BOX S-2

Key Areas of Progress Since 1994

  • Evidence that MEB disorders are common and begin early in life.

  • Evidence that the greatest prevention opportunity is among young people.

  • Evidence of multiyear effects of multiple preventive interventions on reducing substance abuse, conduct disorder, antisocial behavior, aggression, and child maltreatment.

  • Evidence that the incidence of depression among pregnant women and adolescents can be reduced.

  • Evidence that school-based violence prevention can reduce the base rate of aggressive problems in an average school by one-quarter to one-third.

  • Promising evidence regarding potential indicated preventive interventions targeting schizophrenia.

  • Evidence that improving family functioning and positive parenting serves as a mediator of positive outcomes and can moderate poverty-related risk.

  • Emerging evidence that school-based preventive interventions aimed at improving social and emotional outcomes can also improve academic outcomes.

  • Evidence that interventions that target families dealing with such adversities as parental depression and divorce demonstrate efficacy in reducing risk for depression among children and increasing effective parenting.

  • Evidence from some preventive interventions that benefits exceed costs, with the available evidence strongest for early childhood interventions.

  • Evidence of interactions between modifiable environmental factors and the expression of genes linked to behavior.

  • Greater understanding of the biological processes that underlie both normal brain function and the pathophysiology of MEB disorders.

  • Emerging opportunities for the integration of genetics and neuroscience research with prevention research.

  • Advances in implementation science, including recognition of implementation complexity and the importance of relevance to the community.

determinants of mental illnesses was on the horizon. It is now recognized that most disorders are not caused by a small number of genes and that this area of research is highly complex. An emerging area of research involves the influence of the environment on the expression of a specific gene or set of genes, the importance of epigenetic modification of gene expression by experience, and direct injury to neural systems that give rise to illness. This exciting new knowledge has the potential to inform future preventive interventions.

The future of prevention requires combined efforts to (1) apply existing knowledge in ways that are meaningful to families and communities and (2) pursue a rigorous research agenda that is aimed at improving both the quality and implementation of interventions across diverse communities.



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