On purpose of multiple cases: Quaternary prevention on mental health – “Primum non-nocere”

Abstract

Introduction

Quaternary prevention, concept coined by the Belgian Marc Jamoulle, are the actions taken to avoid or mitigate the consequences of unnecessary or excessive intervention of the health system. The concept alludes to actions to avoid the over-diagnoses and over-treatment, trying to reduce the incidence of iatrogeny in patients, which is a serious public health problem and even more in mental health.

Methods

Systematic review of bibliography.

Objectives

Do a systematic review of bibliography and through the results invite to the analytic and critic reflection of our professional activities and the current situation of mental health.

Results

There is not enough studies about quaternary prevention in mental health.

–Some studies found that about one-third of diseases of a hospital are iatrogenic, most of them for pharmacological causes.

–There is iatrogeny at different levels of the attention of mental health: primary prevention, diagnosis and treatment.

–Non-treatment indication avoids in multiple cases iatrogenesis and contributes to the correct distribution of the economic and care resources.

Conclusions

Since one of the fundaments of medicine is “primun non nocere” that means “first do no harm” and one of principles of bioethics is “non-maleficence”, quaternary prevention should prevail over any other preventive or curative option.

–We should define in a more realistic way the limits, benefits and damages of our interventions in order to not promote a passive and sick role.

–Must be recognized the non-treatment intervention as a therapeutic and useful intervention, and one of the best tools of quaternary prevention.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.