European and Worldwide Mental Health Epidemiology and Trends
11.1 Introduction: Mental Health Problems Across the Lifespan
Promoting and maintaining mental health remain a major public health challenge for nations all around the globe. Methodological and epistemological limitations notwithstanding our best evidence indicate that hundreds of millions of people worldwide are affected by mental health problems. Mental health problems are prevalent in all societies, among women and men, at all stages of life.
Wittchen et al. (2011) claim that their prevalence findings underline that mental health problems must be considered to be Europe’s foremost health-care challenge of the twenty-first century. This challenge is complex, with dozens of group of so- called disorders and hundreds of imprecise diagnoses that might require preventive, therapeutic, and rehabilitative interventions of different types and intensities in dif- ferent age groups (Wittchen et al. 2011). In the European Union, over one-third of the population suffers from some form of mental health problem at some point in their life. Almost 50 million European Union (EU) citizens (about 11% of the popu- lation), on average at a single point in time, are estimated to be living with a mental health problem (European Union 2008). The most frequent so-called disorders are anxiety “disorders” (14.0%), insomnia (7.0%), major depression (6.9%), somato- form (6.3%), alcohol and drug dependence (4%), ADHD (5%) in the young, and dementia (1–30%, depending on age) (Wittchen et al. 2011).
In 2014, there were an estimated 43.6 million adults in the USA with a formal mental health problem in the past year, and this number represented 18.1% of all US adults (Center for Behavioral Health Statistics and Quality 2015). Of the 16 million Australians aged 16–85 years, almost half (45% or 7.3 million) had a mental health problem at some point in their life, and one in five (20% or 3.2 million) Australians had a mental health problem that endured longer than 12 months. More than a quar- ter (26%) of people aged 16–24 years and a similar proportion (25%) of people aged 25–34 years had a 12-month (or longer) mental health problem compared with 5.9%
of those aged 75–85 years old. Among all age groups, 12-month so-called anxiety disorders had the highest prevalence, with the highest rate in the 35–44 years age group (18%) (Australian Bureau of Statistics 2007).
The overall 1-year prevalence of mental health problems, within 14 countries worldwide, ranges from 4 to 26% (WHO World Mental Health Survey Consortium 2004). Later, the estimated lifetime prevalence of having one or more of the so- called disorders considered here varies widely across the World Mental Health surveys, from 47.4% in the USA to 12.0% in Nigeria (Kessler et al. 2007). A meta-analysis for the years 1980–2013 (Steel et al. 2014) concluded that on aver- age one in five adults (17.6%) experienced a common mental health problem within the past 12 months and 29.2% across their lifetime. Countries within North and Southeast Asia in particular displayed consistently lower 1-year and lifetime prevalence estimates than other regions, and 1-year prevalence rates were also low among sub-Saharan Africa. The so-called disorders of the brain and mental health problems, in particular, contribute 26.6% of the total all-cause burden. The three most important contributors to burden of disease are depression (7.2% of the over- all burden of disease in Europe), Alzheimer’s disease/dementia (3.7%), and alco- hol/misuse (3.4%). There are clear gender differences: women were disproportionally affected by depression (1 in 10 healthy years of life lost is due to this disorder or 10.3% of all the DALYs), while for men alcohol/misuse is the biggest relative contributor to the mental health disease burden in Europe (Wittchen et al. 2011).
According to the WHO (2016), approximately 15% of adults aged 60 and older suffer from a mental health problem, and so-called neuropsychiatric dis- orders among the older adults account for 6.6% of the total disability (DALYs) for this age group. However, more than half of all adults with existing mental health problems were diagnosed in their childhood (WHO Regional Office for Europe 2014). Analysis of age-of-onset reports shows that many mental health problems begin in childhood-adolescence and have significant adverse effects on subsequent role transitions. Adult mental health problems are found in the World Mental Health data to be associated with high levels of role impairment.
