Hardly a family in America has been untouched by mental illness. As many as one third of American adults will suffer a diagnosable mental disorder sometime in their life, and 20 percent have a mental disorder at any given time. Although research on the causes and treatment of mental disorders remains vitally important—and indeed major advances are leading to better lives for increasing numbers of people—much greater effort than ever before needs to be directed to prevention. The Senate Appropriations Committee of the U.S. Congress believed that a strategic approach to the prevention of mental disorders was warranted. The Congress mandated the National Institute of Mental Health to enter into an agreement with the Institute of Medicine (IOM) to prepare an integrated report of current research with policy-oriented and detailed long-term recommendations for a prevention research agenda. The specific tasks of the IOM committee, as negotiated with NIMH and the co-funding agencies, were as follows: • Review the status of current research on the prevention of mental illness and problem behaviors and on the promotion of mental health throughout the life span. This should include an understanding of available research knowledge, research priorities, and research opportunities in the prevention research area. • Review the existing federal presence in the prevention of mental disorders and the promotion of mental health, spanning the continuum from research to policy and services. • Provide recommendations on federal policies and programs of ABSTRACT xi Ab ou t th is P D F fil e: T hi s ne w d ig ita l r ep re se nt at io n of t he o rig in al w or k ha s be en r ec om po se d fro m X M L fil es c re at ed f ro m t he o rig in al p ap er b oo k, n ot f ro m t he or ig in al ty pe se tti ng fi le s. P ag e br ea ks a re tr ue to th e or ig in al ; l in e le ng th s, w or d br ea ks , h ea di ng s ty le s, a nd o th er t y pe se tti ng -s pe ci fic fo rm at tin g, h ow ev er , c an no t b e re ta in ed , a nd s om e ty po gr ap hi c er ro rs m ay h av e be en a cc id en t a lly in se rte d. P le as e us e th e pr in t v er si on o f t hi s pu bl ic at io n as th e au th or ita tiv e ve rs io n fo r a ttr ib ut io n.

Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research

It was a search for understanding the nature and origins of schizophrenia that brought Norman Garmezy to the study of children at risk for psychopathology, a pursuit that eventually led to the Project Competence studies of competence, adversity, and resilience (Garmezy, 1973). During the 1940s and 1950s, Garmezy developed an interest in the significance of competence in the history and prognosis of patients with serious mental disorders, with a particular focus on premorbid functioning in patients with schizophrenia (Garmezy & Rodnick, 1959). Eventually, the search for antecedents of psychopathology led Garmezy and others to study children of mentally ill parents because of their elevated risk of developing disorders. After hismove to theUniversity ofMinnesota in 1961, Garmezy began to focus his work on children, and subsequently played a leading

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A Resilience Framework for Research, Policy, and Practice

Despite a very large and growing literature demonstrating the significance of social support for health and well-being, surprisingly little is known about the social distribution of this crucial resource. This paper presents data on the distribution of social support and support resources across social class, marital status, age and gender, with the aims of contributing toward an understanding of the impact of social structures on processes of social support, and of assessing the hypothesis that epidemiological variations in mental health arise partially from social support differences. The epidemiology of perceived social support was found to correspond closely to the epidemiology of psychological distress and disorder. The single exception involved gender, where a positive rather than negative relationship was observed, with women demonstrating the highest levels of both social support and psychological distress. The observed patterns of variation in social support link this significant adaptive resource to one's locations in the social structure and reinforce the conclusion that it represents a promising intervention target. The practical importance of these results, however, are not matched by theoretical significance. Except in the case of marital status, our findings largely discount the hypothesis that the social distribution of mental health is partially attributable to social support differences.

Social support and social structure: a descriptive epidemiology

A confluence model is developed that explains the effects of birth order and family size on intelligence. Intellectual development within the family context is conceived of as depending on the cumulative effects of the intellectual environment, which, for the purposes of the model, consist primarily of the siblings’ and parents’ intelligence. Mutual influences, through time, on the intellectual development of the siblings are described by the growth parameter a. The confluence model predicts positive as well as negative effects of birth order, a necessarily negative effect of family size, and a handicap for the last born and the only child. The model explains several features of a large birth order study carried out on nearly 400,000 19-year olds. A number of implications of the model are discussed, among them the effects of age separation between successive children. In agreement with the implications, data on the relatively low IQ of twins and triplets are cited. Extensions of the confluence model to other social processes are discussed. The confluence model is examined for its usefulness in explicating a general class of social-psychological problems: the emergence of individual differences in a social context.

Birth Order and Intellectual Development

Mental health generally and depression in particular have been repeatedly shown to vary in relation to gender, socioeconomic status, marital status, and age. These status differences may be linked to mental health because they tend to define important differences in stress exposure and in the availability of coping resources. This paper examines the capacity of the stress-process model to account for the social distribution of depression. We employ mediation analyses using data from a 1990-1991 survey of Toronto community residents. In general, we found hypothesized risk factors to vary across these statuses with depressive symptoms and disorder and the distribution of protective factors to vary inversely. Results indicate that the model as expressed in our analyses accounts for a substantial minority of observed depression differences across individuals and for a considerable portion of reliably observed variation across social statuses. Our findings with respect to major depressive disorder parallel those for depressive symptomatology. Most compelling is the nearly total explanation of the socioeconomic status association with depressive symptoms and the substantial contribution toward explaining the socioeconomic status-disorder relationship when stress process mediators are accounted for.

The stress process and the social distribution of depression.

Premorbid adjustment and performance in schizoprenia: implications for interpreting heterogeneity in schizophrenia.

Relationship of marital status to incidence and prognosis of schizophrenia.

Stimulus differentiation by schizophrenic and normal subjects under conditions of reward and punishment.

The order of birth of an individual would appear to determine in many ways the family environment to which he is exposed during his developmental years. A person born early in the birth order will be in constant contact with siblings who are younger and therefore weaker and more helpless than he is. A late birth order, on the other hand, means years of close interaction with people who are also labeled children and whom the parents may strive to treat equally but who are bigger, smarter, and more powerful than the newcomer. In addition, the characteristics of the parents may change with birth order. The early-born children have parents who tend to be inexperienced in raising a family. They are likely to be eager to have children but unsure and nervous in handling them, and they may have unrealistic expectations regarding the child's immediate and distant future.

Birth order of recovered and nonrecovered schizophrenics.

Direct study of childparent interactions. Workshop, 1959. 1. The structured situational test: a method for studying family interaction in schizophrenia.

Norman Garmezy

Papers

Premorbid adjustment and performance in schizoprenia: implications for interpreting heterogeneity in schizophrenia.

Relationship of marital status to incidence and prognosis of schizophrenia.

Stimulus differentiation by schizophrenic and normal subjects under conditions of reward and punishment.

Birth order of recovered and nonrecovered schizophrenics.

Direct study of childparent interactions. Workshop, 1959. 1. The structured situational test: a method for studying family interaction in schizophrenia.