Dodge Kenneth A
Sanford School of Public Policy, Duke University, Durham, NC, USA.
J Child Psychol Psychiatry. 2020 Mar;61(3):255-267. doi: 10.1111/jcpp.13141. Epub 2019 Oct 23.
This article proposes that universal and targeted preventive interventions should be compared and evaluated in terms of their benefit-cost ratio in achieving population-wide impact on mental disorders and related outcomes. Universal approaches attempt to affect every individual in a population, whereas targeted approaches select candidates for intervention based on screening of demographic or behavioral characteristics. Unique assets and challenges of each approach in achieving population impact in a cost-efficient way are discussed, along with spillover effects, sensitivity and specificity, developmental processes, timing of intervention, and the relation between severity of risk and plasticity. A general targeted-efficiency framework is proposed as a heuristic to evaluate the collective merits of universal and targeted approaches in specific cases. A tiered approach that combines universal and targeted identification strategies is proposed, and examples are described. Issues for high-priority research are identified.
本文提出，应根据普遍预防干预措施和针对性预防干预措施在实现对精神障碍及相关结果的全人群影响方面的效益成本比进行比较和评估。普遍方法试图影响人群中的每一个个体，而针对性方法则根据对人口统计学或行为特征的筛查来选择干预对象。文中讨论了每种方法在以具有成本效益的方式实现人群影响方面的独特优势和挑战，以及溢出效应、敏感性和特异性、发展过程、干预时机，以及风险严重程度与可塑性之间的关系。提出了一个通用的针对性效率框架，作为一种启发式方法，用于评估普遍方法和针对性方法在特定情况下的综合优点。提出了一种将普遍识别策略和针对性识别策略相结合的分层方法，并描述了相关示例。确定了高优先级研究的问题。
