Economic Burden of Mental Illness Closes in on $200 Billion
Pauline Anderson
June 17, 2008 ? Serious mental illness in the United States was associated with more than $190 billion in lost personal earnings in 2002, most of it due to lost productivity in the workplace, a new study shows.
This financial burden, which the authors say represents "massive losses of productive human capital," is larger than the economic stimulus package proposed by President George Bush earlier this year to avoid an economic recession.
"When people think of diseases in the world, they immediately think of cancer and heart disease, but when you do a study like this on quality of life, mental disorders consistently come out to be considerably more important than cancer and considerably more important than heart disease," lead author Ronald C. Kessler, PhD, from the department of healthcare policy at Harvard Medical School, in Boston, Massachusetts, told Medscape Psychiatry.
Studies like this "let people know that mental illnesses are important and should be considered as part of the decision-making process" when allocating research dollars, said Dr. Kessler.
The results are published in the June issue of the American Journal of Psychiatry.
Population-Based Survey
The estimates were based on data from the National Comorbidity Survey Replication (NCS-R), a population-based study of mental disorders in the United States administered from February 2001 to April 2003. The analysis included reports from almost 5000 respondents of their personal income in the past 12 months before taxes ? not including pensions, investments, or other financial assistance or income. Most (86.1%) reported some personal earnings in the previous 12 months.
The researchers collected information on 5 sociodemographic variables known to predict earnings: age, sex, race/ethnicity, census region, and urbanicity.
They also gathered information about 12-month and lifetime Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) mental disorders. The disorders they assessed included anxiety disorders, mood disorders, and impulse-control disorders. Additional assessments were made for alcohol and illicit drug abuse and dependence.
The researchers found an estimated prevalence of 6.5% for 12-month serious mental illness, 22.6% for other 12-month mental disorders, and 20.3% for other lifetime mental disorders. It was significantly more common for women than men to report a serious mental illness or other 12-month mental disorder.
Using various linear model estimates, the researchers determined that the mean 1-year individual impact of serious mental illness on earnings was $16,306. The estimate was higher among men ($26,435) than women ($9,302).
Taking into account the estimated prevalence of serious mental illness, the researchers then projected this individual effect to the 179.6 million adults in the noninstitutionalized civilian US population and came up with a figure of $193.2 billion for the societal effect of serious mental illness ? $131.3 billion among men and $61.9 billion among women.
Economic Loss Due to Reduced Earnings in Workforce
The researchers found that the economic loss is not so much due to unemployment as to reduced earnings for those who work. Three-quarters of the total association between serious mental illness and earnings is from lower earnings among employed people with serious mental illness, the authors wrote. This, they said, raises the possibility that policy solutions might include increased job training and vocational rehabilitation for workers with serious mental illness.
Other research has shown that up to one-third of illness-related days during which workers were unable to carry out their usual daily activities was related to mental rather than physical disorders, yet only 6.2% of all US healthcare spending is devoted to treatment of mental disorders, according to this report. Currently, said Dr. Kessler, the vast majority of workplaces "have terrible treatment packages for mental disorders."
Dr. Kessler noted that while some people might assume that mental illness is more a "white-collar" issue, the surprising finding was that the effects of mental illness were across the board in this survey.
A similar survey was carried out during the 1980s and another one in the1990s. But instead of doing such large studies every decade, researchers are now starting to do smaller ones on an ongoing basis, said Dr. Kessler.
Financial Loss Higher Than Previous Estimates
In an accompanying editorial, Thomas R. Insel, MD, from the National Institutes of Health, in Bethesda, Maryland, said that determining indirect costs of mental illness is critical for informing public policy. "Once we assess the key components of the economic burden of mental disorders, we can have a more informed discussion about what should be invested to prevent and treat these illnesses."
One of the surprising findings of the report, said Dr. Insel, was that the earnings of men with serious mental illness were still higher than earnings of women without serious mental illness, a result that cannot be fully explained by the number of women outside of the workforce. He noted, too, that the estimated financial loss is much higher than previous estimates and that that difference is only partially explained by inflation.
Dr. Insel also pointed out that the estimates captured by the study are conservative, as they did not include diagnoses of schizophrenia or autism, even though both are associated with chronic disability and lifetime loss of income.
The study was supported by the National Institute of Mental Health, with supplemental support from the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation, and the John W. Alden Trust. Dr. Kessler has been a consultant for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Pfizer, Sanofi-Aventis, and Wyeth and has received research support from Bristol-Myers Squibb, Eli Lilly, Ortho-McNeil, Pfizer, and the Pfizer Foundation. The remaining authors report no competing interests.
