ECNP/EBC Report 2011The size and burden of mental disorders and other disorders of the brain in Europe 2010
Introduction
Depression, schizophrenia, panic disorder, drug dependence and insomnia are examples of “mental disorders”, while dementia, epilepsy and multiple sclerosis exemplify neurological disorders. Both groups together are also frequently referred to as neuropsychiatric disorders, as “Mental, Neurological and Substance use (MNS, Collins et al., 2011) disorders or more recently and more comprehensively as “disorders of the brain”. Until recently, the complexity of disorders with hundreds of specific diagnoses, codified in diagnostic classifications systems (International Classification of Diseases, ICD-10, WHO, 1993; Diagnostic and Statistal Manual of Mental Disorders, DSM-IV, American Psychiatric Association, 1994), was associated with disciplinary fragmentation in research and practice using different concepts and approaches which has significantly impeded a broader and comprehensive appreciation of the size and burden of disorders of the brain. Further, the marginalization and stigma attached to some disorders of the brain have been identified as barriers to a wider recognition of the core relevance of mental disorders (Saxena et al., 2007, Klin and Lemish, 2008, Corrigan, 2004). Both lay persons and professionals are typically unaware of the commonalities and the shared mechanisms of “brain disorders”. Further, there is little awareness of the full range of disorders of the brain and little knowledge about the size and burden associated with these diseases in the community and the society. The low levels of awareness and knowledge are major obstacles for improved research on the causes and the treatment of disorders, improved allocation of mental health treatment resources and improved provision of care.
During the past decade increasingly stronger evidence has become available documenting that disorders of the brain are not only much more frequent than previously thought but also contribute to a greater burden of disease than previously thought, and should, therefore, be considered as a top global health challenge of the 21st century (Collins et al., 2011, Murray and Lopez, 1996, Prince et al., 2007, World Health Organisation, 2001, World Health Organisation, 2008, Wittchen and Jacobi, 2005). Numerous epidemiological studies on mental disorders throughout the world have convergently shown with some variability by diagnoses that in each year about one third of the adult population suffers from a mental disorder (Kessler and Üstün, 2008). The Global Burden of Disease studies, that cover comprehensively all disease groups and injury categories (Murray and Lopez, 1996, World Health Organisation, 2002, World Health Organisation, 2008), have found that increasingly higher proportions of the global burden of disease can be attributed to disorders of the brain. For example, a recent analysis (Collins et al., 2011) estimated that about 13% of global disease is due to disorders of the brain, surpassing both cardiovascular diseases and cancer. However, such global estimates are of limited value for use in the European Union (EU). These estimates are heavily influenced by the most populous countries and regions of the world, with very diverse population, health, and mortality characteristics, as well as different socio-economic and health care systems.
The lack of EU-specific, comprehensive data on the size, burden and cost of mental and neurological disorders prompted the launch in 2003 of a major European wide interdisciplinary effort coordinated by the European Brain Council (EBC) and the European College of Neuropsychopharmacology (ECNP), involving multiple task forces and panels, and using sophisticated methodological approaches including reanalyses of data sets from epidemiological studies in the EU3 up to the year 2004, which resulted in a series of publications (Andlin-Sobocki et al., 2005, Wittchen et al., 2005). These publications documented the size and burden of neurological (Olesen and Leonardi, 2003, Berr et al., 2005, Campenhausen et al., 2005) and mental disorders (Wittchen and Jacobi, 2005) and provided comprehensive health, economic, and cost data for both groups of disorders. For mental disorders alone it was estimated conservatively that every year 27% of the total adult (18–65) EU population is affected by a mental disorder. This amounted to over 82.7 million affected persons of the applicable reference EU population 2004 aged 18–65 of 301.7 million people in the 2005 study. Most frequent disorders were anxiety, depressive, somatoform and substance use disorders.
Further, the 2005 report highlighted the tremendous size and range of associated psychosocial impairments and disabilities due to mental disorders and the generally low treatment rates; only 26% of all cases with mental disorders had any consultation with professional health care services. Among treated cases with mental disorders there was a long delay between onset and first treatment contact and only a small number of patients received minimally adequate interventions (see Kessler and Üstün, 2008, for an overview for the countries participating in the World Mental Health initiative). A substantial degree of the unmet treatment and intervention and poor service provision for mental disorders was due to the combined effects of underutilization, under-recognition, under-treatment and lack of resources.
