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BMC Psychiatry
Published in: BMC Psychiatry 1/2014

Open Access 01-12-2014 | Study protocol

A familial risk enriched cohort as a platform for testing early interventions to prevent severe mental illness

Authors: Rudolf Uher, Jill Cumby, Lynn E MacKenzie, Jessica Morash-Conway, Jacqueline M Glover, Alice Aylott, Lukas Propper, Sabina Abidi, Alexa Bagnell, Barbara Pavlova, Tomas Hajek, David Lovas, Kathleen Pajer, William Gardner, Adrian Levy, Martin Alda

Published in: BMC Psychiatry | Issue 1/2014

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Abstract

Background

Severe mental illness (SMI), including schizophrenia, bipolar disorder and severe depression, is responsible for a substantial proportion of disability in the population. This article describes the aims and design of a research study that takes a novel approach to targeted prevention of SMI. It is based on the rationale that early developmental antecedents to SMI are likely to be more malleable than fully developed mood or psychotic disorders and that low-risk interventions targeting antecedents may reduce the risk of SMI.

Methods/Design

Families Overcoming Risks and Building Opportunities for Well-being (FORBOW) is an accelerated cohort study that includes a large proportion of offspring of parents with SMI and embeds intervention trials in a cohort multiple randomized controlled trial (cmRCT) design. Antecedents are conditions of the individual that are distressing but not severely impairing, predict SMI with moderate-to-large effect sizes and precede the onset of SMI by at least several years. FORBOW focuses on the following antecedents: affective lability, anxiety, psychotic-like experiences, basic symptoms, sleep problems, somatic symptoms, cannabis use and cognitive delay. Enrolment of offspring over a broad age range (0 to 21 years) will allow researchers to draw conclusions on a longer developmental period from a study of shorter duration. Annual assessments cover a full range of psychopathology, cognitive abilities, eligibility criteria for interventions and outcomes. Pre-emptive early interventions (PEI) will include skill training for parents of younger children and courses in emotional well-being skills based on cognitive behavioural therapy for older children and youth. A sample enriched for familial risk of SMI will enhance statistical power for testing the efficacy of PEI.

Discussion

FORBOW offers a platform for efficient and unbiased testing of interventions selected according to best available evidence. Since few differences exist between familial and ’sporadic’ SMI, the same interventions are likely to be effective in the general population. Comparison of short-term efficacy of PEI on antecedents and the long term efficacy for preventing the onset of SMI will provide an experimental test of the etiological role of antecedents in the development of SMI.
Appendix
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Metadata
Title
A familial risk enriched cohort as a platform for testing early interventions to prevent severe mental illness
Authors
Rudolf Uher
Jill Cumby
Lynn E MacKenzie
Jessica Morash-Conway
Jacqueline M Glover
Alice Aylott
Lukas Propper
Sabina Abidi
Alexa Bagnell
Barbara Pavlova
Tomas Hajek
David Lovas
Kathleen Pajer
William Gardner
Adrian Levy
Martin Alda
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2014
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-014-0344-2

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