Mental health disorders are associated with great suffering, high societal costs, and are a rapidly increasing cause of healthy years lost worldwide. About half of mental disorders begin before adulthood. To enable early detection, prevention and treatment, it’s crucial to identify the underlying symptoms and risk factors and, if possible, characterise their interaction.
The American Psychiatric Association’s definition of mental illness emphasises significant changes in thinking, emotion or behaviour coupled with distress or problems in functioning in social, work or family activities. The most common mental-health disorders are anxiety, mood disorders and those related to substance use/abuse. According to the World Health Organization, the worldwide prevalence of mental health disorders is 14 per cent, and a 2011 South African study indicated a lifetime prevalence of 30 per cent.
There is an increased prevalence of mental health disorders in young people.
“The increased prevalence of mental-health disorders in youth is likely multifactorial,” explained Maria Lalouni of the Department of Clinical Neuroscience at the Karolinska Institutet, “but it is definitely influenced by increased awareness and less stigmatisation, which may lead to increased diagnoses. Other suggested explanations are the unrealistic ideals imposed by social media; people spending too much time on their mobile phones at the expense of physical and other activities; as well as the aftermath of the COVID-19 lockdowns and systematic social changes like those in education and work life.”
Lalouni is interested in trying to understand and identify some of the early psychological, social and biological factors that may be associated with and that may even predict later mental-health illness.
Large, long-term dataset
One of her studies is analysing vast amounts of data from the so-called Conscription Cohort – 49,132 adolescent men who underwent military conscription in Sweden in 1969/70. The available data on this cohort comprises over 100 variables, including detailed information about their psychological profiles, physical status, family functioning, school adjustment and substance use. The cohort is also linked to national registers of prospectively registered diagnoses of psychiatric disorders throughout the men’s lives.
“The initial aim was to understand their suitability for military service,” explained Lalouni. “However, because of the existence of health registries in Sweden, there is also long-term health information about these subjects who, from a health point of view, have been followed throughout their lives. This gives us a large dataset and a long-term follow-up period.”
Eight per cent of the cohort subsequently received care for mental illness.
“Our study aims to identify the early psychological, social and biological patterns associated with mental illness or a healthy trajectory,” she said. “The limitations are that it is only men, the baseline data are old, and the availability of and access to healthcare may have differed.”
Because mental health is multifactorial, Lalouni explained that the method used is network analysis, a statistical approach that allows you to detect and depict how different factors interact.
“In recent years, network analyses have been proposed to offer a unique way to assess and illustrate how variables interact. Networks basically consist of nodes, which are the variables included in the network, and the statistical relationship between them (the connection between the nodes), called the edges,” she said. “By using symptom network analysis, significant knowledge has been gained about depression, eating disorders, and how anxiety and depressive symptoms can be interconnected.”
“Network analysis is a hypothesis-generating method of working. Here we generate a hypothesis using 80 per cent of the data and validate it with the remaining 20 per cent using machine learning," she said.
The analysis included all types of mental health diagnoses.
Overall, their results have shown that for the group that remained healthy (not later diagnosed with mental-health disorders), the most important factor was emotional stability, which was found overall to be a protective factor for alleviating the risk of mental illness and promoting resilience.
Focusing on children
Lalouni also presented some of the prevention and intervention studies being undertaken by herself, colleagues and students that are specifically targeting mental-health risk factors in children.
The FRIDa study aims for a childhood free from violence by increasing the ability of child health services to identify family violence. It specifically compares the use of routine questions versus questions based on an existing indication of exposure to family violence.
“‘We have found that the routine questions seem to be good at identifying and preventing violence, and questions based on indication assist in identifying ongoing violence,” said Lalouni.
Safer Kids is a parenting programme that is offered by the social services after reports of suspected child abuse. It includes targeted sessions with caregivers and children, aiming to prevent harsh parenting and strengthen relationships. This programme has been compared with other existing interventions over a 2.5-year follow-up period and has shown that the Safer Kids methods are more effective than those routinely offered.
Tiny Heroes is parent-directed, online cognitive behavioural therapy consisting of four modules, which is aimed at children aged three to six years old identified with anxiety problems at clinics. It was co-developed with clinicians with input from parents. A small pilot study involving 25 children, of whom 80 per cent had been diagnosed with clinical anxiety (including specific, social, separation and generalised anxiety disorders), has been conducted to compare this programme to existing clinical treatment. This will now be expanded to a larger randomised control trial.
In conclusion, Lalouni noted: “The Conscription Cohort has shown us clearly that there were distinct patterns at conscription for male adolescents who later received care for mental illness. We believe that early prevention and intervention targeting core variables/symptoms may therefore be helpful to shape future trajectories.”
“While the studies specifically with children show us it’s about building resilience and equipping children for life, it’s important to intervene early with children to teach them skills to cope with their condition. In doing so, you may be able to change their trajectory, although you would need a very big study to prove this," Lalouni said.
Article: Michelle Galloway
Photo: Ignus Dreyer, SCPS Photos