Similarly detailed analyses for neurological disorders were not possible due to differing methods and standards of epidemiological studies which prohibit the derivation of overall prevalence estimates for having any mental or neurological disorder. Nevertheless, mental and neurological data were used to calculate and estimate the patterns and costs of treatment and the health economic implications in terms of total direct and indirect costs for EU nations (Andlin-Sobocki et al., 2005, Wittchen et al., 2005). This modeling revealed that mental disorders are extremely costly. Compared to many somatic diseases, the categories of costs were different with disproportionally high indirect costs and relatively low direct costs of health care. Together with additional epidemiological evidence for selected neurological conditions, the total EU cost burden of disorders of the brain in 2005 was estimated to be close to 386 billion Euros, of which 277 billion Euros were attributed to mental disorders alone.
The 2005 size, burden, and cost study suffered from several limitations particularly with regard to incomplete age ranges (18–65 for most diagnoses) and the diagnostic scope. As a result, mental disorders in childhood and adolescence, as well as frequent disorders of old age and neurological conditions were not included. Further, we were unable to provide consolidated DALY data for all EU member states, because available data were based on specific groupings of countries used by the World Health Organization that could not be applied to the EU. Along with the wish to describe changes that might have occurred since 2005, the limitations of the 2005 study prompted our efforts to improve the epidemiological estimations by incorporating new available study data. We were particularly interested in broadening the previously restricted scope of mental disorders and the age range covered, including as much as possible additional relevant mental and neurological conditions across the lifespan, and improving previously crude prevalence estimates for some disorders.
Section snippets
Goals
As part of the EBC's and the ECNP's initiative to conduct an updated and improved “Size, Burden and Cost of Disorders of the Brain in Europe” study, we launched a program in 2009 consisting of numerous work groups, organizations, and individuals with interrelated work packages. The major goals of this program were:
- 1.
To provide consolidated best estimates for the 12 month prevalence of mental and neurological disorders for the EU-27 total population in the year 2010.
- 2.
To cover as far as possible all
Overall strategy
Similar to our 2005 review, a stepwise multi-method study approach (described in greater detail in Wittchen and Jacobi, 2005) was adopted consisting of a) reiterative literature searches for epidemiological publications and subsequent data analyses of published material on mental disorders, b) reanalyses of existing accessible epidemiological data sets with uniform assessments, and c) supplementary surveys by country to gather input about existing epidemiological databases via national experts.
12 month prevalence of mental disorders (update of the 2005 report)
Table 2 presents information about the number of studies covered, the prevalence range of studies and median (Md) across studies, with the IQR and gender ratio (females:males) as derived from the findings of community studies. The resulting consolidated “expert-based best estimate” of the 12 month prevalence is highlighted, along with the estimated number of subjects in the EU affected within the applicable age ranges.
The updated and improved 2011 estimates for disorders listed in Table 2, based
Discussion
This report provides for the first time consolidated data on the current size and the burden of mental disorders and neurological disorders for the EU. Based on a complex interdisciplinary effort, structured literature reviews, reanalyses of existing data sets, and appraisals, we describe the 12 month prevalence and the associated disability burden. Extending our previous 2005 report, we cover the 27 EU countries plus Switzerland, Norway and Iceland, a much broader range of diagnoses and a
Conclusion
The results of this EU review are by and at large consistent with those of earlier international studies where a similar range of disorders is considered. However, we document that the true range of mental disorders is obviously considerably larger than the previously available “best-estimate” of 27% suggested in 2005 (Wittchen and Jacobi, 2005). The present survey has covered 27 diagnoses, adding 14 more core diagnoses of mental disorders arriving at a conservative estimate of 38.2%. Thus,
Role of the funding source
This paper was commissioned by the European College of Neuropsychopharmacology (ECNP) who provided grant support to the Technische Universitaet Dresden in the context of European Brain Council (EBC) Task Force project on “Size and Burden and Cost of Disorders of the Brain”. The overall Task Force project received unrestricted educational grant support by H. Lundbeck A/S as well as financial support by the European Federation of Neurological Societies. The funding agencies had no further role in
Contributors
See below under acknowledgements.
Conflict of interest
None of the authors have conflicts of interest associated with the work reported in this paper.
Acknowledgements
This paper was prepared in the framework of the European College of Neuropsychopharmacology (ECNP) and European Brain Council (EBC) Task Force project on “Size and Burden and Cost of Disorders of the Brain in Europe 2010”. The data summarized in this report provide the essential input for the 2011 EBC (www.europeanbraincouncil.org) initiative “Cost of Disorders of the Brain in Europe” (CDBE; steering committee: Jes Olesen, Bengt Jönsson, Hans-Ulrich Wittchen). The support and assistance of many
References5 (194)
- et al.
Prevalence of dementia in the elderly in Europe
Eur. Neuropsychopharmacol.
(2005) - et al.
Snoring and nocturnal oxygen desaturations in an Italian middle-aged male population. Epidemiologic study with an ambulatory device
Chest
(1994) - et al.
