Epidemiology and Burden

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Epidemiology and Burden

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Epidemiology and Burden
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Depression is a highly prevalent disorder I
References

1. Depression. Factsheet no. 369. Available at: http://www.who.int/mediacentre/factsheets/fs369/en/. Accessed April 2016.
2. Ferrari AJ, et al. 2010. PLoS One. 2013a;8(7):e69637
 

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Depression is a highly prevalent disorder II
Slide information
References

Lifetime prevalence: The proportion of individuals in a population that, at some point in their life up to the time of assessment, have experienced MDD

1. Wittchen HU et al. Eur Neuropsychopharmacol 2011;21:655-79
2. Hasin DS et al. Arch Gen Psychiatry 2005;62:1097-106
3. Kessler RC et al. Arch Gen Psychiatry 2005;62:593-602
4. Bromet E et al. BMC Med 2011;9:90 million1,2
5. The Statistics Portal. China Population from 2010 to 2020. Available at: www.statista.com/statistics/263765/total-population-ofchina/ Last accessed: August 2016
6. Gu L et al. Plos One. 2013;8(6):e65356

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12 month prevalence of mental disorders in Europe in 2011
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References

This slide provides data on the current (2011) size of mental disorders and neurological disorders for the EU. 12 month prevalence data is based on a complex interdisciplinary effort, structured literature reviews, re-analyses of existing data sets, and appraisals. The report covers the 27 EU countries plus Switzerland, Norway, and Iceland and with its broad range of psychiatric and neurological diagnoses and age range extents a previous report from 2005 (Wittchen and Jacobi 2005). 

Overall, these data highlights that every year over one third of the total EU population suffers from mental disorders. The true size of “disorders of the brain” including neurological disorders is even considerably larger. No indications for increasing overall rates of mental disorders were found since 2005. The authors conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and 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.

* Comments and further details:

  • Opioid dependence: shown prevalence is from the age group: 15–34: 0.4%. Prevalence is older age groups is lower: age group: 35–44: 0.3%, age group: 45–54: 0.2%, age group: 55–64: 0.1% (see table 2, page 663, in Wittchen et al., 2011).
  • OCD; Obsessive Compulsive Disorders (see figure 1, page 668, in Wittchen et al., 2011).
  • Bipolar Depression (see figure 1, page 668, in Wittchen et al., 2011).
  • Eating disorder (see figure 1, page 668, in Wittchen et al., 2011). Prevalence of eating disorders are also detailed in table 2, page 663 for anorexia nervosa at age range 14–17: 0.54% and at age range 18–65: 0.21% and for bulimia nervosa at age range 14–17: 0.86% and at age range 18–65: 0.14%.
  • Mental retardation (see table 3, page 664, in Wittchen et al., 2011).
  • Cannabis dependence: Data presented is taken from figure 1, page 668, in Wittchen et al., 2011. However, varying  prevalence is reported depending on the age range: ages 14–17: 1.8% and ages 18–64: 0.3% (see table 2, page 663, in Wittchen et al., 2011).
  • Psychotic disorders: Data based on eight studies, while four studies use narrow schizophrenia definition, four studies use a broader definition of psychotic syndromes (see table 2, page 663 and figure 1, page 668, in Wittchen et al).
  • Personality disorders (PD): see figure 1, page 668, in Wittchen et al., 2011 for overall prevalence. PD includes diagnosis for borderline PD (0.7% prevalence) and dissocial/antisocial PD (0.6% prevalence) (table 3, page 664, in Wittchen et al., 2011).
  • PTSD; Post-traumatic stress disorder: Data presented is taken from figure 1, page 668, in Wittchen et al., 2011. However, varying  prevalence is reported depending on the age range: ages 14–34: 2.9%, ages 35–65: 1.3% and over an age of 66: 1.1% (see table 2, page 663, in Wittchen et al., 2011).
  • Conduct disorders (see figure 1, page 668, in Wittchen et al., 2011).
  • Alcohol dependence (see figure 1, page 668, in Wittchen et al., 2011).
  • Somatorform disorders: Without headache (estimate reduced by cases with headache as main somatoform symptom in order to avoid double count with headache diagnosis in EBC “cost of disorders of the brain” report) (see table 2, page 663, in Wittchen et al., 2011).
  • ADHD; Hyperkinetic dis./attention-deficit hyperactivity disorder (ADHD): Prevalence given refers only to age group 2–17, while the age group adjusted prevalence to reflect total population is reported to be 0.6% (table 4, page 666, in Wittchen et al., 2011).
  • Major depression:  see table 2, page 663, in Wittchen et al., 2011. Note that in the figure 1 on page 666 the term unipolar depression is used.
  • Anxiety disorders: Aggregate from one reference study (Jacobi et al., 2004a) because in different studies different anxiety disorders were included; therefore no Md and IQR were calculated; 95% confidence interval is 13.4–15.6%.