Am J. Psychiatry. 2008;165:703-711 Abstract,663-665. Abstract
Pauline Anderson
June 17, 2008 ? Serious mental illness in the United States was associated with more than $190 billion in lost personal earnings in 2002, most of it due to lost productivity in the workplace, a new study shows.
This financial burden, which the authors say represents "massive losses of productive human capital," is larger than the economic stimulus package proposed by President George Bush earlier this year to avoid an economic recession.
"When people think of diseases in the world, they immediately think of cancer and heart disease, but when you do a study like this on quality of life, mental disorders consistently come out to be considerably more important than cancer and considerably more important than heart disease," lead author Ronald C. Kessler, PhD, from the department of healthcare policy at Harvard Medical School, in Boston, Massachusetts, told Medscape Psychiatry.
Studies like this "let people know that mental illnesses are important and should be considered as part of the decision-making process" when allocating research dollars, said Dr. Kessler.
The results are published in the June issue of the American Journal of Psychiatry.
Population-Based Survey
The estimates were based on data from the National Comorbidity Survey Replication (NCS-R), a population-based study of mental disorders in the United States administered from February 2001 to April 2003. The analysis included reports from almost 5000 respondents of their personal income in the past 12 months before taxes ? not including pensions, investments, or other financial assistance or income. Most (86.1%) reported some personal earnings in the previous 12 months.
The researchers collected information on 5 sociodemographic variables known to predict earnings: age, sex, race/ethnicity, census region, and urbanicity.
They also gathered information about 12-month and lifetime Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) mental disorders. The disorders they assessed included anxiety disorders, mood disorders, and impulse-control disorders. Additional assessments were made for alcohol and illicit drug abuse and dependence.
The researchers found an estimated prevalence of 6.5% for 12-month serious mental illness, 22.6% for other 12-month mental disorders, and 20.3% for other lifetime mental disorders. It was significantly more common for women than men to report a serious mental illness or other 12-month mental disorder.
Using various linear model estimates, the researchers determined that the mean 1-year individual impact of serious mental illness on earnings was $16,306. The estimate was higher among men ($26,435) than women ($9,302).
Taking into account the estimated prevalence of serious mental illness, the researchers then projected this individual effect to the 179.6 million adults in the noninstitutionalized civilian US population and came up with a figure of $193.2 billion for the societal effect of serious mental illness ? $131.3 billion among men and $61.9 billion among women.
Economic Loss Due to Reduced Earnings in Workforce
The researchers found that the economic loss is not so much due to unemployment as to reduced earnings for those who work. Three-quarters of the total association between serious mental illness and earnings is from lower earnings among employed people with serious mental illness, the authors wrote. This, they said, raises the possibility that policy solutions might include increased job training and vocational rehabilitation for workers with serious mental illness.
Other research has shown that up to one-third of illness-related days during which workers were unable to carry out their usual daily activities was related to mental rather than physical disorders, yet only 6.2% of all US healthcare spending is devoted to treatment of mental disorders, according to this report. Currently, said Dr. Kessler, the vast majority of workplaces "have terrible treatment packages for mental disorders."
Dr. Kessler noted that while some people might assume that mental illness is more a "white-collar" issue, the surprising finding was that the effects of mental illness were across the board in this survey.
A similar survey was carried out during the 1980s and another one in the1990s. But instead of doing such large studies every decade, researchers are now starting to do smaller ones on an ongoing basis, said Dr. Kessler.
Financial Loss Higher Than Previous Estimates
In an accompanying editorial, Thomas R. Insel, MD, from the National Institutes of Health, in Bethesda, Maryland, said that determining indirect costs of mental illness is critical for informing public policy. "Once we assess the key components of the economic burden of mental disorders, we can have a more informed discussion about what should be invested to prevent and treat these illnesses."
One of the surprising findings of the report, said Dr. Insel, was that the earnings of men with serious mental illness were still higher than earnings of women without serious mental illness, a result that cannot be fully explained by the number of women outside of the workforce. He noted, too, that the estimated financial loss is much higher than previous estimates and that that difference is only partially explained by inflation.
Dr. Insel also pointed out that the estimates captured by the study are conservative, as they did not include diagnoses of schizophrenia or autism, even though both are associated with chronic disability and lifetime loss of income.
The study was supported by the National Institute of Mental Health, with supplemental support from the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation, and the John W. Alden Trust. Dr. Kessler has been a consultant for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Pfizer, Sanofi-Aventis, and Wyeth and has received research support from Bristol-Myers Squibb, Eli Lilly, Ortho-McNeil, Pfizer, and the Pfizer Foundation. The remaining authors report no competing interests.
Am J. Psychiatry. 2008;165:703-711 Abstract,663-665. Abstract
