic (e.g., family history of mental illness) o Biological (e.g., brain trauma, chronic illness) o Family-related (e.g., parental neglect, abuse) o Socio-environmental (e.g., poverty, discrimination, exposure to violence) o Societal (e.g., social adversity, stigma) o Life events (e.g., trauma, major life stressors)  Protective Factors: Factors that buffer against the development of mental health disorders. o Resilience o Social support (strong relationships, social connections) o Good interpersonal relationships o High self-esteem o Good physical health Prevention Strategies and Challenges Prevention Strategies: o Complex Programs: Often involve multiple components and interventions. o Programmatic Approaches: Utilize a combination of strategies at various levels: ▪ Micro-level: Individual-level interventions (e.g., self-help resources, individual counseling). ▪ Meso-level: Community-level interventions (e.g., support groups, community- based programs). ▪ Macro-level: Societal-level interventions (e.g., policy changes, public health campaigns). Examples of Prevention Strategies: o Micro-level: ▪ Self-help interventions: Guided or unguided self-help programs through books, websites, or apps. o Meso-level: ▪ Group prevention: Support groups, skills-training workshops, peer support programs. o Macro-level (universal): ▪ Policy measures: Legislation to reduce suicide risk (e.g., restricting access to lethal means), policies to improve workplace mental health. ▪ Mass media campaigns: Public awareness campaigns to reduce stigma and promote mental well-being. o Selective Prevention: ▪ School interventions: Programs to address bullying, promote resilience, and prevent risky behaviors. ▪ Workplace interventions: Programs to reduce stress, burnout, and improve employee well-being. ▪ Healthcare setting: Interventions for patients or their families to address social, emotional, and practical challenges. o Indicated Prevention: ▪ Group courses for adults with mild depression symptoms. ▪ Brief interventions for individuals at risk for alcohol or substance abuse. Challenges of Prevention: o Practical Challenges: ▪ Complexity: Predicting and preventing future mental health disorders can be complex. ▪ Low Uptake: Engaging individuals in prevention programs can be challenging. o Research Challenges: ▪ Large sample sizes: Prevention studies often require large sample sizes to detect meaningful effects.  ▪ Long follow-up periods: Evaluating the long-term impact of prevention programs requires long-term follow-up. ▪ Generalizability: Identifying and addressing specific risk factors and tailoring programs to diverse populations can be challenging. ▪ Reaching underserved populations: Engaging individuals who are not integrated into existing systems (e.g., homeless individuals, marginalized groups). In Sum o Diverse and Interacting Risk Factors: Mental health problems arise from a complex interplay of various risk factors. o Prevention is Crucial: Prevention programs can significantly reduce the burden of mental health problems. o Multi-Level Approach: Prevention efforts should target individuals, communities, and societal levels. o Diverse Interventions: A range of prevention strategies, from individual-level interventions to policy changes, are necessary. o Importance of Collaboration: Effective prevention requires collaboration between various sectors, including healthcare, education, community organizations, and policymakers. Lecture 2 – depression & prevention Important Messages o Multiple Causes: Depression is complex and arises from a combination of factors. o Hope for Prevention and Treatment: There are many ways to prevent and treat depression. What You Already Know Commonality: Depression is a prevalent mental health condition. High Burden: It significantly impacts individuals and society. Information Processing: Depression affects how people think, feel, and behave. Low Mood: A hallmark symptom of depression. What is Depression? Sadness Depressive Symptoms: A cluster of symptoms, including low mood, loss of interest, fatigue, sleep problems, and changes in appetite. Depressive Disorder Key Dimensions: o Severity: Depression ranges from mild to severe. o Impact on Functioning: Depression can affect daily life, work, relationships, and overall well-being. o Persistence: Depression can be a single episode or recurring/chronic. Heterogeneity in MDD (Major Depressive Disorder) Symptom Severity: People experience depression with varying intensity. Functional Impairment: The impact on daily life differs from person to person. Type of Symptoms: Individuals may have different combinations of symptoms (e.g., some may experience more anxiety, others more physical symptoms).  Comorbidity: Depression often occurs alongside other mental health conditions (e.g., anxiety disorders, substance abuse). Course of Depression: The pattern of depression varies (single episode, recurrent, chronic). Course of Depression Single Episode: 50-60% of people with depression experience a single episode. Relapse/Recurrence: 40-60% experience a return of depressive symptoms after a period of recovery. o Important Note: With each episode, the risk of future episodes increases, and the time between episodes may shorten. Chronic MDD: 20% of people experience chronic depression, lasting for 2 years or more. Other Mood Disorders Major Depression: The most well-known type, requires at least 2 weeks of 5 or more specific symptoms. Minor Depression: Similar to major depression but with fewer symptoms or shorter duration. Dysthymia (Persistent Depressive Disorder): A chronic form of depression with less severe symptoms but lasting for at least 2 years. Bipolar Disorder: Characterized by periods of depression alternating with periods of mania (elevated mood and energy). Prevalence of Mood Disorders Lifting the Burden of Depression Effective Treatments Exist: Medications and therapies can help people with depression. Limitations of Treatment: Even under ideal conditions, treatment alone may not be enough to eliminate 35% of the burden of depression. Stagnation in Outcomes: Despite advances, the overall outcomes of depression care haven't significantly improved in recent decades (30 years). This highlights the need for new approaches like prevention. Lifting the Burden of Depression (cont.) Prevention vs. Treatment Potential Impact of Prevention: Prevention efforts could reduce the burden of depression by 11-27%. Benefits of Prevention: Prevention can offer new, more cost-effective ways to address depression. What is Needed? This slide outlines key elements for effective prevention:  Targeting Risk Factors: Focus on the most important factors that increase the likelihood of depression. Structural and Social Embedding: Integrate prevention into existing systems (schools, workplaces, healthcare) and promote mental health as a social norm. o Socio-political embedding: Involves policy changes and integration within institutions. o Socio-psychological embedding: Focuses on changing attitudes and behaviors around mental health. Determinants: Risk and Protective Factors Theories: Mentions different models for understanding depression, including the vulnerability- stress model and the bio-psycho-social model. Diathesis- Stress Model Diathesis: A predisposition or vulnerability to a disorder (can be biological, social, or psychological). Stress: Exposure to stressful life events or challenges. Interaction: Both diathesis and stress are necessary for a disorder to develop. It's not just about being vulnerable; it's also about encountering stressors that trigger that vulnerability. Stress-Vulnerability Model Interaction and Complexity: Diathesis and stress interact in complex ways to influence the development of mental health problems. Causal Pathways: It's often difficult to pinpoint the exact causes of depression due to the complex interplay of factors. Protective Factors Buffering Against Depression: Protective factors can reduce the risk of depression or help people cope better with stressors. Examples: o Feelings of control over one's life o Strong interpersonal relationships o Social support o High self-esteem o Good physical health Contextual Factors This slide likely expands on the role of contextual factors (social, environmental, cultural) in depression. Risk of First Episode vs. Recurrence Different Predictors: The factors that contribute to a first episode of depression (index episode) may differ from those that predict recurrence (having another episode). Examples: o Major life events are often stronger predictors of a first episode. o Women are more likely to experience a first episode, but not necessarily more likely to have a recurrence. Predictors of First Episode Stressful Life Events: A major life stressor significantly increases the