The size and burden of mental disorders in Europe

This three-year multi-method study, published in European Neuropsychopharmacology, covers 30 countries (the European Union plus Switzerland, Iceland and Norway) and a population of 514 million people. All major mental disorders for children and adolescents (2-17), adults (18-65), and the elderly (65+ years) are included, as well as several neurological disorders. The inclusion of the full spectrum of disorders across all age groups, examined simultaneously in a single study, is unprecedented.

The study's key findings include:

• Each year, 38.2% of the EU's population -- or 164.8 million people -- suffers from a mental disorder.
• Mental disorders are prevalent in all age groups and affect the young as well as the elderly, revealing though differences in what diagnoses are the most frequent.
• The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform disorders (6.3%), alcohol and drug dependence (>4%), attention-deficit and hyperactivity disorders (ADHD, 5% in the young), and dementia (1% among those aged 60-65, 30% among those aged 85 and above).
• Except for substance disorders and mental retardation, no significant cultural or country variations were found.
• No indications for increasing overall rates of mental disorders were found, when compared with the previous comparable study in 2005, which covered a restricted range of 13 diagnoses in adults only. The notable exception is an increase of dementia due to increased life expectancy.
• No improvements were found in the notoriously low treatment rates for mental disorders in comparison with the 2005 data. Still only one third of all cases receive treatment.
• Those few receiving treatment do so with considerable delays of an average of several years and rarely with the appropriate, state-of-the-art therapies.
• Additionally, many millions patients in the EU suffer from neurologic disorders such as stroke, traumatic brain injuries, Parkinson's disease and multiple sclerosis, cases that may have to be counted on top of the above estimates.
• As the result, disorders of the brain, as measured by disability-adjusted life years (DALYs), are the largest contributor to the EU's total morbidity burden, accounting for 26.6% of the total disease burden, covering the full spectrum of all diseases.
• The four most disabling single conditions (in terms of DALY) were depression, dementias, alcohol use and stroke.

The study also identified the critical challenges to improved basic and clinical research on mental and neurological disorders in the region. These include:

• Disciplinary fragmentation in research and practice, with different concepts, approaches and diagnostic systems.
• The marginalisation and stigmatisation of many disorders of the brain.
• The lack of public awareness about the full range of disorders of the brain and their burden on society.

The study concludes that "Concerted priority action is needed at all levels, including substantially increased funding for basic and clinical as well as public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century."

Principal investigator and joint first author Hans-Ulrich Wittchen says, "To address this challenge, we have to address two high priority issues. First, the immense treatment gap documented for mental disorders has to be closed. Because mental disorders frequently start early in life, they have a strong malignant impact on later life. We have to acknowledge that only early targeted treatment in the young will effectively prevent the risk of increasingly larger proportions of severely ill multimorbid patients in the future."

"Second, we have to take into account the developmental pathways of both mental and neurological disorders simultanously. Both groups of disorders share many common mechanism and have reciprocal effects on each other. Only a joint approach of both disciplines, covering the spectrum of disorders of the brain across the lifespan, will lead to an improved understanding of the causes and improved treatments."

"The low levels of awareness and knowledge about disorders of the brain, their prevalence and burden, are a major obstacle for progress in this direction. Dramatically increased funding of research on the causes and the treatment of disorders of the brain to reach this goal is needed. In addition, a better allocation of treatment resources and improved provision of care are priority topics for the more immediate future."

This paper was prepared in the framework of the European College of Neuropsychopharmacology (ECNP) and European Brain Council (EBC) Task Force project on the Size and Burden and Cost of Disorders of the Brain in Europe 2010, supported by funds of the ECNP Council, the EBC and Lundbeck.