Nursing Research: Mental Disorders Prevention

The prevention of mental disorders is based on a science that examines the incidence, prevalence, causes, and consequences of public health problems and the development, evaluation, refinement, and dissemination of interventions intended to prevent the occurrence or reoccurrence of those problems (Coie et al., 1993; Institute of
Medicine[IOM], 1994). Among the tenets underlying the science of prevention is that many mental disorders result from environmental stressors that place individuals and communities at risk. Moreover, dysfunctional intra-and interpersonal patterns that evolve from social and health disparities contribute toward the development of mental health problems (Albee, 1996). However, behavioral strategies can be powerful preventive interventions that block the onset or recurrences of mental disorders.

Mental Disorder

The goal of preventive intervention is to reduce malleable risk factors and/or enhance protective processes. Risk factors are those attributes or circumstances that contribute to an individual’s vulnerability (National Institute of Mental Health [NIMH], 1998a). The likelihood of developing a mental disorder increases for adults with each additional risk factor that they possess or encounter. Among children, each additional risk exponentially raises their susceptibility to mental disorders (Reiss, D., & Price, 1996). Protective processes, on the other hand, are the compensatory resources that moderate or even mollify the negative consequences of adversity (IOM, 1994). Protective factors include individual attributes such as an easy temperament, above-average intelligence, competency skills, and a supportive family environment.
The resiliency of children is enhanced by effective parenting and the involvement of other caring adults. For adults, a supportive marital relationship can be protective.
Two major classifications of mental health preventive intervention exist. The first evolved from a public health perspective (IOM, 1994). Primary prevention is intended for individuals who do not have mental health problems, but who wish to gain greater competence. Secondary prevention is intended for individuals and families who are at risk for developing mental disorders because they live in communities with more than one environmental stressor. Appropriate participants in secondary preventive intervention include those individuals who are experiencing mild or moderate psychological symptoms, but who are not in crisis. Tertiary prevention is directed at those who are in crisis. The goal of such intervention is to prevent psychiatric hospitalization or incarceration. Once the cri-sis is past, such individuals and families should be directed to primary or secondary intervention programs to sustain or enhance their adaptational outcomes. Another classification is derived primarily from the mental health field (IOM, 1994). Universal preventive interventions are directed at populations of individuals. Mc-Clowry (2003) used a translational approach to provide low-risk consumers with a self-help parenting manual. Selective prevention is intended for individuals, families, and com-munities who are at risk for the development of mental disorders. Nies, Chrusical, and Hepworth (in press) engaged inner-city women in a walking exercise program to enhance their health and reduce their level of stress. Indicated interventions are for those high-risk individuals who have biological markers or who have experienced early psychological symptoms of a mental disorder that has not reached a DSM-IV diagnostic level. Schepp and colleagues (1999) reported on an indicated intervention for adolescents who are diagnosed with schizophrenia.
Preventive science is an expansive multi-disciplinary field comprised of researchers and clinicians who often work in teams to capitalize on their various types of expertise.
Moreover, prevention scientists employ a wide range of qualitative and quantitative strategies to examine the multiple and inter-acting causes related to prevention issues. Epidemiological and other descriptive studies identify how risk factors and protective processes are related to mental disorders. The results from such studies subsequently inform interventionists about the mechanisms that are related to the disorder that they are trying to prevent. Interventionists also need to be aware of the cultural implications of the problem or disorder. Partnership with the relevant stakeholders is critical to assess the cultural appropriateness of the program (McClowry, Mayberry, Snow, & Tamis-LeMonda, 2004). The timing of prevention programs is essential for maximizing effectiveness. The optimal time is before dysfunctional behaviors are established (Coie et al., 1993). Transitional times that occur during the life course are particular periods during which individuals and families are vulnerable. The birth of a child or the death of a family member are just two examples of such normative experiences that are transitional and thus lend themselves to preventive intervention.
Prevention science and its related interventions are consistent with the nursing profession. Nurses have a history of being engaged in prevention activities, often labeling them “anticipatory guidance” or “health promotion” (McClowry et al., 2004). Examples of such clinical services include suicide, domestic violence, or drug-abuse prevention, HIV education, pregnancy prevention, and bereavement support. Other prevention programs include parenting programs aimed at reducing child neglect or abuse and those aimed at supporting caregivers of chronically ill or elderly family members.
Nurses engaged in preventive services, however, are unfortunately experiencing the same challenges that face other disciplines in the field. The time restraints imposed by the current health care system compromises the amount of time many health care providers can spend with their clients. Since most types of preventive services are not reimbursable from third-party payers, a danger exists that preventive intervention will be further reduced due to the current health care environment. As patient advocates, nurses will need to work diligently to make sure preventive services remain accessible to health care consumers. A recent report on prevention science (NIMH, 1998a) identified recommendations for future initiatives that will advance the field. A higher level of funding dedicated to preventive intervention and the related basic prevention science topics is essential. The prevention field especially needs to strengthen its epidemiologic foundations and expand the
number of interventions that have been evaluated empirically. Preventive intervention pro-grams often lack standardization and, too frequently, have been inadequately tested to determine whether they are achieving their intended outcomes. Demonstration of the efficacy of prevention programs supports the fact that this type of research is valuable and worthy of additional funding.
Challenges, however, are embedded in expansion of the field. Coordination across federal, state, and private agencies will be difficult to achieve, but necessary to assure that duplication of services is avoided and that the highest quality of programs are developed and tested. Findings should be disseminated so that constituents, funding agencies, and policy makers are kept informed of the developments of the field.

Although the prevention field has ex panded rapidly over the last decade, highly qualified researchers and interventionists are still needed. Nurses are particularly well prepared to contribute toward a recent emphasis on the comorbidities between mental and physical disorders. The ideal way to prepare nurses to engage in such research and to be prevention interventionists is the same as for other professions—interdisciplinary courses, mentoring, and opportunities for collaboration.