risk of a first episode of depression. Vulnerability Factors: These increase susceptibility to depression in the presence of stress: o Cognitive thinking style (e.g., negative thinking patterns) o Family history of depression o Lack of social support o Social health problems (e.g., isolation, relationship difficulties) o Neuroticism (a personality trait associated with negative emotions) Predictors of Recurrence Residual Symptoms: Lingering symptoms after an episode increase the risk of recurrence. Prior History: Having previous episodes increases the likelihood of future episodes. Vulnerability Factors: Similar to first episode predictors, these also play a role in recurrence: o Lack of social support o Social health problems o Neuroticism o Young age of first onset o Cognitive thinking style o Childhood adversity Risk of First Episode vs. Recurrence o Subtype Distinction Model: Some people may have a higher underlying vulnerability that doesn't change over time. o Stress Sensitization: With each episode, a person may become more sensitive to stress, requiring less stress to trigger a new episode. o Scarring Hypothesis: Each episode may leave lasting effects that increase vulnerability to future episodes. Predictors of Chronic Depression Factors Associated with Chronic Depression: o Younger age of onset o Childhood adversity o Chronic stress o Family history of depression  o Hospitalization for depression o Comorbidity (co- occurring conditions like personality disorders or substance abuse) Intervention Spectrum o Universal: Targets the general population. o Selective: Targets at-risk groups. o Indicated: Targets individuals with early signs or symptoms. Meta-Analysis of Randomized Trials Research Findings: This slide likely presents findings from a meta-analysis (a study that combines data from multiple studies) on the effectiveness of different types of prevention: o Limited Evidence for Universal Prevention: More research is needed. o Promising Findings for Selective and Indicated Prevention: These types of prevention can be effective in reducing the risk of depression. Universal Prevention Advantages: o Low stigma because everyone receives the intervention. o Can be integrated into existing settings like schools or workplaces. Disadvantages: o Difficult to prove effectiveness in research studies. o Some participants may already have depression. o Small effect sizes raise questions about impact. Universal Interventions Small Effect Sizes: Universal prevention programs often have small effects. This can mean two completely different things: o Very large impact ▪ Because it reaches a complete population ▪ A small effect has very large impact o No impact at all ▪ A small effect has a bigger chance of being an artifact because of low quality or a bias we cannot measure Selective Prevention Advantages: o Can be tailored to the needs of specific at-risk groups. o Can be effective. Disadvantages: o Often doesn't directly measure the impact on the incidence of new cases of depression. o Some participants may already have depression. o Risk factors have low predictive value (most at-risk individuals won't develop depression). Why Universal and Selective Prevention May Not Be True Prevention Indicated Prevention Advantages: o Can effectively study the impact on the incidence of depression. o Shows a modest but significant effect on preventing depression. o Can identify participants through screening. Disadvantage: o Low uptake (not many people with early signs participate). Where Are We? Current State of Prevention: o Unclear if universal prevention works. o Selective prevention might indirectly treat existing problems. o Low predictive strength of risk factors limits selective prevention. o Indicated prevention works, but participation is low. Indirect Interventions Addressing Low Uptake: This slide introduces a potential solution to the challenge of low participation in prevention programs. Indirect Approach: o Focus on less stigmatized problems related to depression (e.g., sleep, stress, procrastination). o Address everyday challenges that people face. o Useful in community settings where interventions can be co-created with the target population. In Conclusion o Depression is common and has a significant impact. o Depression is diverse in its presentation and course. o Preventive interventions can help reduce the burden of depression by focusing on risk and protective factors. Lecture 3 - Prevention of Addiction Defining Drugs Definition: Drugs are substances that alter the normal functioning of the central nervous system and are used for that purpose. Important Note: This definition emphasizes that using a substance for its intended medical purpose (e.g., prescription medications) does not necessarily constitute drug use in this context. Classes of Drugs  o Downers (Depressants): Slow down the nervous system. o Trippers (Hallucinogens): Alter perception and sensory experiences. o Uppers (Stimulants): Speed up the nervous system. Impact of Drugs Matrix: o Acute Toxicity: Short-term risks and dangers (e.g., overdose). o Chronic Toxicity: Long-term health consequences (e.g., organ damage). o Addiction Potential: How likely a drug is to cause dependence. o Social Damage (Individual): Negative impact on the individual's life (e.g., job loss, relationship problems). o Social Damage (Population): Impact on society (e.g., crime, accidents). Alcohol Risks and Consequences Short-term Risks: o Lowered inhibitions o Hangovers o Memory loss Long-term Risks: o Weight gain  o Increased risk of various cancers (liver, mouth, etc.) o Heart disease o Addiction Alcohol: Dutch Guidelines Pre-2015 Guidelines: o Different drinking limits for men and women. Post-2015 Guidelines (Gezondheidsraad, 2015): o More gender-neutral guidelines: ▪ No more than 7 drinks per week. ▪ No more than 1 drink per day. Diagnosing Addiction Before DSM-5: o Two separate diagnoses: Substance abuse and substance dependence. o Emphasis on biological and genetic factors. DSM-5 (2013): o Single diagnosis with a severity scale (mild, moderate, severe). o Replaced "substance abuse" with criteria related to problematic use. o Included "craving" as a core symptom. o Expanded the definition to include behavioral addictions (e.g., gambling). o Brain reward systems as central component to initiation and maintenance Addiction: Theories on Development Biological Theories: o Genetic Factors: Inherited predisposition to addiction. o Reactivity: Individual differences in how the brain responds to drugs. Cognitive and Behavioral Theories: o Modeling: Learning by observing others. o Coping with Stress: Using substances to cope with negative emotions. o Impulsivity and Sensation-Seeking: Personality traits that increase risk. o Antisocial Behavior: Individuals with antisocial tendencies may be more likely to engage in substance use. Sociocultural Theories: o Stress and Poverty: Higher rates of addiction in disadvantaged populations. o Cultural Norms: Cultural attitudes towards substance use can influence individual behavior. o Gender Differences: Men and women may have different patterns of substance use and addiction. Addiction: Risk and Protective Factors Risk Factors: o Parental alcohol supply: Easy access to alcohol at home. o Impulsivity-related personality traits: High impulsivity, sensation-seeking. Protective Factors: o Restrictive parental approaches: Clear rules and limits regarding substance use. o Education: Higher levels of education are associated with lower rates of addiction. Addiction: Treatment Detoxification: For heavy users, medically supervised withdrawal from substances. Biological Treatment:  o Medications (e.g., naltrexone for opioid addiction, methadone for opioid maintenance therapy). o Medications to assist with withdrawal symptoms. Psychological Therapy: o Exposure and response prevention (for compulsive behaviors). o Cognitive-behavioral therapy (CBT) to address thoughts and behaviors related to substance use. o Systems therapy (involving family members or partners). o Relapse prevention therapy. Sociocultural Therapy: o Support groups like Alcoholics Anonymous (AA) or 12-step programs. Means to the Same End Goals of Prevention: o Increase knowledge about drugs and their effects. o Influence attitudes towards substance use. o Reduce the initiation of drug use. o Delay the onset of drug use. o Harm reduction strategies (e.g., needle exchange programs). National Prevention Agreement (Netherlands) Overview: A national agreement between the Ministry of Health, Welfare and Sport and over 70 societal partners. Goals: To reduce smoking, excessive weight, and excessive alcohol use by 2040. Progress: o Most agreements are in progress. o 18% of agreements have been fully met. o Impact varies across different areas (smoking, weight, alcohol). o The COVID-19 pandemic has likely had an impact on progress. o The report emphasizes the need for more substantial agreements to achieve the goals. Different Approaches to Prevention Specific Target Groups: o GP-based interventions: Prevention efforts within primary care settings. o School-based interventions: Programs implemented in schools. More General Approaches: o Community interventions: Interventions targeting entire communities. o Mass media interventions: Public health campaigns. Emerging Approach: o Internet-based interventions: Online programs and resources for prevention. School-Based Programs Example: "Healthy School and Drugs" Program (2002) o Components: ▪ Educational lessons about drugs. ▪ Parent involvement. ▪ Early detection and guidance for problematic use. ▪ School rules and policies related to drug use. Effectiveness: Some effects on alcohol use, but less impact on cannabis and smoking. Support: Municipal health and addiction care institutes support schools in implementing the program. Effective Elements of School-Based Programs Interactive Methods: Engaging activities rather than passive lectures. Social Influence Principles: Addressing social norms and peer pressure. Serial Approach: Gradual introduction of information and skills over time.  