1. Wittchen, H.-U., Jacobi, F., 2005. Size and burden of mental disorders in Europe — a critical review and appraisal of 27 studies. Eur. Neuropsychopharmacol. 15 (4), 357–376.
2. Wittchen, H.-U. et al, 2011. The size and burden of mental disorders and other disorders of the brain in Europe 2010 Eur. Neuropsychopharmacology (2011) 21, 655–679
3. Jacobi, F. et al 2004. Prevalence, comorbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey
(GHS). Psychol. Med. 34, 597–611.

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Burden of Major Depressive Disorder (MDD)
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WHO Fact Sheet
References

Depression. Factsheet no. 369. Available at: http://www.who.int/mediacentre/factsheets/fs369/en/. Accessed April 2016. 

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MDD is a leading cause of burden
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References

MDD has a worldwide prevalence of 4.4%, corresponding to 298 million people (estimate from 2010 Global Burden of Disease Study [GBDS]).(Ferrari et al., PLoS One 2013) Overall, prevalence is higher in females (5.5%) than in males (3.2%), corresponding to 187 million females and 111 million males worldwide.(Ferrari et al., PLoS One 2013) Prevalence peaks between the ages of 20 and 64 years; the highest number of prevalent cases is in the age group 25–34 years (57 million cases).(Ferrari et al., PLoS One 2013)

Disease burden can be compared across diseases and injuries using the ‘disability-adjusted life-year’ (DALY). One DALY represents the loss of one healthy year of life; it is the sum of the years of life lived with disability (YLD) and years of life lost due to premature mortality.(Ferrari et al., PLoS Med 2013) MDD accounts for 2.5% of global DALYs, making it the eleventh leading cause of disease burden worldwide (estimate from 2010 GBDS).(Ferrari et al., PLoS Med 2013) By 2030, unipolar depressive disorders including MDD are predicted to become the leading cause of DALYs (estimate from 2004 GBDS; not re-estimated following 2010 GBDS).(WHO, 2008) In terms of YLDs, MDD is the second leading cause of burden (accounting for 8.2% of global YLDs), after lower back pain (estimate from 2010 GBDS).(Ferrari et al., PLoS Med 2013)

 

  1. Ferrari et al. PLoS One 2013; 8 (7): e69637; page 9 (‘Final prevalence output’ section)
  2. Ferrari et al. PLoS Med 2013; 10 (11): e1001547; page 5 (‘Direct burden of depressive disorders’ section)
  3. WHO. The Global Burden of Disease 2004 update: page 50 (‘Halving the contribution of Group 1 causes‘ section) and Figure 27
  4. Vos et al. Lancet 2012; 380: 2163–2196; Figure 4.
  5. Ferrari et al., PLoS One 2013 p9; Ferrari et al., PLoS Med 2013 p4/5; WHO, 2008 p50.
  6. Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013; 10 (11): e1001547.
  7. Ferrari AJ, Charlson FJ, Norman RE, et al. The epidemiological modelling of major depressive disorder: application for the Global Burden of Disease Study 2010. PLoS One 2013; 8 (7): e69637.
  8. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380 (9859): 2163–2196.
  9. World Health Organization (WHO). The global burden of disease: 2004 update. © World Health Organization 2008.
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Contribution of non-communicable diseases to disability-adjusted life years
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References

Amongst the classes of non-communicable diseases, neuropsychiatric disorders are the largest contributor to the global disease burden, accounting for 28% of disability-adjusted life years (DALYS) – ahead of cardiovascular disease (22%) and cancer (11%)1 Latest estimates indicate that depression accounts for approximately one third of this neuropsychiatric burden and, by the year 2030, depression is projected to be the largest contributor to the global burden of disease.1,2

1. Prince M, Patel V, Saxena S, et al. No health without mental health. Lancet 2007; 370: 859–877.
2. World Health Organization (WHO). Global Burden of Disease, 2004 Update. Published 2008.

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The burden associated with depression is large and increasing
References

1. Ratnasingham S et al. Opening Eyes, Opening Minds: The Ontario Burden of Mental Illness and Addictions Report. Institute for Clinical Evaluative Sciences and Public Health Ontario, 2012
2. Wittchen HU et al. Eur Neuropsychopharmacol 2011;21:655-79.
 

