“An ounce of prevention is worth a pound of cure” – Ben Franklin
Prevention efforts for psychiatric and neurological disorders of the brain lag significantly behind national and global efforts to prevent most other communicable and non-communicable diseases. Funding and research in the area of brain disorders are focused primarily on treatment. For example, there are countless studies evaluating the effectiveness of psychiatric medications and talk therapy (e.g. cognitive behavioral therapy) at reducing psychiatric symptoms but comparatively few studies that evaluate prevention efforts. Although undeniably important, a focus on treatment at the expense of prevention is shortsighted.
There are several approaches to preventing the development of brain disorders. What public health practitioners call primary prevention benefits the whole population by targeting factors, such as the social environment, which increase the risk for developing a brain disorder. One example is the Drug Abuse Resistance Education (D.A.R.E) program, which is open to all children and seeks to prevent drug use and violent behavior in youth. Secondary prevention aims to reduce the prevalence of mental illness through early detection and/or treatment of emotional or behavioral symptoms by targeting populations identified as at risk for brain disorders. One example is screening women who have a history of depression after they have given birth to improve early detection of post-partum depression. Tertiary prevention targets populations that have been diagnosed with a brain disorder by aiming to improve their functioning and decrease the risk of recurrence. These programs include transitional housing or day programs for individuals following their discharge from a psychiatric hospital.
In 2012 approximately 18.6 percent of the U.S. adult population had a diagnosable mental illness within a year of when they were asked. Given this staggering statistic it is puzzling that the momentum behind efforts to prevent brain disorders pales in comparison to efforts aimed at preventing other communicable and non-communicable diseases. Two of the many obstacles contributing to the unpopularity of brain disorder prevention are: (1) limited political and financial investment and (2) the many and varying disorders encompassed within the brain disorder category.
Investing in prevention of brain disorders can be unsatisfying for the investor since efforts to prevent brain disorders do not produce immediate results. This is because rather than measuring the success rate of treatment after an individual has developed a particular disorder, the measure of success for the prevention of mental health translates to the absence of illness over the life span. Thus, prevention involves a long-term commitment to behaviors—such as exercise—that population science research has found promotes health. Additionally, it is difficult to measure the success of prevention on an individual level. For instance, we cannot determine the success of prevention efforts if we do not know for certain that someone would have developed the particular ailment had he or she not taken the preventative steps. Therefore, the success of efforts to prevent a particular disorder can only be determined by observing overtime a decrease in the prevalence of the disorder in a population. Such results will take decades to amass even though the financial and political investments need to be made now.
“Brain disorders” is a broad category. It includes neurological disorders like Alzheimer’s disease; child development disorders like separation anxiety disorder; and mental disorders that occur in adulthood like depression, anxiety, and psychotic disorders. To date, interventions that target factors associated with a specific disease are the most common form of prevention programs for brain disorders. However, these interventions, while important, are limited in their reach. By contrast interventions focused on generic risk factors, which influence the trajectory of multiple brain disorders, can have a broader population impact while simultaneously reducing the incidence of multiple brain disorders. Presently, we need an organizing framework for how to approach the prevention of brain disorders. Such a framework can inform the design and implementation of primary prevention efforts.
The successful implementation of prevention will not only result in a healthier population, but it will greatly reduce the global economic and social burden of brain disorders currently experienced. You can help to bring the prevention of brain disorders to the forefront of public health by participating in the Preventing brain disorders: Improving global mental health symposium, on May 2, 2014, co-hosted by the Peter C. Alderman Foundation, Columbia University Global Mental Health Program, and the Columbia University Department of Epidemiology. Visit CUESS.org for more information and to register for the event.
Edited by Elaine Meyer