Peer-Led Programs: Involving students in prevention efforts. Parent Involvement: Engaging parents in the prevention process. Cognitive-Behavioral Methods: Teaching coping skills and problem-solving strategies. Selective and Indicated Prevention: Tailoring interventions to specific at-risk groups. School-Based Programs Current Program: "Helder op School" project. Focus: Addresses smoking, alcohol, drugs, and gaming. Components: o Policy: School policies related to substance use. o Education: Educational programs for students, teachers, and parents. o Signal: Early detection and intervention for students with potential problems. o School Environment: Creating a supportive and healthy school environment. Support: Provided by Jellinek (a Dutch addiction care organization). Community Interventions Definition: Interventions that combine various approaches within a specific community. Key Features: o Involve multiple sectors (schools, healthcare, community organizations). o Aim to create a supportive environment for healthy behaviors. Effectiveness: o Some evidence of effectiveness in reducing alcohol-related problems (e.g., use, alcohol-related violence, alcohol-impaired driving). o Less research on the effectiveness of community interventions for other drugs. Community Interventions: Example Mass Media Interventions Overview: Public health campaigns using various media channels (television, radio, internet, social media). Aims: To raise awareness about the risks of substance use, promote healthy behaviors, and change social norms. Internet Interventions Principles: o Peer Normative Feedback (PNF): Providing individuals with information about their substance use compared to their peers. o Motivational Interviewing (MI): A counseling approach that helps individuals explore their own motivations for change. o Cognitive-Behavioral Therapy (CBT): Techniques to address thoughts, feelings, and behaviors related to substance use.  Combinations: Many internet interventions combine these principles. Slide 28: Internet-Based Intervention for Alcohol Use Riper et al., 2018 Focus: Adult problem drinking. Setting: Online intervention delivered through the internet. Integration: May be integrated into community or healthcare settings. Internet-Based Intervention for Cannabis Use Tait, Spijkerman & Riper, 2013 Likely focuses on: o Reducing cannabis use among young people. o May utilize online platforms, mobile apps, or interactive websites. Internet-Based Intervention for Illicit Drugs Boumparis et al., 2017 Focus: Preventing the use of illicit drugs (e.g., cocaine, heroin). May involve: o Interactive online modules. o Risk assessment tools. o Personalized feedback. Regression of Alcohol Effect Size on Depression Effect Size the relationship between alcohol use and the presence of depression = positive Prevention - What Works? Key Findings: o Interactive programs: More effective than non-interactive programs. o Age-appropriate interventions: Tailoring programs to the developmental stage of the target population. o Beyond Information: Prevention should go beyond simply providing information about the risks of substance use. It should focus on developing skills (e.g., resisting peer pressure, coping with stress). o Combined Approaches: Combining family-focused interventions with community- based interventions may be more effective. Principles of Effective Prevention Programs Focus on Risk and Protective Factors: Interventions should aim to reduce risk factors and strengthen protective factors. Long-Term Effects: Prevention programs should have a lasting impact on behavior. Intensity: The intensity of the intervention should match the level of risk. Combination of Interventions: Combining different approaches may be more effective than single interventions. Cultural Sensitivity: Programs should be culturally appropriate and sensitive to the needs of diverse populations. Developmental Considerations: Interventions should be tailored to the developmental stage of the target population. High-Risk Groups: Prioritize interventions for individuals at high risk for substance use. Boozebuster Example Focus: A mobile app-based intervention to prevent problem drinking in young adults. Goals: o Help young adults develop healthier drinking habits. o Improve mood and sleep. Target Population: Young adults (18-30 years old).  Intervention Components: o Minority uses traditional prevention or counseling services o Digital interventions known to be effective o Lack of tailored mobile interventions aimed at preventing problem drinking Study Design: o Randomized controlled trial comparing Boozebuster to a control group. Outcomes: o Measured changes in drinking quantity, frequency, binge drinking, and alcohol-related problems. Results: o May have found limited or no significant differences between the Boozebuster group and the control group. o The study likely explored factors that may have influenced the effectiveness of the intervention (e.g., motivation, app usage). Discussion: o Discusses the limitations of the study and potential areas for improvement. o Emphasizes the importance of engaging and motivating young adults to use prevention tools. Future Directions: o Making alcohol-related information available and appealing to young adults to tackling alcohol-related harms and improving this target group’s well-being Lecture 4 – Prevention in Children and Adolescents Guiding Principle for Prevention Quote: "Preventive interventions for children and adolescents should be guided by an emphasis on promoting competence and reducing ineffective resolution of the stage-salient developmental tasks at different periods of development." (Ialongo et al., 2006: 970) Key Takeaway: Prevention programs should be tailored to the specific developmental needs and challenges of children and adolescents at different ages. Theoretical and Research Basis Quote: "The complex theoretical framework and extant research suggest that we can identify particular groups of children and families who are at risk to develop problems, and then intervene in children's lives before problems become serious, debilitating, diagnosable, and resistant to treatment." (Cummings, Davies & Campbell, 2000: 375) Key Takeaway: Prevention efforts should be based on a solid understanding of risk factors and developmental pathways. Developmental Tasks List: This slide lists key developmental tasks that children and adolescents need to accomplish for healthy development: o Physiological homeostasis (regulating bodily functions) o Differentiation and regulation of affects (understanding and managing emotions) o Attachment development (forming secure bonds with caregivers) o Development of self, self-esteem, and identity o Representational capacities (thinking symbolically and understanding the world) o Effective relationships with peers o Adjustment to school Developmental Pathways: Attachment Theory Figure 1: A pathway toward anxious attachment and depression.  