Mental Health Burden Massive in Europe

[David Baxter PhD]

Mental Health Burden Massive in Europe
By PATRICE WENDLING, Clinical Psychiatry News
Sept. 5, 2011

The overall burden of mental health remains steady in Europe, but patients continue to struggle to receive appropriate treatment,
according to a new report.

"There has been tremendous improvement in terms of recognition, but recognition is senseless, if no appropriate treatment follows,"
lead author Dr. Hans-Ulrich Wittchen said in an interview. "And there?s no indication that the rate of minimally adequate treatment has been improving over the last 10 years."



It is estimated that 38.2% or 164.8 million Europeans suffer each year from at least one mental disorder, according to the 2011 report by the European College of Neuropsychopharmacology (ECNP) and European Brain Council (EBC). Still, despite all efforts, only 10% are treated.

When the group published its initial report in 2005, the annual burden was 27.4%, representing 82 million affected adults, aged 18-65 years, among 301.7 million European Union (EU) residents.

The increased prevalence today is attributable to a larger EU reference population of 514 million residents, and the inclusion of 14 additional disorders covering children/adolescents and the elderly, Dr. Wittchen explained at the annual congress of the ECNP where the data were presented. Without the additional diagnoses, the overall prevalence rate would have been comparable, at 27.1%.

The current figures are a conservative estimate since many disorders could not be included, and only cases meeting full diagnostic criteria were considered, he said.

Anxiety disorders were the most common, affecting 14% of the population, followed by insomnia (7%), major depression (6.9%), somatoform disorders (6.3%), alcohol and drug dependence (less than 4%), attention-deficit/hyperactivity disorders among the young (5%), and dementia at 1% among those 60-65 years, but 30% in those 85 and older.

The lack of adequate treatment is particularly worrisome for affected children and adolescents. Notably, the first onset of anxiety disorders is almost invariably in childhood or adolescence, but with early recognition the risk of later onset depression can be reduced by more than 50%, said Dr. Wittchen, chair and director of the Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies at Dresden University of Technology in Dresden, Germany

He suggests that the poor provision of mental health services is likely tied to underrecognition of the scope of mental and neurologic disorders, scarce resources and an inadequate number of providers with sufficient expertise.

"It would be unacceptable to other disciplines in medicine like cardiology if such complex treatment plans that we have developed for most mental disorders would be simply applied by primary care," Dr. Wittchen said.

Immediate ECNP past-president Prof. David Nutt said that with some disorders, patients have to overcome three hurdles in order to receive adequate care. Many patients do not know they are ill or think it?s their fault, their primary care provider fails to provide adequate treatment, or there is no approved therapy once the see a psychiatrist and the proper diagnosis is made.

Current political winds may only worsen the situation for patients with mental disorders in the United States and Europe, often envied by Americans for its universal insurance coverage. Both men cited proposed legislation in Denmark that would require only those patients with mental disorders to pay for their treatment. In Britain, the conservative government wants to redefine addiction as a lifestyle choice, said Dr. Nutt, professor of neuropsychopharmacology at the Imperial College in London.

"If we lose, we?re going to go back into the dark ages," he said. "It could set us back 30, 40 years."

The authors note that frequent and high degrees of impairment and disability can be directly linked to deficient treatment provision. Unlike other diseases, mental disorders are costly because of high indirect costs and not because of direct treatment costs.

The report, which covers residents in all 27 countries in the EU plus Switzerland, Iceland, and Norway, includes recommendations for political action. They include strengthening and broadening existing programs, improving allocation of scarce resources to mental disorders, boosting research and research support from industry and investors, and training for all health professions on disorders of the brain and their appropriate treatments.

The report was simultaneously published in the September issue of the journal, European Neuropsychopharmacology (2011;21:655-79).

Dr. Wittchen and Dr. Nutt reported no disclosures.

 

[David Baxter PhD]

Nearly 40% of Europeans have mental illness
By Kate Kelland, Modern Medicine
Sep 5, 2011

Europeans are plagued by mental and neurological illnesses, with almost 165 million people or 38% of the population suffering each year from mental disorders such as depression, anxiety, insomnia or dementia, according to a large new study.

With only about a third of cases receiving the therapy or medication needed, mental illnesses cause a huge economic and social burden -- measured in the hundreds of billions of euros -- as sufferers become too unwell to work and personal relationships break down.

"Mental disorders have become Europe's largest health challenge of the 21st century," the study's authors said.

At the same time, some big drug companies are backing away from investment in research on how the brain works and affects behavior, putting the onus on governments and health charities to stump up funding for neuroscience.

"The immense treatment gap ... for mental disorders has to be closed," said Hans Ulrich Wittchen, director of the institute of clinical psychology and psychotherapy at Germany's Dresden University and the lead investigator on the European study. "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."

Wittchen led a three-year study covering 30 European countries -- the 27 European Union member states plus Switzerland, Iceland and Norway -- and a population of 514 million people.

A direct comparison of the prevalence of mental illnesses in other parts of the world was not available because different studies adopt varying parameters.

Wittchen's team looked at about 100 illnesses covering all major brain disorders from anxiety and depression to addiction to schizophrenia, as well as major neurological disorders including epilepsy, Parkinson's and multiple sclerosis. The results, published by the European College of Neuropsychopharmacology on Monday, show an "exceedingly high burden" of mental health disorders and brain illnesses, he told reporters at a briefing in London.

Mental illnesses are a major cause of death, disability, and economic burden worldwide and the World Health Organization predicts that by 2020, depression will be the second leading contributor to the global burden of disease across all ages.

Wittchen said that in Europe, that grim future had arrived early, with diseases of the brain already the single largest contributor to the EU's burden of ill health. The four most disabling conditions -- measured in terms of disability-adjusted life years or DALYs, a standard measure used to compare the impact of various diseases -- are depression, dementias such as Alzheimer's disease and vascular dementia, alcohol dependence and stroke.

The last major European study of brain disorders, which was published in 2005 and covered a smaller population of about 301 million people, found 27% of the EU adult population was suffering from mental illnesses.

Although the 2005 study cannot be compared directly with the latest finding - the scope and population was different -- it found the cost burden of these and neurological disorders amounted to about 386 billion euros ($555 billion) a year at that time. Wittchen's team has yet to finalize the economic impact data from this latest work, but he said the costs would be "considerably more" than estimated in 2005.

The researchers said it was crucial for health policy makers to recognize the enormous burden and devise ways to identify potential patients early -- possibly through screening -- and make treating them quickly a high priority. "Because mental disorders frequently start early in life, they have a strong malignant impact on later life," Wittchen said. "Only early targeted treatment in the young will effectively prevent the risk of increasingly largely proportions of severely ill...patients in the future."

David Nutt, a neuropsychopharmacology expert at Imperial College London who was not involved in this study, agreed. "If you can get in early you may be able to change the trajectory of the illness so that it isn't inevitable that people go into disability," he said. "If we really want not to be left with this huge reservoir of mental and brain illness for the next few centuries, then we ought to be investing more now."

SOURCE: ECNP/EBC Size and Burden of Mental Disorders in Europe Report

Eur Neuropsychopharmacol 2011