Size and burden of mental disorders in Europe
Depression, anxiety disorders such as panic disorder and obsessive-compulsive disorders, alcohol and drug dependence, dementia and Parkinson’s disease are just a few examples of “disorders of the brain.”
“The size, the burden and cost of brain disorders in the EU is immense, and has so far been underestimated,” as Prof. Dr. Hans Ulrich Wittchen emphasized at the Official Press Conference to the 20th ECNP Congress for Neuropsychopharmacology in Vienna (October 13-17, 2007).
Increasing Lifetime Risk — Unmet Needs
Mental disorders such as anxiety and depressive disorders are disorders of the brain and involve complex patterns of disturbances of cognition (such as perception, attention, memory), affect and emotion (such as depressed mood, panic), somatic functioning (e.g. appetite, heart rate variability) and behaviour. These patterns and disturbances are all associated with disturbances in the transmitter systems of the brain and the central nervous system. What is special about most mental disorders is that they predominantly manifest early in life, before the age of 20. They are also associated across the life span with a high risk of developing complications and other — so called comorbid — disorders.
Conservatively estimated 27% of the adult EU-population has been suffering from at least one mental disorder in the past 12 months, such as depression, specific phobias, somatoform disorders, alcohol- and drug dependence, social phobia, generalized anxiety disorder (GAD), bipolar disorder, psychotic disorders, obsessive compulsive disorder (OCD) or eating disorders. The estimated total number of affected is 82,7 million in any given year.
Over the life span, the majority of the population in the EU will suffer a mental disorder at least once in their lifetime, and there are indications that mental disorders are on the rise. For instance, over the past decades there has been a steep increase in the risk for depression, especially among women. The reasons for this development is up to now poorly understood, but seems to be most likely linked to socioeconomic changes of modern life in industrialized regions.
Unlike to somatic diseases, such as diabetes and cancer, the vast majority of people affected by mental disorders remain unrecognized and untreated by the health care system. The large degree of unmet needs of patients with mental disorders represents a global problem. „The vast majority of disorders of the brain remain untreated, particularly in adolescents and young adults”, Wittchen said. „Typically, treatment starts late after many years of illness when severe complications are present. But even among those treated rarely appropriate treatment is provided.” As an effect of early onset, high prevalence, persistence, associated disability and low treatment rates, the resulting disability is tremendously high.
Health Economic Costs
Mental disorders rank as number one in terms of direct and indirect health economic costs, with a total estimated cost of Euro 294.719 billion. The vast majority of cost is not due to treatment costs, but rather due to indirect costs, which marks the loss of productivity as a consequence of disease (e.g. disability, premature death or retirement). For mental disorders extremely high indirect costs and relatively low direct costs contrast high direct costs typical for somatic disease. For instance, pharmaceutical costs account for only 3% of total costs for mental disorders, whereas for diabetes the rate is 13% and for cardiovascular disease 15%. The outpatient care for mental disorders accounts for only 12% of the total costs.
Neuropsychopharmacology and ECNP
The brain is undoubtedly the most complex organ of animals and human beings. Modern neuroscience techniques like imaging have been instrumental to understand the complexity of the human brain. The communication among the billions of nerve cells (neurons) in the brain is ensured by extremely complex transmitter systems and mechanisms of various kinds. The field of neuropsychopharmacology is the core field to study these mechanisms and to influence them within the clinical target, amongst others with drugs.
The early onset and high burden of mental disorders — particularly in females — calls for systematic programs to explore the benefits of early intervention and preventive measures. The comprehensive and exciting programme of the ECNP Congress is due to the input from researchers and clinicians of all over the world, and helps defining new areas of research and to single out new therapeutic approaches to improve the lives of the millions of people who suffer from mental disorders.
Eur Neuropsychopharmacol. 2005 Aug;15(4):357-76.
Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany. firstname.lastname@example.org
Epidemiological data on a wide range of mental disorders from community studies conducted in European countries are presented to determine the availability and consistency of prevalence, disability and treatment findings for the EU. Using a stepwise multimethod approach, 27 eligible studies with quite variable designs and methods including over 150,000 subjects from 16 European countries were identified. Prevalence: On the basis of meta-analytic techniques as well as on reanalyses of selected data sets, it is estimated that about 27% (equals 82.7 million; 95% CI: 78.5-87.1) of the adult EU population, 18-65 of age, is or has been affected by at least one mental disorder in the past 12 months. Taking into account the considerable degree of comorbidity (about one third had more than one disorder), the most frequent disorders are anxiety disorders, depressive, somatoform and substance dependence disorders. When taking into account design, sampling and other methodological differences between studies, little evidence seems to exist for considerable cultural or country variation. Disability and treatment: despite very divergent and fairly crude assessment strategies, the available data consistently demonstrate (a) an association of all mental disorders with a considerable disability burden in terms of number of work days lost (WLD) and (b) generally low utilization and treatment rates. Only 26% of all cases had any consultation with professional health care services, a finding suggesting a considerable degree of unmet need. The paper highlights considerable future research needs for coordinated EU studies across all disorders and age groups. As prevalence estimates could not simply be equated with defined treatment needs, such studies should determine the degree of met and unmet needs for services by taking into account severity, disability and comorbidity. These needs are most pronounced for the new EU member states as well as more generally for adolescent and older populations.