Early disruptions like a parent's death and guilt-inducing discipline push the trajectory toward insecure attachment and depression. Later interventions, such as psychotherapy, can help redirect the trajectory toward healthier outcomes. Figure 2: A pathway toward hostility and delinquency. Environmental stressors such as an unstable home and parental abandonment lead to self-reliance and antisocial behaviors. Positive influences (e.g., a helpful teacher) may briefly stabilize the pathway, but ongoing family conflict can reinforce negative outcomes. Predicting Mental Well-Being Factors: o Diathesis-Stress Model: This model explains how a combination of vulnerability (diathesis) and stressful experiences can lead to mental health problems. o Differential Susceptibility: This concept suggests that some children are more sensitive to both positive and negative environmental influences. Risk Factors for Mental Health Problems Psychopathology in one or more family members Marital conflicts between parents Single parent family Strict, inconsistent disciplining Parents low in warmth and involvement Insecure attachment relationships Conflicts with siblings, peers Unsafe neighborhood Low socio-economic status (SES) Risk Factor: single parent family Teenage mothers are at high risk themselves and are more likely to place their infants at risk out of ignorance rather than malicious intent. Targets for Prevention in Children and Adolescents Levels: o Families o Schools o Individual children and adolescents o Peer groups Universal Prevention: Examples: Anti-smoking campaigns, anti-alcohol programs, immunization programs, and programs to prevent depression. Family: Relational Interventions Targets: o Families at risk for developmental delays o Improving the quality of parenting behavior  o Preventing child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect) At Risk for Developmental Delays Prevention programs for children at risk for developmental delays. Examples: o Language development programs o E-mental health resources o Home visits by health professionals o Psychoeducation for parents o Video feedback interventions Quality of Parenting Behavior Interventions: o Promoting increased physical contact between parents and infants (e.g., using baby carriers). o Video-feedback interventions to improve positive parenting (e.g., VIPP, Circle of Security). o STEEP/Instapje program. STEEP/Instapje Methods: o Educational materials for parents. o Support from a coach. o Play partner for the child Prevention for Maltreatment Risk Factor: insecure disorganized attachment as a risk factor for child maltreatment. Interventions: o Attachment and Biobehavioral Catch-up (ABC) o Child-Parent Psychotherapy (CPP) o Parent-Child Interaction Therapy (PCIT) ABC (Attachment and Biobehavioral Catch-up) Description: the ABC intervention aims to improve attachment security in families at risk for maltreatment. Targets: o Providing nurturing care when the child is distressed. o Following the child's lead when they are not distressed. o Avoiding frightening or unpredictable behaviors. Graph showing the effectiveness of the ABC intervention in increasing secure attachment. Specific Topics for Children (≤ 12 years)  Support Programs: o Individual and group support programs for children of parents with mental health problems (KOPP programs). o Interventions to improve the quality of peer relationships. Quality of Peer Relations Interventions: o Cooperative learning activities. o Peer and cross-age tutoring. o Anti-bullying interventions. ▪ Good Behavior Game (GBG). Why focus on improving peer relations? Often aimed at reducing anxiety and depression. Good Behavior Game (GBG): Results Effectiveness: o GBG is effective if teachers implement it correctly (e.g., reduce number of negative remarks about obstructive behavior). o Interaction effect between gender and type of bullying: ▪ For girls, lower relational bullying reduces anxiety and depression. ▪ For boys, lower physical bullying reduces anxiety and depression. o Gender and context were moderators of outcome: ▪ Effective for highly aggressive boys in classrooms with higher levels of aggression → change of climate ▪ Not so effective for highly aggressive boys in low-aggressive classrooms → family factors outside program Universal interventions: effective for internalizing problems, in particular yearly and facilitated by teachers/ school. Universal School-Based Interventions Meta-Analysis: This slide presents findings from a meta-analysis of 424 studies on school- based interventions for social and emotional learning (SEL). Conclusions: o SEL programs improve peer relationships and emotion regulation skills in children. o Teacher-delivered programs are more effective. o SEL programs have a bigger positive impact on school climate and safety. o Interventions that include all four "SAFE" features are most effective. What is SAFE? o Sequenced: Teach intrapersonal skills (e.g., self-awareness, emotion regulation) before interpersonal skills (e.g., social skills, conflict resolution). o Active: Use active learning methods that engage students. o Focused: Devote specific components of the program to personal and social skills. o Explicit: Target specific SEL skills rather than just promoting general positive development. Specific Topics for Youth (> 12 years) o School dropout o Substance use o Risky sexual behavior o Delinquency and violence o Youth suicide o Cognitive problems ▪ Role of mindset and self-esteem IPT-A for Adolescents.  o 12 individual sessions. o Sessions with parents. o Parent-only sessions during 12 weeks. Focus Areas: (problems in 4 problem areas) o Grief o Interpersonal role disputes o Role transitions o Interpersonal deficits Wrap-Up: Prevention ≠ Psychotherapy o In Psychotherapy, families seek treatment for a wide range of reasons. o Children only get treatment if parent, school or other caregivers think they need it. o Only 20% of families/children who need treatment apply ➔ highlighting the need for prevention. Slide 27: Wrap-Up: General Remarks about Risk Factors o Risk factors increase the likelihood of negative developmental outcomes. o Risk factors can exist at multiple levels (biological, social, environmental). o It's important to also consider protective factors that can buffer against risk. General Aim of Prevention Programs o Reduce stress and enhance security. o Reduce developmental delays. o Improve chances for further development. Lecture 5 - An environmental perspective Topics and Learning Objectives This lecture focuses on how the physical environment influences mental health, with attention to urbanization, nature, and preventive interventions. The learning objectives include: 1. Understanding why urbanization is a risk factor for mental health issues. 2. Understanding why nature is a protective factor. 3. Designing environmental preventive interventions. Theoretical Approaches 1. Stimulation Theories: How physical stimuli (e.g., light, sound) affect behavior and emotions. The physical environment is seen as a crucial source of sensory information. o Arousal Theory: Environment can provide psychological stimulation, which can have behavioral effects. Balancing stimulating and calming stimuli is crucial. Preference for stimuli which help maintain an optimal level of arousal: 1. Arousal increasing properties: complexity, novelty, ambiguity 2. Arousal decreasing properties: familiarity and patterning o Environmental load or over-stimulation theory: People only have limited capacity to process incoming stimuli. Excessive stimuli reduce attention and tolerance. So sensory overload leads to frustration. o Adaption level theory: Stimuli are judged based on past experiences and recolllections. Types of stimulations: sensory, social, movement. Dimensions of stimulations: intensity, diversity and patterning. 2. Control Theories: Emphasizes the importances of an individuals real, perceived, oer desired control over environmental stimulants or stressors. The degree of perceived control over the environment can either reduce or increase stress. o Sense of control: Feeling sufficient choice, freedom, and autonomy that encourages you to feel motivated and act o Personal control: being able or unable to influence stimulation 3. Restoration Theories: Nature reduces stress and mental fatigue through stress recovery and attention restoration (e.g., Stress Reduction Theory and Attention Restoration Theory). Mental health problems are more prevalent in urban areas, compared to rural areas. Urbanization and Mental Health  Risk Factors: Urbanization is linked to higher rates of depression, anxiety, and psychotic disorders due to: o Selective migration: people predisposed to mental health issues often move to cities. Potential explanations: genetic risk (polygenic risk) may explain a small part of the association, health care services are located in urban areas, reduced stigma in psychiatric illness in urban areas, ethnic/migrant populations might have higher incidence of mental health disorders. o Social stressors: social economic status, inequality, social fragmentation of neighborhoods (vs. ethnic dense neighborhoods), social cohesion, social exclusion, social capital, social safety. o Environmental pollution: inflammation and oxidative stress, through physical (in)activity, reduced use of public