Preventing adversity in children at ultra-high risk of mental illness: a randomized controlled longitudinal study

Research problem and research questions: Mental illness, particularly depression and anxiety, is the leading cause of disability in children and young people in Sweden and worldwide.

From early puberty, incidence of and impairment from mental illness increase drastically, predicting academic and job market failure, criminality, addiction, morbidity, and death by accident, homicide, and suicide, and vastly exceeding risks associated with physical health. Offspring where both parents are affected by mental disorders are at ultra-high risk of developing mental illness.

This is explained by a combination of genetic and environmental factors that interact to transform vulnerabilities into disabling mental illness. Can adversity in children at ultra-high risk of mental illness be prevented?

This project (summarized in Fig 1) addresses this question using a randomized controlled trial (RCT) embedded in a longitudinal study.Data and method: Aim 1 is to develop a long-term preventive and developmentally sensitive framework with high feasibility and acceptability.

Aim 2 is to recruit an ultra-high-risk cohort of 8-9-year-old children where both biological parents have mental illness (N = 558) and a control cohort from the general community (N = 279). Aim 3 is to randomize the ultra-high-risk cohort to long-term prevention or life as usual.

Acute and 1-year outcomes on risk/protective factors will be evaluated and health economic evaluations performed.Plan for project realization: The project group has expertise in mental health and illness, RCTs, genetic research, longitudinal studies, and health economics. Infrastructure and the human resources required to complete the project are in place.

A pilot study will secure feasibility and acceptability.

The project will be conducted as a collaboration between the child and adult mental health services in Skåne.Relevance: From puberty and onwards, mental illness causes vast human suffering and high societal costs. This study uses the best available knowledge to prevent adverse outcomes in high-risk children.

The initial aim is to affect leverageable risk/protective factors and the long-term goal to decrease incidence of mental disorders and improve everyday functioning and quality of life.

A unique longitudinal cohort will be generated that will increase our understanding of mechanisms governing mental health and illness with the goal to increase chances for high-risk children to achieve their full human potential.