Families Overcoming Risks and Building Opportunities for Well-being (FORBOW): Early Intervention Targets Psychopathological Antecedents to Pre-empt Severe Mental Illness in Youth at Risk

Severe mental illness, such as schizophrenia, bipolar disorder and depression, tends to develop in late adolescence. Once the illness is established, available treatments cannot cure it. Early intervention before the illness develops may avoid years of suffering and disability. Families Overcoming Risks and Building Opportunities for Well-being (FORBOW) tests a novel type of pre-emptive early intervention that aims to prevent severe mental illness. In addition to youth from the general population, we include children of parents with schizophrenia, bipolar disorder and depression, who are themselves at high risk of developing a mental illness. This risk is increased further among those who show antecedent symptoms like mood lability, anxiety and unusual sensory experiences. We focus on assessing these symptoms as well as using genetic tests to identify individuals who may benefit most from pre-emptive early interventions. In those aged 9-17 who have one or more antecedent symptom, we test the Skills for Wellness (SWELL) intervention, which helps young people learn skills that not only address their present problems, but also equip them to deal with future challenges. Half of the eligible youth are randomly selected to be offered the SWELL intervention. We monitor all participants annually to assess their health and development. We test the effects of the intervention by comparing those who were offered SWELL against those who were not offered the intervention. We also want to find out whether a genetic test may help select individuals who are most likely to benefit from the intervention. Our vision is to provide timely personalized interventions to maximize the benefits for mental health of the next generation.