spaces. o Abundance of environmental stressors: crowding, noise, traffic, housing quality, deprivation. o Lack of natural space Benefits of Urban Living: Improved transportation, healthcare access, access to play and exercise opportunities, entertainment, shops, culture and social networks. Nature and Mental Health Protective Effects of Green and Blue Spaces:  o Reduction in stress and recovery from mental fatigue. Lower prevalence of depression and anxiety.Mechanisms: Reducing Harm: Green and blue spaces can contribute to the provision of water and the reduction of the urban-heat island effect, noise, air pollution. Restoring Capacities: Restoration is the process of recovering physical an psychological resources or capabilities diminished in ongoing efforts to meet everyday demands. A restorative environment is an environment that supports restoration form stress and mental fatigue. Theories: Stress recovery theory (Ulrich, 1983): Non-harmful and survival promoting natural elements evoke an initial positive affective response (such as preference, interest). Attention restoration theory (Kaplan en Kaplan, 1989): Nature engages attention in an effortless manner (indirect attention) allowing the direct attention resoucers to rest and restore. Direct attention: effortful attention, needed to focus and concentrate, becomes fatigue with prolonged use, directed attention fatigue can lead to irritability and less productivity. Indirect attention: involuntary and effortless attention Building Capacities: Green and blue spaces promote physical activity and social interaction and soical cohesion. Prevention and Interventions Facilitation: Providing access to green and blue spaces. Behavior Change: Encouraging people to use these resources. Examples: o Neighborhood improvements in the Netherlands (2008–2012).  o Blue space regeneration for well-being. o Specific interventions like nature imagery in psychiatric hospitals. Challenges Complexity: Environmental factors are not the sole predictors of mental health. Costs and low adoption of interventions. Research difficulties: Long timelines for results and lack of controlled studies. Summary The physical environment can influence mental health, which theoretically can be explained by simulation theories, control theories, and restoration theories. Urbanicity is a risk factor for mental health disorders. This may be explained by selective migration, social stress, pollution, environmental stressors and lack of green (and blue) spaces. Green spaces and blue spaces are a protective factor for mental health. This may be explained by three mechanisms: reducing harm, restoring capacities, and building capacities. Environmental interventions are based on facilitation and behavior change. Lecture 6 – Prevention of suicide Learning goals: Understand the difference between milder suicidal thoughts and those that indicate a higher risk of suicidal behavior. Identify psychological, social, and biological factors that contribute to suicidal behavior. Recognize and critically evaluate common myths about suicide Apply knowledge to recognize early warning signs and protective factors in suicidal behavior. Evaluate key theories from O'Connor and Nock (2014) about the psychology behind suicidal thoughts. Develop empathetic, informed strategies for addressing suicidal thoughts in others. Terror management Theory - Jeff Greenberg, Sheldon Solomon, and Tom Pyszczynski Awareness of Mortality: Humans possess a unique awareness of their mortality and understand that they will eventually die. This realization can cause existential anxiety (or "terror"). Cultural Worldviews: Humans create and embrace cultural worldviews (such as religion, ideologies, norms, and values) to give life meaning and order. These worldviews provide a sense of symbolic immortality through the idea of being part of something greater that continues after death. Self-Esteem as a Buffer: Self-esteem is a crucial psychological mechanism that helps reduce mortality-related anxiety. Having a sense of self-worth, achieved by meeting the standards and expectations of cultural worldviews, gives people the feeling that their lives have value. TMT and suicide - Confrontation with one's own mortality - Strengthening of group identity - Rejection of dissenters ‘Of Suicide’ – David Hume (1755) In his essay "Of Suicide" (1755), Hume argued that suicide was not inherently immoral and that individuals had the right to control their own lives. Myth of Sisyphus – Albert Camus For Camus, suicide arises from a confrontation with the absurd, which he defines as the clash between: - The human desire for meaning, purpose, and clarity. - The universe's silent indifference to these desires. Camus sees suicide as a way of escaping the absurd rather than confronting it. He rejects this option, arguing that choosing death is a refusal to engage with life's challenges and possibilities. For Camus, suicide amounts to surrendering to despair, an act that denies the potential for personal freedom and rebellion. Suicide Prevention: An In-Depth Exploration This lecture addresses suicide, a deeply sensitive yet critical subject. Suicide impacts countless individuals, either directly or indirectly. By increasing awareness and understanding, we can combat the stigma surrounding it and learn to navigate one of the most complex aspects of human behavior. The ultimate goal is to develop empathetic and informed strategies for prevention and resilience. The Importance of Addressing Suicidality Suicidal thoughts and behaviors are more common than many realize. Knowledge about these issues not only enhances understanding but also empowers individuals to identify warning signs, challenge myths, and foster an environment of support. Understanding Suicide Definition: Suicide: the act of deliberately killing oneself Suicide attempt: any non-fatal suicidal behaviour: intentional self-inflicted poisoning, injury or self- harm, which may or may-not have a fatal intent or outcome Suicidal behaviourrefers to a range of behavioursthat include thinking about suicide (or ideation), planning for suicide, attempting suicide and suicide itself. Key Facts: Over 700,000 people die by suicide annually. It is the fourth leading cause of death among 15–29-year-olds. Low- and middle-income countries bear a significant burden, with 77% of global suicides occurring there. Common methods include ingestion of pesticides, hanging, and firearms. Language matters In Dutch: “Suïcide” often used by researchers and policy makers “Zelfmoord” in media and debate Bereaved give preference to “zelfdoding” In english: Instead of commited suicide we use died by suicide Instead of suicide attempters we use people that did a suicide attempt Myths and Facts Several misconceptions about suicide persist: Talking about suicide does not increase the likelihood of someone acting on it.  Suicidal thoughts do not necessarily mean someone wants to die. The media plays a role in influencing suicide rates, with both positive and negative effects. While men die by suicide more often, women are more likely to express suicidal thoughts. The Psychology of Suicidality Suicide arises from a complex interplay of psychological, social, and biological factors. Theories like Shneidman's psychache highlight the profound emotional pain that can drive suicidal thoughts. Psychache refers to “the hurt, anguish, soreness, aching, psychological pain in the psyche, the mind”.Psychache arises when vital psychological needs are blocked or unmet and that if psychachebecomes sufficiently severe, it can become “unbearable” or “intolerable,” and in turn motivate suicide (Shneidman, 1993, 1998). Mark Williams' arrested flight theory describes suicide as a response when all perceived avenues for escape seem blocked. Another framework, the interpersonal theory of suicidal behavior, identifies three critical elements: 1. Perceived burdensomness: Self-hatred and the belief in being a liability 2. Belonginess: Loneliness, Lack of reciprocal care, Social disintegration 3. Acquired capability: The physical and psychological ability to carry out a suicide attempt, fearlessness about death, tolerance for pain, repetition and exposure Prevention Strategies Effective suicide prevention requires a multi-level approach: 1. Policy Changes: o Limiting access to means (e.g., firearms, pesticides, bridges). o Improving mental health services. o Reducing alcohol misuse. 2. Community and Relationship Interventions: o Strengthening social connections and support networks. o Addressing stigma to encourage help-seeking behavior. 