The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders
J. Am. Acad. Child Adolesc. Psychiatry
(2003) - et al.
Prevalence of sleep apnea syndrome among Swedish men — an epidemiological study
J. Clin. Epidemiol.
(1988) - et al.
Prevalence and correlates of generalized anxiety disorder among older adults in the Australian National Survey of Mental Health and Well-Being
J. Affect. Disord.
(2011) - et al.
Diagnosing major depression in the elderly — evidence for response bias in standardized diagnostic interviews
J. Psychiatr. Res.
(1994) - et al.
Child psychiatric diagnoses in a population of Dutch schoolchildren aged 6 to 8 years
J. Am. Acad. Child Adolesc. Psychiatry
(2001) - et al.
Estimated prevalence of dementia in the Maltese Islands
Malta Med. J.
(2007) - et al.
Prevalence and treatment of mental disorders in Germany: results from the European study of the epidemiology of mental disorders (ESEMeD) survey
Diagnostic and Statistical Manual of Mental Disorders
(1980)
Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
Prevalence of very mild to severe dementia in Denmark
Acta Neurol. Scand.
Cost of disorders of the brain in Europe
Eur. J. Neurol.
Gender differences in depression
Eur. Arch. Psy. Clin. N.
Obsessive–compulsive severity spectrum in the community: prevalence, comorbidity, and course
Eur. Arch. Psy. Clin. N.
Èpidémiologie des troubles Psychiatiques dans la Province de Luxembourg
Brochure editée par la plate-forme de concertation psychiatrique de la Provence de Luxembourg
The prevalence of mental disorders and service use in France: results from a National Survey 2001–2002
Six-month prevalence of phobic symptoms in Iceland: an epidemiological postal survey
J. Clin. Psychol.
Depressive disorders in Europe: prevalence figures from the ODIN study
Br. J. Psychiatry
Anxiety, depression, somatization and alcohol abuse. Prevalence rates in a general Belgian community sample
Acta Psychiatr. Belg.
Depression in the Italian community: epidemiology and socio-economic implications
Int. Clin. Psychopharmacol.
Comparison of diagnostic criteria for attention deficit disorders in a German elementary school sample
J. Am. Acad. Child Adolesc. Psychiatry
Prevalence of dementia in a rural population [Article in Polish]
Psychiatr. Pol.
Incidence and prevalence rates of mental disorders in a community sample of young women: results of the “Dresden Study”
Mood episodes and mood disorders: Patterns of incidence and conversion in the first three decades of life
Bipolar Disorders
Incidence and risk patterns of anxiety and depressive disorders and categorization of Generalized Anxiety Disorder
Arch. Gen. Psychiatry
Performance of a five item mental health screening test
Med. Care
Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS)
Soc. Psych. Psych. Epid.
Current and residual functional disability associated with psychopathology: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)
Psychol. Med.
Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands Mental Health Survey and Incidence Study
Am. J. Public Health
The prevalence of treated and untreated mental disorders in five countries
Health Aff.
The prevalence of dementia in 95 year olds
Neurology
Incidence of dementia in England and Wales: the MRC Cognitive Function and Ageing Study
Alzheimer Dis. Assoc. Disord.
Metal Health in Belgium: Current Situation and future perspectives
Epidemiology of autism spectrum disorders in adults in the community in England
Arch. Gen. Psychiatry
Prevalence and incidence of Parkinson's disease in Europe
Eur. Neuropsychopharmacol.
Prevalence and correlates of personality disorder in Great Britain
Br. J. Psychiatry
Grand challenges in global mental health
Nature
How stigma interferes with mental health care
Am. Psychol.
Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey
J. Trauma. Stress
Prevalence of common mental disorders in Italy: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD)
Soc. Psychiatry Psychiatr. Epidemiol.
The prevalence of mental disorders and service use in Italy: results from the National Health Survey 2001–2003
Mental Disorders and Service Use in the Netherlands: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD)
The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): design and methods
Int. J. Methods Psychiatr. Res.
Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2
Soc. Psychiatry Psychiatr. Epidemiol
Occurrence of cognitive impairment and dementia after the age of 60: a population-based study from Northern Italy
Dement. Geriatr. Cogn. Disord.
The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands
J. Trauma. Stress
Genetic influences in self-reported symptoms of obstructive sleep apnoea and restless legs: a twin study
Twin Res
Diagnostik-System für psychische Störungen nach ICD-10 und DSM-IV für Kinder und Jugendliche — II
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- 1
Equally shared first authorship.
- 2
Also affiliated with Psychologische Hochschule Berlin, Germany.
- 5
References with an * refer to publications and studies cited in Table 1.