فرصت هایی برای پیشگیری از اختلالات روانی با کاهش آسیب شناسی روانی
Abstract
1- Evidence for a meaningful general factor of psychopathology
2- Can we target the general factor of psychopathology to prevent psychopathology?
3- Implications for interventions
4- Conclusion
References
Abstract
This paper explores the concept that reducing general psychopathology early in the life course provides unprecedented opportunities to prevent the development of all forms of psychopathology later in life. We review empirical evidence for the existence of the general factor of psychopathology and theories regarding the psychological nature of the factor. We then highlight specific examples of environmental risk factors for general psychopathology and discuss translational implications for the transdiagnostic prevention of psychopathology beginning in early childhood. Ultimately, we propose a developmentally informed and transdiagnostic stepped care approach to intervention in which reduction of general psychopathology in early childhood represents the foundational step for prevention and intervention of subsequent psychopathology. This model heralds three key benefits over the current treatment zeitgeist: (1) Reducing the burden and confusion in healthcare and education systems by providing a coherent and systematic structure for early intervention across a child's development, (2) maximising the breadth of the impact of intervention by focusing on common shared risks across psychopathology, and (3) increasing the efficiency of intervention by corresponding with the development of psychopathology and leveraging the emergence of general psychopathology in early childhood.
Evidence for a meaningful general factor of psychopathology
Mental disorders are traditionally conceptualized in terms of hundreds of discrete and putatively separate categories. This is the type of approach taken in authoritative nosologies; most notably, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-III, DSM-IV, and DSM-5; APA, 2013). However, these mental disorder categories tend to co-occur at levels much higher than chance. From a categorical standpoint, this phenomenon has been termed “co-morbidity,” reflecting the idea that two putatively distinct “categorical forms of morbidity” (mental disorders) have co-occurred. In fact, “multi-morbidity” is a more accurate term for what is observed, because essentially all DSM-defined mental disorders covary at rates higher than chance (e.g., Kessler, Chiu, et al., 2005). The observation that diverse forms of psychopathology co-occur at high rates gave rise to efforts to model the multivariate patterns empirically. This is now a topic of substantial interest in the psychopathology literature. Earlier literature in this area focused specifically on mental disorders known to be relatively common in the general population, as observed in large, community-based epidemiologic samples.