3. Individual-Level Support: o Recognizing early warning signs like rumination, hopelessness, and impulsivity. o Providing ongoing care for those who have attempted suicide. Global and National Data Suicide rates vary significantly worldwide, influenced by cultural, social, and economic contexts. For example, high-income countries tend to have better data collection but also report higher suicide rates compared to low- and middle-income countries. In the Netherlands, longitudinal studies like NEMESIS II reveal key insights: 34% of respondents reported thoughts of death. 11% experienced suicidal thoughts. 2.7% attempted suicide. The public health model Challenges in Prevention Preventing suicide is a complex challenge due to: The stigma surrounding mental health. Variability in registration and reporting across countries. The multifaceted nature of suicidal behavior, which often involves overlapping psychological, biological, and social factors. Conclusion By fostering understanding and promoting effective interventions, we can make strides in suicide prevention. Whether through individual empathy, community support, or systemic changes, addressing this issue requires a concerted and compassionate effort from all levels of society Lecture 7 – psychosis prevention What is Psychosis? o Psychotic symptoms are experiences that deviate from reality, such as hallucinations and delusions.2 o Psychosis is a clinical syndrome characterized by the presence of psychotic symptoms that significantly impair a person's functioning. o Schizophrenia is a specific mental disorder that includes psychosis along with other symptoms.3 Prevalence of Psychosis Fact: Psychotic symptoms are much more common than schizophrenia. o Yearly incidence of psychotic symptoms: 2% (100 times more than schizophrenia) o Prevalence of psychosis: 12 times the prevalence of schizophrenia Psychotic Symptoms o Hallucinations (seeing or hearing things that are not there)4 o Delusions (fixed false beliefs) 5 o Paranoia (distrust of others)6 o Anhedonia (inability to experience pleasure) o Impaired cognition Psychosis is Common, Not Rare Psychotic experiences are more widespread than commonly believed. Psychosis on a Continuum Psychosis is not an all-or-nothing phenomenon but exists on a spectrum in the general population.7 What Causes Psychosis? Vulnerability and Trigger: Psychosis is caused by a combination of factors: o Vulnerability: Increased risk due to genetics or brain development. 8 o Trigger: Extraordinary experiences (internal or external) combined with assigning them an extraordinary meaning/explanation can tip someone into psychosis. Multiple Causes of Psychosis Genetics: o Family history increases the risk of developing schizophrenia and other psychoses.9 Environmental Factors: o High stressed envirorement o Focus on trauma: Reducing childhood trauma can potentially reduce the incidence of psychosis. o People with psychosis: ▪ 30% sexually abused ▪ 50% physically abused ▪ The more trauma the higher the chance of developing psychosis Why Prevent Psychosis? Negative Consequences: o Loss of functioning in various aspects of life (friendships, work, etc.) 10 o Worse prognosis the longer psychosis lasts11 o Reduced life expectancy – 10 years o Limited effectiveness of current treatments Why Prevent Psychosis or delaying psychosis: Maintain social functioning o Relationships, friendships, study or work, and other social roles Improve quality of life Reduction of stigmatization and traumatization (psychiatric wards) Improve access to mental health care Clinical Staging Model: This slide presents a model of the clinical stages of psychosis: o Premorbid phase: Period before the onset of any significant symptoms.  o Prodromal phase: Early phase characterized by subtle changes in functioning and the emergence of mild psychotic-like symptoms. o Psychotic phase (First Episode Psychosis - FEP): Onset of full-blown psychotic symptoms. o Recovery phase: Period of improvement in symptoms and functioning. o Duration of Untreated Psychosis (DUP): The time between the onset of psychotic symptoms and the initiation of treatment. Early Detection and Primary Prevention Early Intervention: o Focus on early detection and intervention in the prodromal phase. o Aims to prevent or delay the onset of full-blown psychosis. Prognostic Modeling in Mental Health Factors: This slide highlights factors used to predict the likelihood of developing psychosis in individuals at risk: o Help-seeking behavior (individuals seeking mental health care for other reasons) o Age (14-35 years) o PQ-16 score (results of the Prodromal Questionnaire-16) o GAF (Global Assessment of Functioning) score o CAARMS interview results o Family history of psychosis At-Risk Mental State (ARMS) / Ultra High Risk (UHR) Key Points: o Age Range: Young individuals aged 14–35. o Decline in Social Functioning: Difficulty maintaining social relationships or fulfilling social roles. o Seeking Help in Mental Health Care: Often due to co-occurring (comorbid) mental health disorders. o Psychosis-like Experiences: Subtle or extraordinary experiences that resemble psychosis but may not meet diagnostic criteria. The diagram highlights overlapping domains that define at-risk individuals: 1. Subclinical Psychotic Experiences (Blue Circle): o Mild or low-frequency psychotic symptoms that are not severe enough to constitute a full psychotic episode. 2. Genetic or Familial Risk (Green Circle):  o Family history of psychotic disorders or schizotypal personality disorder. 3. BLIPS (Brief Limited Intermittent Psychotic Symptoms) (Pink Circle): o Short episodes of psychosis (lasting less than one week) that remit spontaneously without medical intervention. High Genetic Risk (ARMS) - Copy Number Variant 22q11.2 Deletion Syndrome (VCFS) 22q11.2 Deletion Syndrome: o A genetic disorder caused by the deletion of a small piece of chromosome 22. o Increases the risk of developing psychosis significantly (up to 30% lifetime risk). o Associated with other health problems (heart defects, learning disabilities, facial abnormalities). Effectiveness of Early Intervention Key Finding: Early intervention programs for individuals at high risk for psychosis (ARMS/UHR) can be effective in reducing the transition to psychosis. Cognitive Behavioral Therapy (CBT) for ARMS/UHR: o Can decrease the transition rate to psychosis by approximately 50%. Early Intervention: What We Do EDIE (Early Detection and Intervention) Team: o A team of mental health professionals specializing in early intervention. o Provides assessment and treatment for individuals at risk for psychosis. Target Population: Help-seeking individuals aged 18-35 years. Screening: Utilize the PQ-16 for initial screening. Assessment: Conduct a comprehensive assessment using the CAARMS interview. Treatment: Offer CBT-based interventions for individuals identified as being at high risk. The ARMS/UHR Population Characteristics: o Experience subclinical psychotic symptoms. o Show a decline in social functioning. o Exhibit dysfunctional cognitive biases and tendencies. o Are often distressed and fearful of "going mad." EDIE-NL CBT Protocol Focus: This slide describes the CBT protocol used in the EDIE-NL program. Key Components: o Introduction and engagement. o Psychoeducation about psychosis, including "normalizing" psychotic-like experiences. o Problem formulation and goal setting. o Meta-cognitive training. o Cognitive behavioral techniques (e.g., challenging negative thoughts, developing coping strategies). o Consolidation and relapse prevention. "Normalizing" Psychoeducation Key Message: o Reassure individuals that their experiences are not necessarily signs of serious mental illness. o Explain that many people experience unusual thoughts or perceptions at some point in their lives. o Emphasize the importance of how these experiences are appraised and interpreted. Stress and the Dopamine Hypothesis o Stress: Chronic stress can disrupt the balance of neurotransmitters, including dopamine. o Dopamine Hypothesis: This hypothesis suggests that an imbalance of dopamine activity in the brain plays a role in the development of psychosis. Practical Advice Tips for individuals at risk for psychosis: o Talk to loved ones or confidants about their experiences. o Maintain social activity. o Maintain a healthy lifestyle (sleep, diet, exercise). o Minimize stress. o Avoid substance use (especially drugs that can exacerbate psychotic symptoms). o Don't get too involved with things that scare you o Decrease Stress / decrease effect of Trauma (treatment) Slide 36: CBT for ARMS/UHR Therapeutic Relationship: Emphasizes a collaborative and egalitarian relationship between the therapist and the client. Shared Understanding: The therapist and client work together to develop a shared understanding of the client's experiences. Problem Identification: Identify the core problems that are maintaining the client's distress and dysfunction. Cognitive Interventions: Challenge negative thoughts and