title: A familial risk enriched cohort as a platform for testing early interventions to prevent severe mental illness.
abstract: BACKGROUND
  Severe mental illness (SMI), including schizophrenia, bipolar disorder and severe depression, is responsible for a substantial proportion of disability in the population. This article describes the aims and design of a research study that takes a novel approach to targeted prevention of SMI. It is based on the rationale that early developmental antecedents to SMI are likely to be more malleable than fully developed mood or psychotic disorders and that low-risk interventions targeting antecedents may reduce the risk of SMI.
  
  
  METHODS
  Families Overcoming Risks and Building Opportunities for Well-being (FORBOW) is an accelerated cohort study that includes a large proportion of offspring of parents with SMI and embeds intervention trials in a cohort multiple randomized controlled trial (cmRCT) design. Antecedents are conditions of the individual that are distressing but not severely impairing, predict SMI with moderate-to-large effect sizes and precede the onset of SMI by at least several years. FORBOW focuses on the following antecedents: affective lability, anxiety, psychotic-like experiences, basic symptoms, sleep problems, somatic symptoms, cannabis use and cognitive delay. Enrolment of offspring over a broad age range (0 to 21 years) will allow researchers to draw conclusions on a longer developmental period from a study of shorter duration. Annual assessments cover a full range of psychopathology, cognitive abilities, eligibility criteria for interventions and outcomes. Pre-emptive early interventions (PEI) will include skill training for parents of younger children and courses in emotional well-being skills based on cognitive behavioural therapy for older children and youth. A sample enriched for familial risk of SMI will enhance statistical power for testing the efficacy of PEI.
  
  
  CONCLUSIONS
  FORBOW offers a platform for efficient and unbiased testing of interventions selected according to best available evidence. Since few differences exist between familial and 'sporadic' SMI, the same interventions are likely to be effective in the general population. Comparison of short-term efficacy of PEI on antecedents and the long term efficacy for preventing the onset of SMI will provide an experimental test of the etiological role of antecedents in the development of SMI.
authors.affiliation: Capital District Health Authority, Halifax, Nova Scotia, Canada. uher@dal.ca.|IWK Health Centre, Halifax, Nova Scotia, Canada. uher@dal.ca.|Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. uher@dal.ca.|Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada. uher@dal.ca.|Department of Public Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada. uher@dal.ca.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Uher
authors.affiliation: Capital District Health Authority, Halifax, Nova Scotia, Canada. Jill.Cumby@cdha.nshealth.ca.
authors.forename: Jill
authors.initials: J
authors.lastname: Cumby
authors.affiliation: Capital District Health Authority, Halifax, Nova Scotia, Canada. Lynn.MacKenzie@cdha.nshealth.ca.|Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada. Lynn.MacKenzie@cdha.nshealth.ca.
authors.forename: Lynn E
authors.initials: LE
authors.lastname: MacKenzie
authors.affiliation: Capital District Health Authority, Halifax, Nova Scotia, Canada. Jessica.Morash@cdha.nshealth.ca.
authors.forename: Jessica
authors.initials: J
authors.lastname: Morash-Conway
authors.affiliation: Capital District Health Authority, Halifax, Nova Scotia, Canada. Jacqueline.Glover@cdha.nshealth.ca.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Glover
authors.affiliation: Capital District Health Authority, Halifax, Nova Scotia, Canada. alice.aylott@dal.ca.|Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. alice.aylott@dal.ca.
authors.forename: Alice
authors.initials: A
authors.lastname: Aylott
authors.affiliation: IWK Health Centre, Halifax, Nova Scotia, Canada. Lukas.Propper@iwk.nshealth.ca.|Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. Lukas.Propper@iwk.nshealth.ca.
authors.forename: Lukas
authors.initials: L
authors.lastname: Propper
authors.affiliation: IWK Health Centre, Halifax, Nova Scotia, Canada. Sabina.Abidi@iwk.nshealth.ca.|Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. Sabina.Abidi@iwk.nshealth.ca.
authors.forename: Sabina
authors.initials: S
authors.lastname: Abidi
authors.affiliation: IWK Health Centre, Halifax, Nova Scotia, Canada. alexa.bagnell@iwk.nshealth.ca.|Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. alexa.bagnell@iwk.nshealth.ca.
authors.forename: Alexa
authors.initials: A
authors.lastname: Bagnell
authors.affiliation: Capital District Health Authority, Halifax, Nova Scotia, Canada. Barbara.Pavlova@cdha.nshealth.ca.|Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. Barbara.Pavlova@cdha.nshealth.ca.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pavlova
authors.affiliation: Capital District Health Authority, Halifax, Nova Scotia, Canada. tomas.hajek@dal.ca.|Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. tomas.hajek@dal.ca.
authors.forename: Tomas
authors.initials: T
authors.lastname: Hajek
authors.affiliation: IWK Health Centre, Halifax, Nova Scotia, Canada. David.Lovas@iwk.nshealth.ca.|Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. David.Lovas@iwk.nshealth.ca.
authors.forename: David
authors.initials: D
authors.lastname: Lovas
authors.affiliation: IWK Health Centre, Halifax, Nova Scotia, Canada. pajerk@gmail.com.|Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. pajerk@gmail.com.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Pajer
authors.affiliation: IWK Health Centre, Halifax, Nova Scotia, Canada. william.p.gardner@gmail.com.|Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. william.p.gardner@gmail.com.
authors.forename: William
authors.initials: W
authors.lastname: Gardner
authors.affiliation: Department of Public Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada. adrian.levy@dal.ca.
authors.forename: Adrian
authors.initials: A
authors.lastname: Levy
authors.affiliation: Capital District Health Authority, Halifax, Nova Scotia, Canada. MALDA@Dal.Ca.|Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. MALDA@Dal.Ca.
authors.forename: Martin
authors.initials: M
authors.lastname: Alda
mesh_terms: D000293:Adolescent; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology; D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015331:Cohort Studies; D061345:Early Medical Intervention / Q000379:methods*; D005190:Family / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000517:prevention & control* / Q000523:psychology; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult