A landmark study released last week by the European College of Neuropsychopharmacology (ECNP) sheds new light on the state of Europe’s mental and neurological health, revealing that mental disorders have become “Europe’s largest health challenge in the 21st Century”.
The three-year multi-method study, published in European Neuropsychopharmacology, also highlights that the majority of mental disorders remain untreated.
The study covers 30 countries (the EU plus Switzerland, Iceland and Norway) and a population of 514 million people. All major mental disorders for children and adolescents (two-to-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 authors note.
Conducted by the ECNP and the European Brain Council (EBC), under the co-ordination of ECNP vice-president Professor Hans-Ulrich Wittchen, the study includes information on (amongst others) depression, bipolar disorder, anxiety disorders, insomnia, addiction, and schizophrenia, as well as several neurological disorders, including stroke, epilepsy, Parkinson’s disease and multiple sclerosis.
The study’s key findings include:
• Each year, 38.2 per cent 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;
• The most frequent disorders are anxiety disorders (14.0 per cent), insomnia (7.0 per cent), major depression (6.9 per cent), somatoform disorders (6.3 per cent), alcohol and drug dependence (>4 per cent), attention-deficit and hyperactivity disorders (ADHD, five per cent in the young), and dementia (one per cent among those aged 60-65, 30 per cent 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 of 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 per cent 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 improving 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.
Principal investigator and joint first author Prof Wittchen said that in order to address this challenge, two high priority issues must be addressed.
“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,” he said.
“Second, we have to take into account the developmental pathways of both mental and neurological disorders simultaneously. Both groups of disorders share many common mechanisms 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 ECB also published statistics showing that the annual cost of brain disorders in Europe has soared to €798 billion (US$1 trillion). This figure – which equates to €1,550 per person in Europe – is more than double the estimate made by a previous EBC study, published in 2005.
The cost of brain disorders is substantially higher than other long-term or chronic illnesses like cardiovascular disease or cancer. The European Heart Network set the EU cost of cardiovascular disease at €192 billion in 2008, while the total annual cancer cost is estimated at €150-250 billion.
