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Working with Patients, Clients, Families and Communities

Working with families to prevent mental illness in children

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Mental health researchers at NSHA and the IWK Health Centre are leading a long-term study to learn what helps children stay healthy and well, even when they have a family history of serious mental illness that may increase their risk of developing a similar disorder.

Families Overcoming Risks and Building Opportunities for Wellness—known as FORBOW—is enrolling youth and their parents, including families in which one or more parent has been diagnosed with major depression, bipolar disorder or schizophrenia.

“Parents are very open to joining our study,” says FORBOW lead researcher Dr. Rudolf Uher, NSHA psychiatrist and professor in Dalhousie’s Department of Psychiatry. “Many of them are concerned by the possibility that one or more of their children could go on to develop an illness like theirs and want to do whatever they can to reduce that risk.”

Families with children as young as one and old as 21 can enroll in the study, which will follow them for five years or longer to see what factors best predict—and prevent— serious mental illness.

“I’ve always worried that my son might develop a mental illness,” says one woman with bipolar disorder who enrolled her family in the study soon after it launched in 2013. “He suffers from tremendous anxiety. It’s reassuring to know he’s being carefully monitored through his teen years for early signs of potentially more serious illness.”

Anxiety is one of the early antecedents to serious mental illness that the FORBOW researchers look for and track in the study children. A rapidly changing emotional state, unusual perceptions, and the sudden, brief loss of an ability (such as speech or hearing), are also warning signs of potential trouble ahead. But the researchers look even deeper.

“We examine the children’s learning styles, how they think, go about remembering a story, or solving a problem,” Dr. Uher says. “This is a relatively new area of brain research, but it may be that people with certain ways of thinking are more susceptible to mental illness than people with different cognitive styles.”

The assessments are rigorous but the researchers make them fun. “Our team takes the children through a series of carefully designed activities, including puzzles and games, which reveal a great deal about their cognitive function and psychological state,” says mental health nurse and FORBOW research manager, Jill Cumby. “We also assess the parents’ mental health history, look for current signs of severe mental illness, and identify any additional supports they may need.”

Families can choose to take part in sub-studies involving DNA analysis of saliva samples and magnetic resonance imaging (MRI) scans of the brain. “These studies will shed light on the genetics of mental illnesses and how they may affect the structure and function of the brain,” Cumby says. “They may also reveal potential new ways to identify kids at the highest risk who would benefit most from early intervention.”

Children who show early signs of elevated risk are enrolled in FORBOW’s intervention arm, SWELL (Skills for Wellness). “We know that building children’s coping skills and resilience can prevent them from developing serious mental illnesses,” Dr. Uher says. “We want to know what methods are most acceptable to children and families and have the most protective effects.”

Given that anxiety is highly predictive of risk, for example, the researchers ensure that anxious parents receive treatment for their anxiety, and teach them parenting skills so they can help their children better manage anxiety as well.

“Very few research teams in the world are working with families in this way,” notes Dr. Uher. “Nova Scotia is a great place for this kind of research. Our population is so willing to contribute to the research—families from one end of the province to the other are involved.”

Dr. Uher and his research team (10 staff members and about 20 collaborating psychiatrists and psychologists at NSHA and the IWK Health Centre) received a five-year $1.2 million Foundation Grant from the Canadian Institutes of Health Research (CIHR) in 2016.