心理预防概念的更新及其对实践的指导意义

The Updating of Preventive Concept and Its Practical Implications

继Caplan的"公共卫生预防模型"之后,Gordon提出另一个综合性预防模型;美国国家医学研究所绘制了"心理健康干预光谱";美国国家研究所和国家科学院医学院则进一步将"心理健康促进"正式纳入心理预防概念。"心理健康促进"是针对消极被动的传统预防而提出的积极主动的预防。心理预防概念的发展与更新,特别是将"心理健康促进"纳入心理预防体系,要求树立预防的全局观念,提高预防的针对性,将消极心理预防与积极心理健康促进结合起来。

Caplan＇s public health prevention model including primary prevention, secondary prevention and tertiary prevention exerted an important influence on the early development of prevention programs. Gordon indicated that most disorders might turn into more serious psychological crises without effective treatment. From a developmental perspective, all the treatment would be potentially labeled as prevention. Gordon thus claimed that the tertiary prevention in Caplan＇s model, which refers to the rehabilitation of disability for those suffering from disorders, should not be included in the prevention system. Based on the costs and benefits of delivering the intervention to the different targeted populations, Gordon proposed an alternative threefold classification called comprehensive prevention model that includes universal prevention, selective prevention and indicated prevention. After that, American Institute of Medicine emphasized the importance of putting prevention into a broader context and depicted a mental health intervention spectrum, in which not only the prevention and treatment of disorders but also the maintenance interventions are included. American National Research Council and Institute of Medicine insisted that the mental health promotion should be recognized as an important component of the mental health intervention spectrum so that it can serve as a foundation for both the prevention and treatment of disorders. Mental health promotion is characterized by focusing on people＇s well - being or healthy outcomes rather than the prevention of illnesses and disorders. These outcomes are intrinsically valuable in decreasing the incidence of disorders. Mental health promotion attaches importance to enhancing individuals＇ ability to achieve successes with positive self - identity or high self - esteem and strengthening their ability to cope with various adversities. Most researchers tend to accept the mental health promotion approach and support a more synthetic prevention model. Although there is a considerable overlap between prevention and promotion, the mental health promotion in the mental health area is consistent with the recognition that health promotion is an important component of public health that goes beyond the prevention of disease. In conclusion, prevention, treatment and promotion are complementary components in a new comprehensive model. The development and renovation of the psychological prevention concept, especially the integration of mental health promotion into the psychological prevention system, suggest that we adopt an overall point of view and improve the pertinence and effectiveness of prevention. We also need to combine the negative mental prevention with the positive mental health promotion.