Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally‐sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high‐risk for psychosis paradigm has received the most empirical validation, while clinical high‐risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non‐genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi‐endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence‐based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost‐effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.

中文翻译：

---

预防精神病学：改善年轻人心理健康的蓝图

预防方法最近在改善年轻人的心理健康方面受到关注。在本文中，我们首先评估了预防精神病学的概念基础，包括公共卫生、戈登、美国医学研究所、世界卫生组织，以及良好的心理健康框架，以及对神经发育敏感的临床分期模型。然后，我们回顾了支持对精神病、双相和常见精神障碍进行一级预防和促进良好精神健康作为降低年轻人这些障碍发病率的潜在变革策略的证据。在指定的方法中，精神病的临床高风险范式已获得最多的经验验证，而双相和常见精神障碍的临床高风险状态正日益成为关注的焦点。选择性方法主要针对家庭脆弱性和非遗传风险暴露。对弱势亚群进行选择性筛查和心理/心理教育干预可能会改善焦虑/抑郁症状，但它们在降低精神病/双相/常见精神障碍发病率方面的功效尚未得到证实。选择性的体育锻炼可以降低焦虑症的发生率。普遍的心理/心理教育干预可以改善焦虑症状，但不能预防抑郁/焦虑症，而普遍的体育锻炼可以降低焦虑症的发病率。针对学校气候或社会决定因素（人口、经济、社区、环境、社会/文化）精神障碍最有可能降低整个人群的风险状况。目前促进良好心理健康的方法是分散的。我们利用从审查中获得的知识，为青少年预防精神病学的未来研究和实践制定蓝图：整合通用和有针对性的框架；推进多变量、跨诊断、多终点的流行病学知识；协同预防常见和罕见的精神障碍；共同预防身心健康负担；实施分层/个性化预后；建立循证预防干预措施；制定道德框架，通过教育/培训改善预防；巩固预防精神病学的成本效益；并减少不平等。这些目标只能通过紧急的个人、社会和全球层面的反应来实现，这促进了科学、卫生保健、社会和政府部门之间的积极合作，以实施预防性精神病学，这对患有或处于危险中的年轻人来说至关重要对于新出现的精神障碍。