The effectiveness of mental health promotion, prevention and early intervention in children, adolescents and adults: a critical appraisal of the literature

Doughty C
Record ID 32005000403
Authors' objectives:

The purpose of this review was to provide an evidence-based review of the effectiveness of mental health promotion, prevention and early intervention programmes for children, adolescents and adults. Studies were considered if they aimed either (a) to prevent the development of mental health conditions relating to alcohol and drug disorders, conduct disorder, eating disorders, mood and/or anxiety, or (b) to intervene in the early stages of a mental health condition to alter its development or pathway.

Authors' recommendations: The conclusions and recommendations are based on the current evidence available from this report's critical appraisal of literature published on the effectiveness of mental health promotion, prevention and early intervention in children, adolescents and adults. The scope of this review was extremely broad hence, although it used a systematic approach to search for and retrieve relevant studies, it should still be considered to be selective, rather than exhaustive. It is likely that individual studies of specific programmes may have been missed in the search and retrieval process despite extensive additional citation searching. Where a significant group of studies have been conducted or there are multiple study replications examining variants of a similar programme it is less likely that there will be omissions. Of particular note, the restriction on the timeframe means that many primary studies outside the time limited scope were not considered when making general conclusions. Four broad subgroups of mental disorders were considered in this review. Given that each has inherent differences in their approach to prevention it is not possible to make specific conclusions that generalise across all conditions. Unfortunately specific conclusions can also not be made about the transferability of programmes but this is reflected in a general lack of consensus internationally about what works best and where. A number of generic recommendations reported previously by Nicholas and Broadstock (1999) in the context of early intervention for young people are still highly relevant given the paucity of outcome evaluations conducted to date (six years since the original report and only one subsequent randomised controlled trial) in New Zealand. Therefore, it is suggested that in the future primary prevention of mental disorder in New Zealand will be best supported by the following actions: - mental health prevention and promotion providers should examine the work of others internationally and consider which programme development strategies would best meet their needs and are likely to be able to be tailored to suit the New Zealand population, - mental health prevention and promotion programme providers should consider transferring programmes already implemented and evaluated elsewhere, keeping in mind features of their own community, resources available, and their overall work plan priorities, - mental health prevention and promotion programmes should be pilot-tested on a small scale, with rigorous process evaluation to gauge the potential for more widespread success as well as to inform modifications which will maximise their chance of being effective, - mental health prevention and promotion programmes should involve outcome evaluation strategies which are well planned, realistically resourced as part and parcel of service provision, and appropriately extended over time to measure short, medium and long-term success, - mental health prevention and promotion programmes should include process evaluations which will help maintain the fidelity of a programme, and tell us why outcome effects are found or not found, - any future evaluations of mental health prevention and promotion initiatives should routinely examine the cost effectiveness both of achieving changes in outcomes and conducting the programmes, - New Zealand-based workforce development and training initiatives should be instituted in the areas of mental health prevention and promotion programme development, implementation, and evaluation. This should include the development and funding of intervention science/scientists, - high level advice and expertise on planning and conducting evaluations of mental health prevention and promotion programmes (e.g. in the areas of study design, instrument development, statistical analysis) should be made available to service providers from the early stages of developing their programme. Despite the lack of information about how to determine what strategies are the best from among the many that have been evaluated, there remains a large body of evidence that suggests a number of programmes have proven preventive effects for specific disorders. Evidence that it is possible to reduce the incidence of mental disorder is still pending. Cultural applicability makes the task of dissemination of evidence-based interventions complicated and relatively slow (World Health Organization 2004) with the onus now on funders and planners, mental health, public health and other sectors to work together to make delivery and evaluation of mental health prevention and promotion initiatives a reality in New Zealand.
Authors' methods: Systematic review
Project Status: Completed
Year Published: 2005
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: New Zealand
MeSH Terms
  • Adolescent
  • Adult
  • Anxiety
  • Child
  • Conduct Disorder
  • Depression
  • Feeding and Eating Disorders
  • Health Promotion
  • Mental Disorders
  • Primary Prevention
  • Substance-Related Disorders
Organisation Name: New Zealand Health Technology Assessment
Contact Address: Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, P.O. Box 4345, Christchurch, New Zealand. Tel: +64 3 364 1145; Fax: +64 3 364 1152;
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Copyright: New Zealand Health Technology Assessment (NZHTA)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.