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Depression is the most burdensome disorder of all brain diseases in the EU
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References

The DALY is a health gap measure for burden of disease, capturing both years of life lost due to premature mortality and years of life lost due to living with disability. Overall, the burden of disease in mental and other disorders of the brain is mainly due to disability, i.e., these disorders impact on the daily functioning of people, rather than leading to premature mortality compared to cancer or cardiovascular disorders.

In the EU, mental and other disorders of the brain are responsible for a huge proportion of overall burden of disease: almost 1 in 3 of all years of life lost due to premature mortality in women, and almost 1 in 4 in men are due to disorders of the brain. 

The three most important contributors to burden of disease are depression (7.2% of the overall burden of disease in Europe), Alzheimer's disease/dementia (3.7%) and alcohol use disorders (3.4%). There are clear gender differences: women were disproportionally affected by depression (one in 10 healthy years of life lost is due to this disorder, or 10.3% of all the DALYs), while for men alcohol use disorders are the biggest relative contributor to the disease burden in Europe (5.3% of all the DALYs).

1. Wittchen, H.-U. et al, 2011. The size and burden of mental disorders and other disorders of the brain in Europe 2010 Eur. Neuropsychopharmacology (2011) 21, 655–679

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Depression has detrimental effects on overall health
References

Adapted from Moussavi S et al. Lancet. 2007;370:851-8.

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Depression is associated with significant personal and societal consequences
References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Health Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013
2. Krol M, et al. Pharmacoeconomics. 2011;29(7):601–19
3.Marcus M, et al. 2012. http://www.who.int/mental_health/management/depression/who_paper_depress... Accessed April 16, 2014.
 

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The personal burden of MDD can be significant and wide-ranging
References

1. Kessler RC. Psychiatr Clin North Am 2012;35(1):1-14.

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MDD has significant costs to society
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References

This slide illustrates the global social burden of MDD. The data is based on a systematic review of epidemiological data by Ferrari et al 2013. For this; data was pooled using a Bayesian meta-regression. These weights were used to calculate years lived with disability (YLDs) and disability adjusted life years (DALYs). Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders.

Country data for key countries also exist.

  1. World Health Organization (WHO). Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. 2011. http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_9-en.pdf. Accessed June 2015
  2. WHO. The Global Burden of Disease 2004 Update. http://www.who.int/healthinfo/global_burden_dis ease/2004_report_update/en/. Accessed July 2015 
  3. Ferrari AJ et al. PLoS Medi 2013;10:e1001547
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MDD has significant costs to society: EU
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References

This slide illustrates European burden of MDD with a focus on costs inferred due to impact on work. 

Note that: 
Absenteeism = lost days of work
Presenteeism = low performance while at work, which is transformed into lost day equivalents

1. Hughes S. MEP: Depression in the Workplace. http://www.enwhp.org/fileadmin/user_upload/pdf/Policy_recommendations_de.... Accessed July 2015

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Depression is associated with significant economic costs
References
  1. Collins PY et al. Nature. 2011;475:27-30
  2. Sobocki P et al. J Ment Health Policy Econ. 2006;9:87-98
  3. Stewart WF et al. JAMA. 2003; 289:3135-44; 
  4. World Health Organization. Available at: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004updat... = 1. Accessed June 2016 
     
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Cost per patient of brain disorders in Europe in 2010
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References

This slide shows the cost per patient of selected mental disorders in Europe in 2010. The report covers the 27 EU countries plus Switzerland, Norway, and Iceland. The wider spectrum of mood disorders (also labeled affective disorders), include two particularly important diagnoses with large societal costs; namely major depression and bipolar disorder.

Variations in the epidemiological data covering mood disorders across studies from various European countries are primarily explained by varying study designs whereas the true differences across countries are small. Therefore, data is based on the median European best estimates of the prevalence rates for all countries. That is, 6.9% for major depression (age 18+) and 0.9% for bipolar disorder (age 18–65). 

 

  1. Gustavsson et al., Cost of disorders of the brain in Europe 2010 Eur Neuropsychopharm (2011)21,718-779
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Cost per patient of mental disorders in Europe in 2010
Slide information
References

This slide shows the cost per patient of selected mental disorders in Europe in 2010. The report covers the 27 EU countries plus Switzerland, Norway, and Iceland. The wider spectrum of mood disorders (also labeled affective disorders), include two particularly important diagnoses with large societal costs; namely major depression and bipolar disorder.

Variations in the epidemiological data covering mood disorders across studies from various European countries are primarily explained by varying study designs whereas the true differences across countries are small. Therefore, data is based on the median European best estimates of the prevalence rates for all countries. That is, 6.9% for major depression (age 18+) and 0.9% for bipolar disorder (age 18–65).

