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Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research
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Institute of Medicine. Washington D.C.: National Academy Press; 1994. $49.95.
The Institute of Medicine report included in this book was a response to a request from the U.S. Congress to integrate current research and policy-oriented and detailed long-term recommendations into a prevention research agenda for mental disorders. Although the report addresses a topic that should be of obvious relevance to practicing physicians, the details of the report are probably only relevant to researchers in the field of mental disorders.
The conclusion of the committee assigned to the task were that a critical mass of knowledge now exists about the prevention of mental disorders but that rigorous research to evaluate specific preventive strategies is scarce. Increased coordination and research training is required to build the infrastructure for research, to expand the knowledge base, and to conduct well-evaluated interventions related to the prevention of mental disorders. If the specific recommendations of the committee became reality, they would begin to achieve a balance between the amount of resources directed at research in the prevention of mental disorders and the societal effects of these disorders.
Although several mental disorders relevant to internal medicine are specifically addressed in the book—including alcohol abuse and dependence, depressive disorders, Alzheimer disease, and schizophrenia—almost no mention is made of the role of the primary care sector in the prevention of mental disorders. Primary prevention is the main concern of the report and the community is the usual target. However, identification of persons at high risk for mental disorders because of either physical illness or genetic background would probably require the resources available in primary care settings. Many innovative prevention programs are briefly described. The San Francisco Depression Prevention Research Project, directed by Ricardo Munoz, is particularly relevant to primary care providers. Munoz reports the success of a cognitive behavioral small-group intervention to prevent depressive disorder in low-income patients with a few depressive symptoms who were attending a primary care clinic. Throughout the text, little attention is given to the potential for harm that may occur from identifying persons at high risk for mental disorders.
For the nonpsychiatric physician who wants to learn more about how to manage patients with a very common mental disorder, depression, I would recommend the complete version of the Agency for Health Care Policy and Research's Practice Guidelines: Depression in Primary Care, published in 1993. For those more interested in a recent synthesis of mental health research in general medicine I would recommend Mental Disorders in Primary Care, edited by Jeanne Miranda and colleagues and published by Jossey-Bass in 1994.
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