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Can we prevent mental illness? Understanding risk and resilience

We’ve all heard of campaigns that tell us to eat our five a day to keep our heart healthy, to wear sunscreen to protect us from skin cancer or to make sure we get the flu jab in winter. These measures help to prevent physical health problems from occurring – but what about mental health? How do we protect ourselves against mental illness?

Right now, scientists are on a global mission to discover what puts people at risk of mental illness, and crucially, what makes someone resilient. This understanding opens up huge potential for creating interventions that can tackle mental health problems before they arise.

How does adversity impact the brain?  

Professor Eamon McCrory is co-director of the Developmental Risk and Resilience Unit at University College London. He studies how maltreatment in childhood can put someone at risk of future mental health problems. “My work is really trying to understand how those early experiences get under the skin in ways that can increase vulnerability or resilience”, says Eamon.

His research has shown that child maltreatment changes how the brain processes emotional information. The group found that that children who suffered from maltreatment had greater activity in the amygdala, a key emotional-processing area of the brain, when presented with emotional facial expressions. There was a similar heightened response when a group of maltreated children recalled negative memories.

These studies suggest that children who are maltreated are hyper-sensitive to emotional situations. This focus can become problematic in a number of ways. As Eamon explains: “There could be a long-term impact on the ability of the child to cultivate and sustain positive relationships. Without strong support networks, a child is more vulnerable when new stressful events arise in the future.” Ultimately, this could lead to mood disorders or anxiety.

With a better understanding of how these changes in the brain can lead to mental health problems, we may be able to develop strategies to increase resilience in at-risk children. “I would imagine that the basis of a preventative intervention will be social at its core,” says Eamon. “Children may be more likely to recalibrate how they process their internal and external worlds through a relationship with trusted adults and peers.”

Fostering social support

Social aspects of resilience are also being explored by MQ-funded researcher Dr Anne-Laura van Harmelen, Royal Society Dorothy Hodgkin fellow at the University of Cambridge. “Resilience is dynamic, so it can fluctuate,” she says. “How resilient you are can go up or down, depending on environmental or other influences.”

Anne-Laura is particularly interested in whether support from family and friends can increase resilience.

To answer this question, she looked at almost 800 adolescents from the ROOTS study. This project measured aspects of teenagers’ mood and lifestyle over the course of three years, so Anne-Laura’s group was able to examine how social support early in adolescence affected symptoms of depression later in at-risk teenagers.

Participants in the study who had experienced more bullying from peers or family when they were children tended to have more symptoms of depression at age 17. But when children had strong social support around them, their symptoms of depression decreased.

Importantly, the kind of support needed to match the type of adversity experienced. “If you had early negative family experiences, family support helped, but if you had negative experiences in the peer environment, friendships helped – but not the other way around,” says Anne-Laura.  

These results come from statistical models, and Anne-Laura says that future studies are needed to conclusively show that social support promotes resilience: “You would have to have a group of people and increase their social support, and examine their response to that.”

Nevertheless, the results are promising. “I think all our findings in the lab really suggest that increasing these resilience factors might help. So increasing friendships and increasing family support could help reduce mental health problems,” she said.

Targeting the adolescent brain

Professor Sarah-Jayne Blakemore at University College London is an expert in the adolescent brain. She says that adolescence is a crucial time for targeting interventions, because it is a stage of life where the brain is still adaptable. “It’s a period of heightened plasticity, which increases both vulnerability to mental illness and also opportunity for things like rehabilitation and therapy.”

Sarah-Jayne is part of a project called My Resilience in Adolescence (MYRIAD), a seven-year programme investigating mindfulness run together with researchers from Cambridge and Oxford. Almost 6,000 children aged 11-14 will participate in the study, across 76 schools. Participants will either receive eight sessions of mindfulness, or teaching as usual. The researchers will then examine whether mindfulness training has a positive effect on measures like well-being and rates of depression.

The research is important as it is not yet clear whether mindfulness improves well-being in children. “Some schools already have mindfulness classes but the evidence-base really isn’t there yet. The randomised control trial in MYRIAD will help us understand if mindfulness classes in schools are beneficial for young people’s mental health and wellbeing,” says Sarah-Jayne.

The project has only recently started and results won’t be known for a few years. But in theory, many children might benefit from mindfulness.

Sarah-Jayne says: “The hypothesis is that it might be quite good for everyone, even children who are thriving. There are always times in young people’s lives that are stressful, like exams or sports matches, so mindfulness might be quite useful for everyone across the board, not just for those who are at risk of mental illness.”

A shift in focus

There are many other researchers – from across different scientific fields – also looking at resilience, from targeting the immune system to investigating the role of genetics. This shift in focus offers a new approach to tackling major challenges in mental health. If we are able to foster good mental health at an early stage in life, rather than waiting for conditions to emerge, then we might be able prevent the impact of debilitating conditions.

Eamon McCrory and Sarah-Jayne Blakemore will be speaking at MQ’s Mental Health Science Meeting in London on 1-2 February 2018. For further information and to register, please click here.

Last updated: 17 January 2018


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