A familial risk enriched cohort as a platform for testing early interventions to prevent severe mental illness

BMC Psychiatry

Martin Alda²  Adrian Levy³  William Gardner²  Kathleen Pajer²  David Lovas²  Tomas Hajek²  Barbara Pavlova²  Alexa Bagnell²  Sabina Abidi²  Lukas Propper²  Alice Aylott²  Jacqueline M Glover⁴  Jessica Morash-Conway⁴  Lynn E MacKenzie¹  Jill Cumby⁴  Rudolf Uher³ 

[1] Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada;Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada;Department of Public Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada;Capital District Health Authority, Halifax, Nova Scotia, Canada

关键词: Early interventions;    Targeted prevention;    High-risk offspring;    Cohort study;    Major depressive disorder;    Bipolar disorder;    Schizophrenia;    Severe mental illness;   

Others  :  1091678
DOI  :  10.1186/s12888-014-0344-2

 received in 2014-10-06, accepted in 2014-11-19,  发布年份 2014

【 摘 要 】

Background

Severe mental illness (SMI), including schizophrenia, bipolar disorder and severe depression, is responsible for a substantial proportion of disability in the population. This article describes the aims and design of a research study that takes a novel approach to targeted prevention of SMI. It is based on the rationale that early developmental antecedents to SMI are likely to be more malleable than fully developed mood or psychotic disorders and that low-risk interventions targeting antecedents may reduce the risk of SMI.

Methods/Design

Families Overcoming Risks and Building Opportunities for Well-being (FORBOW) is an accelerated cohort study that includes a large proportion of offspring of parents with SMI and embeds intervention trials in a cohort multiple randomized controlled trial (cmRCT) design. Antecedents are conditions of the individual that are distressing but not severely impairing, predict SMI with moderate-to-large effect sizes and precede the onset of SMI by at least several years. FORBOW focuses on the following antecedents: affective lability, anxiety, psychotic-like experiences, basic symptoms, sleep problems, somatic symptoms, cannabis use and cognitive delay. Enrolment of offspring over a broad age range (0 to 21 years) will allow researchers to draw conclusions on a longer developmental period from a study of shorter duration. Annual assessments cover a full range of psychopathology, cognitive abilities, eligibility criteria for interventions and outcomes. Pre-emptive early interventions (PEI) will include skill training for parents of younger children and courses in emotional well-being skills based on cognitive behavioural therapy for older children and youth. A sample enriched for familial risk of SMI will enhance statistical power for testing the efficacy of PEI.

Discussion

FORBOW offers a platform for efficient and unbiased testing of interventions selected according to best available evidence. Since few differences exist between familial and ’sporadic’ SMI, the same interventions are likely to be effective in the general population. Comparison of short-term efficacy of PEI on antecedents and the long term efficacy for preventing the onset of SMI will provide an experimental test of the etiological role of antecedents in the development of SMI.

【 授权许可】

   
2014 Uher et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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