beliefs. Behavioral Interventions: Develop and practice new coping strategies and behaviors. Understanding Psychotic-Like Experiences Cognitive Model: This slide presents a cognitive model of psychotic-like experiences, outlining the following steps: o Situation or Intrusion: An external or internal event triggers the experience. o Automatic Appraisals/Interpretations: The individual automatically assigns meaning to the experience (e.g., "This is a sign that I'm going crazy"). o Emotions: These interpretations elicit strong emotions (e.g., fear, anxiety, paranoia). o Behavior: The individual engages in behaviors to cope with the distress (e.g., avoidance, reassurance-seeking). o Consequences: These behaviors may reinforce negative beliefs and further impair functioning. o Early Experiences: Past experiences (e.g., trauma, abuse) can influence how individuals interpret and respond to these experiences. o Core Beliefs: Underlying beliefs about self, others, and the world (e.g., "I'm not safe," "The world is a dangerous place"). o Life Norms and Expectations: Societal expectations and norms general conclusions Early detection is feasible in routine mental health care Prognostic modelling is successful and needs further improvement  Interventions with ARMS/UHR are effective, highly tolerable and cheap Mental health will be sustainable in future, because of huge costs savings Case Example Background: Sina is a young woman with a history of depression and family violence (sexual abuse by her brother). Symptoms: o Experiencing anxiety and fear of harm. o Belief that people are out to get her (conviction: 60%). o Fear of a spirit entering her body (conviction: 60%). o Avoidance behaviors: Avoiding going outside, hypervigilance, engaging in rituals to prevent the spirit from entering her body. Treatment Plan Psychoeducation: o "Normalizing" psycho-education: ▪ Reassuring Sina that her experiences are not necessarily signs of serious mental illness. ▪ Explaining the dopamine hypothesis and how it relates to unusual experiences. o Practical Advice: ▪ Emphasizing the importance of a healthy lifestyle (sleep, diet, exercise). ▪ Advising against substance use (especially cannabis). ▪ Encouraging social interaction and engagement in enjoyable activities. Cognitive Interventions: o Identifying and challenging negative and dysfunctional beliefs. o Example: ▪ Situation: Someone standing outside her house. ▪ Automatic Thought: "Someone is out to get me." ▪ Emotion: Fear (85%) ▪ Behavior: Avoiding going outside, hypervigilance. ▪ Consequences: Reinforces the belief that she is in danger, limits social interactions, increases anxiety and depression. o Developing Realistic Alternative Thoughts: "He's waiting for somebody," "He's minding his own business." Behavioral Interventions: o Encouraging Sina to engage in behaviors that challenge her fears. o Example: ▪ Going outside despite her fears. ▪ Reducing vigilance behaviors (e.g., not constantly scanning for threats). ▪ Gradually increasing exposure to feared situations. Consolidation and Blueprint Consolidation: This phase involves summarizing the treatment plan, reviewing coping strategies, and addressing any remaining concerns. Blueprint: Creating a personalized "blueprint" for Sina to refer to between sessions, outlining her goals, coping strategies, and warning signs of relapse. Lecture 8 – new stressors Mental Health  o High mental wellbeing or flourishing: Individuals with high levels of well-being and no diagnosable mental illness. o Lowered mental wellbeing and no diagnosable mental illness: Individuals experiencing some level of distress but not meeting the criteria for a mental disorder. o Lowered mental wellbeing and a diagnosable mental illness: Individuals with a mental disorder and significant distress. o Severe and persistent mental illness: Individuals with severe and long-lasting mental health conditions. Mental Wellbeing Definition: This slide defines mental wellbeing based on Ryff's model: o Self-acceptance: Positive attitude toward oneself. o Purpose in life: Having a sense of direction and meaning in life. o Autonomy: Feeling independent and in control of one's life. o Personal growth: Feeling that one is continuing to learn and grow. o Positive relationships: Having satisfying and fulfilling relationships with others. o Environmental mastery: Feeling competent and effective in managing one's environment. Resilience Definition: Resilience is an individual's capacity to adapt effectively to stressful and adverse life events. Key Point: Resilience is associated with positive mental wellbeing. Resilience: Metatheory Two Main Approaches: o Trait-oriented approach: Focuses on individual personality traits and characteristics that contribute to resilience (e.g., optimism, self-efficacy). o Process-oriented approach: Emphasizes the dynamic processes involved in adapting to stress. This approach considers how individuals cope with challenges and how their responses may change over time. Resilience: Process o Stressors: Life events or challenges that disrupt an individual's homeostasis (e.g., trauma, loss, illness). o Responses:  ▪ Resilient reintegration: Successfully adapting to the stressor and emerging stronger. ▪ Back to homeostasis: Returning to a pre-stress level of functioning. ▪ Reintegration with loss: Accepting the loss and adjusting to the new reality. ▪ Dysfunctional reintegration: Coping with stress in maladaptive ways (e.g., substance abuse, aggression). Global Societal Developments Key Point: Rapid global changes are creating new stressors that can impact mental health. They have direct and indirect effects. And increase inequality Examples: o Macro-stressors: Large-scale events with widespread impact (e.g., climate change, pandemics, economic crises). o Micro-stressors: Everyday stressors that accumulate over time (e.g., job stress, financial strain, social media pressures). The new stressors are: Continuous connectivity Climate change Energy transition Geopolitical conflict Changing population Covid-19 Complexity Climate Change Impact: Climate change has both direct and indirect effects on mental health. o Direct Effects: Natural disasters (e.g., floods, wildfires) can cause trauma and mental health problems. o Gradual Changes: Rising temperatures, sea-level rise, and environmental degradation can lead to disruptions in daily life and social systems. o Indirect Effects: Economic instability, displacement, and social conflict resulting from climate change can also impact mental health. o Subjective Perception: Individuals' perceptions of climate change (e.g., fear, anxiety, hopelessness) can also significantly impact their mental well-being. Climate Change and Mental Health Evidence:  o Evidence suggests a link between climate-related events and poor mental health outcomes (e.g., PTSD, depression, anxiety). o Some evidence suggests a link between pollution and certain mental health conditions Inequality WHO Policy Brief: This slide refers to a policy brief published by the World Health Organization on mental health and climate change. Key Point: Inequality can exacerbate the mental health impacts of climate change. Disadvantaged communities are often disproportionately affected by climate change and may have fewer resources to cope with its effects. New Mental Health Problems Eco-anxiety: Chronic fear of environmental cataclysm and its impact on future generations. Ecological grief: Grief experienced in response to environmental losses (e.g., loss of biodiversity, destruction of natural habitats). Sostalalgia: Distress caused by changes in the home environment due to environmental factors. Does climate change affect mental health? Umbrella review of meta-analyses: Reasonable evidence that climate events are related to poor mental health (PTSD, depression, anxiety) Some evidence that pollution has small relations with mental disorders (depression, suicide, autism after exposure through pregnancy) Digitalization Social Media Risks: o Social comparison: Comparing oneself to others on social media can lead to feelings of inadequacy and low self-esteem. o Fear of missing out (FOMO): Constant exposure to others' seemingly perfect lives can create anxiety and a sense of missing out. o Cyberbullying: Online harassment and bullying can have a significant impact on mental health. o Social media addiction: Excessive use of social media can lead to addiction and negatively impact sleep, relationships, and overall well-being. o Echo chambers: Exposure to only like-minded views can reinforce biases and limit perspectives. o Unreliable information: The spread of misinformation and disinformation on social media can contribute to anxiety and confusion. Benefits: o Social connections: Social media can facilitate social interaction and provide support