Opportunities for very early intervention in youth at high risk for severe mental illness

Severe mental illness, such as schizophrenia, bipolar disorder and major depression, tends to develop in adolescence and cause life-long disability. These diseases share many risk factors, the strongest of which is having one or both parents with mental illness. Recent accrual of knowledge on antecedents to mental illness may enable us to predict mental illness and develop interventions to forestall its onset. However several key questions remain to be answered regarding the target group specific interventions. The proposed study will map antecedents across childhood and adolescence among individuals at familial risk for severe mental illness. Children and young people aged 3 to 15 will be recruited if at least one of their birth parents suffers from schizophrenia, bipolar disorder or recurrent severe depression. Four known antecedents will be assessed at recruitment and three annual follow ups: delay in cognitive development, anxiety, psychotic-like experiences and affective lability. These antecedents are potential targets for preventive interventions. We will map the development of antecedents across ages to demarcate the age group that is most likely to benefit from interventions. We will establish the presence of developmental antecedents against a comparison group of offspring without family history of severe mental illness. We will test specificity of each antecedent to parents' diagnosis to decide whether diagnosis-specific or transdiagnostic interventions are more likely to be efficient. Rate of consent for being contacted with offers of interventions among offspring with antecedents will help estimate the numbers available for testing specific interventions. This project will advance knowledge on the development of severe mental illness among young people at familial risk and prepare grounds for testing of interventions aimed at reducing the risk of illness and avoiding life-long disability.