This article first appeared in Bench Press, a publication of the Mass General Research Institute.
When it comes to treating diseases of the body, such as diabetes, heart disease, and cancer, early diagnosis and treatment play a key role in keeping patients healthy and improving their quality of life.
The same principle applies to diseases of the mind, such as depression, anxiety and psychosis, where early intervention and treatment can also be beneficial.
Mental illness continues to be a major public health issue in the United States, particularly among youth and young adults.
According to the National Institute of Mental Health, nearly one in ten youth in the U.S., aged six to 17 years, have experienced a major depressive episode in the past year. Suicide is the second leading cause of death among individuals aged 10-34.
This week, we interviewed Daphne Holt, MD, PhD, the director of the Resilience and Prevention Program and the Emotion and Social Neuroscience Laboratory at Massachusetts General Hospital, MGH Research Scholar 2018-2023, and an associate professor of Psychiatry at Harvard Medical School. Holt and her team are working on ways to identify the early signs of psychiatric disorders in youth and provide them with tools to manage their mental health.
“I came to a realization about a decade ago that little progress had been made in developing preventive approaches in psychiatry, unlike most other areas of medicine, such as infectious disease, oncology and cardiology,” Holt states.
One of the challenges in early identification of symptoms of depression and anxiety is the lack of measurable biological indicators for these diseases, such as those that can be identified through a blood test or an MRI.
In modern medicine, diagnoses for psychiatric disorders are based on self-reported symptoms, explains Holt. Clinicians ask questions such as “Do you have little interest or pleasure in doing things?” or “Are you feeling down, depressed, or hopeless?”
“One could argue that we need these types of biomarkers in psychiatry more than in other fields of medicine since ‘self-report’ of subjective symptoms is a particularly unreliable source of information at times, especially in people who have illnesses that may affect their judgment and their ability to perceive themselves accurately,” Holt says.
This self-report method may also overlook individuals who do not meet the criteria for a diagnosable illness but still suffer from a variety of symptoms and may be at risk of developing more severe mental illness later on. Many youth fall into this category because although symptoms of mental disorders can start during childhood, the peak time of onset for many mental illnesses is during late adolescence and early adulthood.
To address this challenge, Holt founded and currently leads the MGH Resilience and Prevention Program, which focuses on identifying youths with early signs of mental illness and teaching them resilience training to improve their mental health.
Training individuals in techniques that foster resilience when they may be at-risk for developing a mental illness equips them with the skills needed to better “bounce back” in the face of adversity. So far, this program has been tested and shown success in reducing or eliminating the early signs of mental illness in college students, adolescents, and healthcare workers.
“We conducted a randomized control trial that showed our program for at-risk young adults works. It significantly decreased early symptoms of mental illness long-term more so than a control condition. Since then, we have started training clinicians in this approach to hopefully implement it on a broader scale.”
Could this program be the next step in promoting youth mental health?
About the Mass General Research Institute
Research at Massachusetts General Hospital is interwoven through more than 30 different departments, centers and institutes. Our research includes fundamental, lab-based science; clinical trials to test new drugs, devices and diagnostic tools; and community and population-based research to improve health outcomes across populations and eliminate disparities in care. Support Research at MGRI.
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Clauss JA, Bhiku K, Burke A, Pimentel-Diaz Y, DeTore NR, Zapetis S, Zvonar V, Kritikos K, Canenguez KM, Cather C, Holt DJ. Development of a transdiagnostic, resilience-focused intervention for at-risk adolescents. J Ment Health. 2023 Jun;32(3):592-601.
Daphne Holt, MD, PhD is the Co-Director of the MGH Psychosis Clinical and Research Program, Director of the MGH Resilience and Prevention Program, and an Associate Professor in Psychiatry at Harvard Medical School. Using functional neuroimaging in combination with physiology, behavioral tasks and clinical assessments, she has investigated the neurocognitive basis of the core symptoms of psychotic illness, including delusions, negative affect and social impairment. Her research has also focused on identifying changes in brain function and behavior linked with risk for serious mental illness and has been developing novel interventions to increase resilience and potentially prevent serious mental illnesses in at-risk youth.