networks. o Mental health awareness: Social media can raise awareness about mental health issues and provide access to information and support resources. Games Benefits: o Training: Games can provide cognitive training and develop problem-solving skills. o New experiences: Games can offer opportunities for exploration and creativity. o Social connections: Online games can facilitate social interaction and build connections with others. Risks: o Game addiction: Excessive gaming can lead to addiction and negatively impact other areas of life. o Cyberbullying: Online gaming environments can be susceptible to cyberbullying. Working in a Digital World Benefits of Remote Work: o Work-life balance: More flexibility and control over work schedules. o Reduced commuting time. o Increased productivity for some individuals. Risks of Remote Work: o Blurred boundaries between work and personal life. o Increased isolation and loneliness. o Difficulties with communication and collaboration. (professional isolation) Digital Divide Inequality: The digital divide refers to the gap between those who have access to technology and those who do not. Impact: o Individuals without access to technology may be disadvantaged in education, employment, and social participation. o They may also miss out on the benefits of digital tools for mental health support and well-being. Interventions Regulatory Measures: o Social media bans: Some countries have implemented bans on social media use in schools. o Smartphone banned in schools o Regulation of social media platforms: Efforts to regulate the content and algorithms of social media platforms to reduce harmful effects. o Digital Services Act in Europe: This legislation aims to create a safer and more transparent online environment. Lecture 9 – secondary prevention of PTSD o Green: Countries with official investigations by the International Criminal Court (ICC). o Light red: Countries with ongoing preliminary examinations. o Dark red: Countries with closed preliminary examinations that did not result in an investigation. o This map likely serves to emphasize the global scope of war crimes and the need for interventions. Genocide, war crimes, crimes against humanity, and aggression This slide likely provides definitions or brief descriptions of these international crimes. It may also include historical examples, such as: o World War II: A major historical example of widespread war and displacement, with an estimated 60 million refugees. o Dutch children refugees arriving at Coventry Station in the U.K. in 1945: This specific example highlights the human impact of war and displacement. Traumatic event: trauma: damage, injury, wound Event including: o Actual or threatened death, serious injury of sexual violation o Direct experience of the traumatic event o Witnessing the traumatic event in person o Learning that the traumatic event occurred to a close person o Experience of first-hand repeated or extreme exposure to aversive details of the traumatic event Trauma  This slide defines trauma as an event that overwhelms an individual's ability to cope. It then lists various mental health outcomes that can result from trauma exposure: o PTSD o Depression o Anxiety o Substance abuse o Grief (including complicated grief) o Somatoform disorders (physical symptoms with no apparent medical cause) o Somatic complaints (physical symptoms) o Suicidal behavior o Chronic pain o Eating disorders o Insomnia Symptoms of PTSD The core symptoms of PTSD as defined by the ICD-11: Insomnia Re-experiencing symptoms Avoidance symptoms Symptoms related to a sense of heightened current threat Any disturbing emotions or thoughts Changes in behaviour that trouble the person or others around them (e.g. aggressiveness, social isolation/withdrawal and (in adolescents) risk-taking behaviour) Regressive behaviours, including bedwetting (in children) Medically unexplained physical complaints including hyperventilation and dissociative disorders of movement and sensation (e.g. paralysis, inability to speak or see). Risk Factors of PTSD o Pre-trauma predictors:  ▪ Gender (women have a higher prevalence) ▪ Prior trauma exposure ▪ Pre-existing mental illness o Peri-trauma predictors: ▪ Severity and type of trauma (interpersonal trauma like sexual assault or torture carries a higher risk) o Post-trauma predictors: ▪ Early symptom severity (individuals with more severe initial symptoms are at higher risk for developing chronic PTSD) PTSD – ICD11 PTSD requires the presence of re-experiencing, avoidance, and hyperarousal symptoms, along with significant dysfunction in personal, social, or occupational areas. Prevalent Symptoms of PTSD The most common symptoms of PTSD observed in clinical settings. o Dysphoria (persistent sadness, low mood) o Social isolation o Dissociative symptoms (e.g., detachment, depersonalization) o Somatic complaints (e.g., chronic pain, fatigue) o Suicidal ideation and behavior o Alcohol and drug abuse o Anger, shame, sadness, humiliation, guilt o Anxiety, panic attacks, obsessions/compulsions triggered by trauma-related cues. Clinical Vignette A hypothetical case example of an individual affected by the war in Ukraine. For example: An employee of the Mariupol Drama Theater who survived the bombing may experience nightmares, intrusive thoughts, and high blood pressure. The vignette highlights the potential impact of trauma on daily life, such as difficulty concentrating, avoidance of certain places or situations, and the impact on family members (e.g., the child's fear of loud noises). It raises questions about access to mental health care, the role of family doctors, and the availability of culturally appropriate services. Preschool and School Age Children The specific reactions and fears that children may experience after exposure to trauma: o Helplessness and passivity: Children may feel powerless and unable to protect themselves. o General fearfulness: Disasters can undermine children's sense of security and make them fearful of the world. o Confusion about the danger: Children may have difficulty understanding the nature and extent of the danger, and may fear that it will recur. o Not talking: Children may become withdrawn and have difficulty expressing their emotions. o Fear of the disaster returning: Constant reminders of the trauma can cause ongoing anxiety and fear. o Sleep problems: Nightmares, difficulty falling asleep, and frequent awakenings. o Returning to earlier behaviors: Children may exhibit behaviors that they had previously outgrown, such as thumb-sucking or bedwetting. o Difficulties understanding death: Children may struggle to comprehend the permanence of death and may blame themselves for the loss of loved ones. Firstaidtoterror.com  Time-Sensitive Interventions This slide likely presents a timeline illustrating the recommended interventions at different stages following a traumatic event: o Ongoing stress: Optimisation of survival (Calibration of expectations - Connections - Routine - Hope - Follow up) o 0-3 days: First aid (urgent basic and specific needs, connection with family, listening).  o 3-30 days: Intermediate help (stress management, assessment and monitoring of PTSD symptoms). o After 1 month: PTSD treatment (stress management, exposure therapy, trauma- focused CBT, EMDR). Tasks for Professionals This slide outlines the key roles and responsibilities of mental health professionals in the immediate aftermath of a traumatic event: o Safety and comfort: Ensuring the physical and emotional safety of individuals. o Practical assistance: Providing basic necessities such as shelter, food, and medical care. o Information gathering: Assessing immediate needs and concerns, identifying risk factors. o Connecting with social supports: Linking individuals with family, friends, and community Message for Patients o Feelings of shock are normal following a traumatic event. o Many individuals recover naturally with the support of their social networks. o Healthy coping mechanisms are crucial, such as: ▪ Discussing difficulties with loved ones. ▪ Spending time for oneself (engaging in hobbies, relaxation techniques). ▪ Pursuing social activities. ▪ Developing and performing rituals (if helpful). ▪ Acknowledging the victim's experience is important; avoiding blame or guilt. o Professional help is necessary for symptoms that persist beyond one month or are severe. First Psychological Aid o Safety and basic needs: Ensuring physical safety and meeting basic needs (food, water, shelter). o Information gathering: current needs and concerns; risk factors o Connection: Facilitating social connections with family, friends, and community members. o Stress management (breathing exercises, progressive muscle relaxation) o Information on adaptive coping o Linkage with collaborativ