1. Gustavsson et al., Cost of disorders of the brain in Europe 2010 Eur Neuropsychopharm (2011)21,718-779

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Number of persons with disorders of the brain in Europe 2010
Slide information
References

This slide shows the number of persons with disorders of the brain in Europe. The report covers the 27 EU countries plus Switzerland, Norway, and Iceland. The wider spectrum of mood disorders (also labeled affective disorders), include two particularly important diagnoses with large societal costs; namely major depression and bipolar disorder.

Variations in the epidemiological data covering mood disorders across studies from various European countries are primarily explained by varying study designs whereas the true differences across countries are small. Therefore, data is based on the median European best estimates of the prevalence rates for all countries. That is, 6.9% for major depression (age 18+) and 0.9% for bipolar disorder (age 18–65). 

The total number of persons with any of the disorders of the brain was estimated at 260 million. In the 27 EU countries plus Norway, Iceland and Switzerland; a population of 514 million people were estimated. 

 

1. Gustavsson et al., Cost of disorders of the brain in Europe 2010 Eur Neuropsychopharm (2011)21,718-779

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Mood disorders bear the highest total cost of brain disorders in Europe 2010
Slide information
References

This slide shows the cost per diagnosis of selected mental disorders in Europe in 2010. Due to the relative high number of persons diagnosed and the relative high cost per patient, mood disorders ranks as number 1 of the diseases contributing to the total costs of mental or neurological disorders in Europe. 

The report covers the 27 EU countries plus Switzerland, Norway, and Iceland. The wider spectrum of mood disorders (also labeled affective disorders), include two particularly important diagnoses with large societal costs; namely major depression and bipolar disorder.

Variations in the epidemiological data covering mood disorders across studies from various European countries are primarily explained by varying study designs whereas the true differences across countries are small. Therefore, data is based on the median European best estimates of the prevalence rates for all countries. That is, 6.9% for major depression (age 18+) and 0.9% for bipolar disorder (age 18–65). 

In the 27 EU countries plus Norway, Iceland and Switzerland with a total population of 514 million people, the total cost of disorders of the brain was estimated to be €798 billion per year. This cost burden corresponds to 25% of the direct health care expenses and the non-medical direct cost as well as the indirect costs, such as lost work time, are higher than for most other diseases due to the persisting nature of many brain diseases. In total, probably one third of all health related expenses are caused by brain disorders. Mood disorders was the largest contributor with cost estimated to be €113405 million (ppp).

1. Gustavsson et al., Cost of disorders of the brain in Europe 2010 Eur Neuropsychopharm (2011)21,718-779

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Mood disorders bear the highest total cost of mental disorders in Europe 2010
Slide information
References

This slide shows the cost per diagnosis of selected mental disorders in Europe in 2010. Due to the relative high number of persons diagnosed and the relative high cost per patient, mood disorders ranks as number 1 of the diseases contributing to the total costs of mental or neurological disorders in Europe. 

The report covers the 27 EU countries plus Switzerland, Norway, and Iceland. The wider spectrum of mood disorders (also labeled affective disorders), include two particularly important diagnoses with large societal costs; namely major depression and bipolar disorder.

Variations in the epidemiological data covering mood disorders across studies from various European countries are primarily explained by varying study designs whereas the true differences across countries are small. Therefore, data is based on the median European best estimates of the prevalence rates for all countries. That is, 6.9% for major depression (age 18+) and 0.9% for bipolar disorder (age 18–65). 

In the 27 EU countries plus Norway, Iceland and Switzerland with a total population of 514 million people, the total cost of disorders of the brain was estimated to be €798 billion per year. This cost burden corresponds to 25% of the direct health care expenses and the non-medical direct cost as well as the indirect costs, such as lost work time, are higher than for most other diseases due to the persisting nature of many brain diseases. In total, probably one third of all health related expenses are caused by brain disorders. Mood disorders was the largest contributor with cost estimated to be €113405 million (ppp).

1. Gustavsson et al., Cost of disorders of the brain in Europe 2010 Eur Neuropsychopharm (2011)21,718-779

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Depressive symptoms persist during periods of remission and subsequent depressive episodes
References

1. Conradi HJ et al. Psychol Med. 2011;41:1165-74.
 

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Depression costs more to employers than is spent on managing it
References
  1. Olesen J et al. Eur J Neurol. 2012;19:155–62.
  2. Stewart WF et al. JAMA. 2003;289(23):3135-44.
  3. Perkins M, Back A. Mental health failing costs business $11b. 2014. Retrieved from: http://www.smh.com.au/national/mental-healthfailing-costs-business-11b-2.... Accessed May 2015
     
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Depression directly impacts working time
References

IDEA: Impact of Depression at Work in Europe Audit Final report. Ipsos Healthcare. October 2012.

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