A recent article from a Canadian medical journal reported something striking: between 1997 and 2023 there has been a 60% increase in the incidence of psychotic disorders among youth aged 14–20.
This doesn’t strike me as a small uptick. It’s a dramatic shift in the mental health landscape of our children and adolescents.
What changed?
And perhaps even more importantly:
What can we do about it—before it starts?
A Conversation That Started Years Ago
This topic is not new to me.
In October 2017, I had the privilege of presenting at the annual meeting of the American Academy of Environmental Medicine (AAEM). My lecture focused on how preconception care is an invaluable tool - not for treating mental illness, but for preventing it in the next generation.
Back then, the idea that we could influence a child’s long-term neurological and psychiatric health before they are even conceived felt radical to some.
Today, it feels urgent.
Mental Health Begins Before Pregnancy
We tend to think of mental health as something that develops in childhood or adolescence. But research increasingly tells a different story.
The foundations of brain development are shaped by so many things including:
- The nutritional status of mom and dad
- Inflammation and immune signalling
- Environmental exposures
- Hormonal balance
- Mitochondrial function and
- Gut health
These factors influence how a baby’s brain is built—structurally and biochemically.
In other words: Mental health doesn’t start in high school. It starts in the preconception period.
What Can We Actually Do?
The good news is that there are clear, actionable, evidence-based steps couples can take to support optimal brain development and reduce risk.
1. Optimize Nutrient Status Before Conception
All of the following nutrients have been found to be critical for early brain development:
- Folate (preferably methylfolate)
- Choline
- Omega-3 fatty acids
- Iron
- Iodine
Suboptimal levels—especially in early pregnancy—can have significant, lasting effects.
2. Support Gut Health and the Microbiome
A baby’s first major microbial exposure comes from the mother during delivery—and early breast-feeding, where applicable.
The maternal microbiome is so important because it will influence the development of baby's microbiome, which will then have many downstream effects on their development.
3. Minimize Environmental Toxin Exposure
Emerging research continues to link certain environmental exposures, like heavy metals, phthalates and air pollution, with neurodevelopmental risk, as they may affect:
- Brain development
- Hormonal signalling
- Mitochondrial function
4. Support Mitochondrial Function
Because the developing brain is one of the most energy-demanding tissues in the body, we must ensure that mom’s mitochondria are sufficiently powered to support this critical window of development (particularly during the third trimester).
5. Address Stress and Nervous System Regulation
It appears that chronic maternal stress can influence fetal brain development through hormonal and inflammatory pathways. Couples need to be encouraged to prioritize the things that help them manage the stressful circumstances in their lives (adequate sleep, mindfulness/prayer times, healthy relationships etc.) in order to optimize the health of their children.
A Shift in Perspective
A 60% rise in psychotic disorders, can seem overwhelming.
But this is also an opportunity to shift our lens.
Instead of asking only:
“How do we treat mental illness?”
We can also ask:
“How do we build brains more resilient to it in the first place?”
And in the face of rising mental health challenges, that may be one of the most impactful things we can offer the next generation.
References
Braun JM, et al. Prenatal environmental chemical exposures and child behavior. Environmental Health Perspectives. 2016;124(12):1908–1915.
Dawson SL, O’Hely M, Jacka FN, et al. Maternal prenatal gut microbiota composition predicts child behaviour. eBioMedicine. 2021;68:103400.
Freedman R, Hunter SK, Hoffman MC. Prenatal primary prevention of mental illness by micronutrient supplements in pregnancy. American Journal of Psychiatry. 2018;175(7):607–619.
Głąbska D, et al. Maternal nutrition and neurodevelopment: a scoping review. Nutrients. 2021.
Myran DT, et al.Incidence of psychotic disorders by birth cohort: a population-based cohort study in Ontario, Canada. Canadian Medical Association Journal (CMAJ). 2026.
Sourander A, et al. Maternal vitamin D levels during pregnancy and offspring schizophrenia. Schizophrenia Research. 2024.
Spoelstra SK, et al. Maternal choline supplementation during pregnancy to promote mental health in offspring. Early Intervention in Psychiatry. 2023;17(7):643–651.
Van den Bergh BRH, et al. Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy. Neuroscience & Biobehavioral Reviews. 2020;117:26–64.
Vuong HE, et al. The maternal microbiome modulates fetal neurodevelopment in mice. Nature. 2020;586:281–286.
