Prevention has been proposed as one of the “grand challenges” for global mental health. Psychiatry and mental health have lagged behind other disciplines in devising and implementing preventive strategies. In this symposium we will demonstrate a range of population based approaches to both primary and secondary prevention, ranging from prenatal complications to adolescent substance use and suicidal ideation, to use of omega 3 fatty acids.
Professor Anne Thorup will present results from a Danish high risk offspring study showing that prenatal and early developmental markers may form the basis for preventive interventions and preliminary results from a feasibility study of a parenting supports for parents with mental health problems
Dr Subash Raj Susai will present data showing that supplementation with omega 3 fatty acids can improve outcome for a subset of young people with major depression which is associated with increased inflammatory markers
Dr Joni Lee Pow will present data on the association between cannabis use and risk of psychosis in Trinidad showing that the risk is highest for those who commence cannabis use in adolesence.
Professor David Cotter presents data from a longitudinal population based cohort study showing that reports of suicidal ideation in adolesence is associated with increased risk of mental disorder at age 24. The highest risk was for later psychotic disorder thus identifying a novel risk group for later psychosis.
We expect that these presentations on this important topic will inspire discussion and further ideas for research.
16:35 pm
Early risk factors in children born to parents with severe mental illness: the VIA 7 study
Prof. Dr. Anne Thorup | University of Copenhagen
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Author:
Prof. Dr. Anne Thorup | University of Copenhagen
Aim: Evidence shows that early factors in life play an important role in the developmental process of psychopathology later in life, since brain development is very sensitive to the quality of stimulation and support from the environment during the earliest years of life. Most likely, this is exaggerated in children who are born with at genetic predisposition to mental illness like schizophrenia or bipolar disorder.
We aimed to investigate the frequency of a range of early risk factors in a group of children born to parents with schizophrenia or bipolar disorder
Method: A cohort of 522 7-years old children, 202 born to parents diagnosed with schizophrenia, 120 born to parents diagnosed with bipolar disorder and 200 population-based controls was established. Extensive interviews were conducted with the primary caregiver about pre and postnatal early development and life circumstances in order to analyze frequencies and possible group differences.
Results: Children born to parents with severe mental illness experienced higher levels of risk factors during pregnancy, (e.g. being exposed to smoking, medication and stress) and during early life years (stressful life events, deviations in development). A linear correlation between number of early risk factors and decreasing level of functioning at age 7 was found.
Conclusion: Factors in early life show correlation with later functioning. Early parenting support among parents with mental health problems are being tested in a feasibility study.
16:50 pm
Cannabis use as a risk factor for psychoses in Trinidad: Findings from the INTREPID II programme
Dr. Joni Lee Pow | University of West Indies
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Dr. Joni Lee Pow | University of West Indies
Aims: Cannabis use may be the most modifiable identified risk factor (compared to urbanicity, trauma or genetics) associated with psychoses making it an important strategy in psychosis prevention. We aimed to examine the association between cannabis use and incidence of psychosis. Methods: A case-control study within the International Programme of Research on Psychotic Disorders (INTREPID) II was conducted between 2018 and 2020, recruited over 200 pairs of matched cases and controls in three settings (Kancheepuram India; Ibadan, Nigeria; Trinidad). Results: In Trinidad we found strong associations between cannabis use and the incidence of psychoses; frequent use (adj. OR 1.99, 95% CI 1.10-3.60), early age of first use (adj. OR 1.83, 95% CI 1.03-3.27) and high cannabis dependency (adj. OR 4.70, 95% CI 1.77-12.47). Cannabis use was also associated with an earlier age of onset (mean age 25 vs. 30 years). Cannabis use in the other two settings were too rare to examine associations. In Trinidad, early age of first use was linked to frequent adult use where half the participants whose first cannabis use was ≤ 15 years went on to become frequent adult users. In Trinidad, 27% cases compared to 10% controls tried to previously quit cannabis but high co-use with tobacco. Conclusions: Targeting the prevention of adolescent cannabis use might help reduce earlier age of onset and indirectly reduce adult frequent use and dependency.Cannabis cessation strategies may need to consider co-use with tobacco and address nicotine addiction.
17:05 pm
Suicidal ideation at age 17 is associated with increased risk of psychiatric disorders at age 24
David Mongan | Queens University Belfast
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David Mongan | Queens University Belfast
Aims: Early intervention for mental disorders is associated with improved outcomes. Identification of high-risk subgroups enables targeting of preventative interventions. Previous evidence suggests presentation to hospital with self-harm may be a risk indicator for mental disorders in later life.Method: In this study we investigated whether reporting thoughts of self-harm in late adolescence was associated with psychotic disorder, depressive disorder or generalised anxiety disorder in early adulthood. The study sample was drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK-based cohort study. Logistic regression was used to evaluate prospective associations between thoughts of self-harm at age 17 and mental disorders at age 24. Results: We found that there was strong evidence for prospective associations between thoughts of self-harm at age 17 years and psychotic disorder (odds ratio [OR] 7.15, 95% confidence interval [CI] 2.80 – 18.27), depressive disorder (OR 2.19, 95% CI 2.12 – 4.78) and generalised anxiety disorder (OR 3.64, 95% CI 2.57 – 5.17) at age 24 years. Conclusion: Individuals reporting thoughts of self-harm in late adolescence represent a subgroup at enhanced risk of mental disorders, particularly psychotic disorder, in early adulthood. Future studies should first replicate this finding. Secondly, it is possible that interventions targeting this population will have a significant impact on later rates of psychiatric disorder, particular psychosis. This needs to be pursued.
17:20 pm
The interactive effects of omega-3 and Interleukin-6 on mental health symptoms and functioning in young people with major depressive disorder
Prof. David Cotter | Royal College of Surgeons in Ireland | Ireland
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Prof. David Cotter | Royal College of Surgeons in Ireland | Ireland
Dr. Subash Raj Susai | RCSI University of Medicine and Health Sciences
Aims: The pro-inflammatory cytokine Interleukin (IL) - 6 has been found to be altered in both acute and chronic states of depressive disorder. Supplementation with omega-3 fatty acids (FAs) is a suggested treatment option for depressive disorder but data remains sparse. The current study investigate the interaction between IL-6 levels and omega-3 FAs on clinical symptoms in a study of young people undergoing treatment for Major Depressive Disorder (MDD). Method: This study was based within the YODA-F (Youth depression alleviation-Fish Oil) study of youth depression. IL-6 concentrations in plasma samples were measured using immune-assays. The omega-3 index was measured using gas chromatography. Clinical outcomes included the depressive and anxiety symptoms, functioning and overall clinical improvement. Linear regression models were adjusted for age, sex, BMI, smoking status and site. For the interaction analysis 12-week change in omega-3 and IL-6 levels were used to estimate the effect on clinical outcome at follow-up. Results: A total of 175 participants from YODA-F study having a mean age of 19 years (± 3), an overall BMI of 25.3 (± 6.7) Kg/m2 were considered for the current analysis. No main associations were found between plasma levels of IL-6 or Omega -3 index with clinical outcomes. However, at 12-weeks a change in IL-6 and omega-3 levels demonstrated a significant negative interaction effect on depression and anxiety scores and a positive interaction effect on functional outcomes at follow-up.Conclusion: Overall the results suggest that the clinical effect of omega-3 is linked to IL-6 levels in plasma. The findings indicate that omega-3 supplementation could be more beneficial in treating depressive, anxiety and functional symptoms in a subset of young people with major depressive disorder associated with increasing plasma IL-6 levels.