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A third of Europeans have mental health disorder, study shows

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d5595 (Published 06 September 2011) Cite this as: BMJ 2011;343:d5595
  1. Matthew Limb
  1. 1London

In any one year more than a third of Europeans have a mental health disorder, but most cases go untreated, finds a major new study.

The study, which covered 30 countries—those of the European Union and Switzerland, Iceland, and Norway—is said to be the first to depict “comprehensively” the size and burden of mental disorders across the European Union (European Neuropsychopharmacology 2011;21,655-79, doi:10.1016/j.euroneuro.2011.07.018).

The study, which included previously published research, reanalyses of existing data, national surveys, and expert opinion, covered 27 diagnoses of mental health disorder made between the late 1980s and 2010 according to criteria of the ICD-10 (international classification of diseases, 10th revision) and the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth revision).

The most common diagnoses were anxiety (with an estimated 12 month prevalence of 69.1 million cases), major depression (30.3 million), sleep disorders (29.1 million), somatoform disorders (20.4 million), substance misuse (17 million), dementias (6.3 million), mental disability (4.2 million), and disorders of childhood and adolescence, such as attention-deficit/hyperactivity disorder (3.3 million).

The researchers calculated that 38.2% of the EU population is affected by a mental health disorder, equivalent to 165.8 million people, after adjustment for age and comorbidity. This constitutes Europe’s largest health challenge in the 21st century, they say. The proportion is far higher than the previous “best estimate” of 27% made in 2005 (European Neuropsychopharmacology 2005;15:357-76, doi:10.1016/j.euroneuro.2005.04.012). The authors conclude that the true size of the problem has been “significantly underestimated” in the past and that the new figures are higher because they now include 14 new disorders, children and elderly people, and new EU member states. There was no evidence that overall rates of mental disorders had risen, they say, but they add that, importantly, the level of care and treatment had not improved since 2005.

The findings showed clear sex differences in particular diagnostic categories, with women disproportionately affected by depression, especially in their reproductive years, and men more likely to have alcohol misuse disorders. With the exception of substance misuse and mental disability, no substantial cultural differences or variations between countries were found.

But only a minority of people receive treatment, even in the countries with the best health systems. “Less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs,” the authors wrote.

“The immense treatment gap documented for mental disorders has to be closed,” said the study’s principal investigator, Hans-Ulrich Wittchen, of the Institute of Clinical Psychology and Psychotherapy and Centre of Clinical Epidemiology and Longitudinal Studies at Dresden University of Technology, at the release of the findings at the European College of Neuropsychopharmacology Congress in Paris.

Depressive episodes in young adolescents were twice as common now as in the 1970s, although the number had levelled off in the past 10-15 years, he said, adding that mental health disorders at this age had a profound effect on mental health in 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,” he said.

The researchers also looked at the effect on disability of neurological disorders, such as epilepsy, Parkinson’s disease, and stroke. They found that these together with mental health disorders represented 26.6% of the total burden of disability. “Bringing these two disciplines together might dramatically change how we provide treatment,” Professor Wittchen suggested.

The authors conclude that public health efforts should take a life course approach and that concerted action is urgently “needed at all levels,” including substantially increased research funding to improve prevention and treatment.

Notes

Cite this as: BMJ 2011;343:d5595