Literature Collection

Mental health is an escalating global health priority, yet prevention strategies remain underdeveloped and underutilized. This commentary outlines ten priorities to advance a modern, equitable, and effective approach to mental health prevention. It advocates expanding the At-Risk Mental State (ARMS) framework beyond psychosis to include other common mental disorders, and calls for routine, dynamic risk assessment, particularly targeting early-life adversities. A transdiagnostic approach is encouraged to better identify and respond to nuanced, dimensional early signs of psychological distress. Emphasizing a neurodevelopmental perspective, the commentary supports life-course interventions and improved continuity between child and adult mental health services. It urges to redesign mental health systems to enable early access and sustained youth engagement, particularly through multidisciplinary, integrated care models that encompass both mental health and addiction services. The commentary also highlights growing evidence of shared biological mechanisms, such as inflammation and metabolic dysregulation, linking mental and physical health, reinforcing the need for holistic prevention strategies. Finally, it underscores the necessity of societal and policy-level interventions to address structural determinants of mental illness, including inequality, environmental stressors, and youth marginalization. Together, these priorities present a proactive and collaborative vision of prevention that spans individual, community, and systemic levels. Achieving this vision requires a fundamental shift from reactive clinical care to preventive, intersectoral public health action. While ambitious, such a transformation is essential to reduce the global burden of mental illness and promote lifelong mental well-being.

Prior research has identified subgroups of HIV-positive gay and bisexual men (GBM) based upon information, motivation, and behavioral skills (IMB) profiles related to HIV medication adherence and methamphetamine use. We conducted a randomized controlled trial of a combined motivational interview (MI) and cognitive behavioral therapy (CBT) intervention tailored specifically to the unique context of HIV-positive GBM, and tested whether IMB profiles moderated treatment effects. HIV-positive GBM (N = 210) were randomized to MI + CBT or an attention-matched education control. Both conditions resulted in reduced methamphetamine use, improved medication adherence (and higher CD4 and lower viral loads), and fewer acts of condomless anal sex at 3, 6, 9 and 12 months post-intervention. Furthermore, the MI + CBT condition achieved greater improvements in medication adherence for men who had greater barriers to change compared to similarly-classified men in the control condition, suggesting the importance of pre-intervention profiles for tailoring future interventions.