Despite this burden, the majority of mental health problems go untreated (Kessler et al. 2009a). Worldwide, the leading causes of years lost because of disability (YLDs) for 10–24-year-olds were so- called neuropsychiatric disor- ders (45%) (Gore et al. 2011). More than 10% of children and adolescents in Europe have some form of mental health problem (European Public Health Alliance 2014).
Wittchen et al. (2011) have concluded that the most frequent mental health prob- lems in EU, in terms of the estimated number of persons affected across all age groups, are so-called anxiety disorders (69.1 million) with the unipolar depression (30.3 million) being next. The so-called anxiety disorders, which include panic
“disorder,” generalized anxiety “disorder,” post-traumatic stress “disorder,” pho- bias, and separation anxiety “disorder,” are the most common class of mental health problems presenting in the general population; the estimated lifetime prevalence of any so-called anxiety disorder is over 15%, while the 12-month prevalence is more than 10% which is generally higher in developed countries than in developing coun- tries (Kessler et al. 2009b). Moreover, most so-called anxiety disorders are more prevalent in women than in men (McLean et al. 2011).
A meta-analysis for the years 1980–2013 showed that women had higher rates of mood (7.3%:4.0%) and anxiety (8.7%:4.3%) problems during the previous 12 months (Steel et al. 2014). An earlier study showed that phobias and separation anxiety “disorder” all have very early ages of onset (medians in the range 7–14 years), while generalized anxiety “disorder,” panic “disorder,” and post-traumatic stress
“disorder,” in comparison, have much later age-of-onset distributions (median 24–50 years), and the median age of so-called onset of mood disorders ranges between the late 20s and the early 40s (29–43 years) (Kessler et al. 2007). In New Zealand and the USA, prospective measurement yielded lifetime estimates that sug- gest the experience of certain so-called DSM-defined disorders by age 32 may be very common: anxiety disorder (49.5%) and depression (41.4%) (Moffitt et al.
2010). A nationwide cross-sectional study which was conducted among Nepalese adults showed that prevalence of anxiety, depression (HADS-D), and comorbid of anxiety and depression were 16.1%, 4.2%, and 5.9%, respectively (Risal et al.
2016).
Mathers and Loncar (2006) support that by 2030, depression is likely to be the second highest cause of disease burden. Almost all studies show a higher prevalence of depression among women than men, with a ratio of between 1.5:1 and 2:1 (Hyman et al., Hyman et al. 2006). The World Mental Health survey showed a 2.4%
lifetime prevalence of bipolar spectrum and 1.5% 12-month prevalence (Merikangas et al. 2011). A recent systematic review found that the prevalence of bipolar disor- der ranges from 0.1 to 7.5% (Caetano Dell’Aglio et al. 2013). Moreover, unipolar depression occurs in 7% of the general elderly population, and it accounts for 5.7%
of YLDs among over 60-year-olds (WHO 2016).
Moreover, depression is the predominant cause of illness and disability for both boys and girls aged 10–19 years (WHO 2014a), while so-called major depressive disorders are the most frequent conditions in children and adolescents, followed by so-called anxiety disorders, so-called behavioral or emotional disorders, and sub- stance misuse problems (European Public Health Alliance 2014). In Australia (Australian Bureau of Statistics 2007) approximately 15% of young people (aged 16–24) have so-called anxiety disorders, and 6% have so-called affective disorders (such as depression). The World Mental Health surveys estimate that the prevalence of 12-month serious mental illness is 4–6.8% in half of the countries, 2.3–3.6% in one-fourth, and 0.8–1.9% in one-fourth (Kessler et al. 2009b). Assuming
conservatively that the main age range of risk is between ages 15 and 55, research- ers estimate lifetime risk is in the range of 0.08 to 0.44 percent for schizophrenia.
Although schizophrenia is a relatively uncommon mental health problem, estimates of disease burden are high – around 2,000 DALYs lost per one million total popula- tion (because the condition is associated with early onset, long duration, and severe disability) (Hyman et al. 2006).