EUGLOREH project
THE STATUS OF HEALTH IN THE EUROPEAN UNION:
TOWARDS A HEALTHIER EUROPE

FULL REPORT

PART II - HEALTH CONDITIONS

5. HEALTH IMPACTS OF NON COMMUNICABLE DISEASES AND RELATED TIME-TRENDS

5.5. Mental and brain diseases and disorders

Introduction

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Introduction

 

Between 15% and 20% of adults suffer some form of mental health problem (European Commission 2003), which range from mild forms of depression through to complex psychiatric disorders. Depression and depression-related problems account for more than 7% of all estimated ill-health and premature mortality in Europe with women twice as susceptible as men8. Disadvantaged groups face a greater risk of mental illness. People with mental disorders may face stigma, discrimination and social exclusion. The impact on the EU economy of mental ill health is estimated to be equivalent to a reduction of 3% to 4% of the total GDP9.

 

There are gender-specific risk factors for some common mental disorders. Women are at much greater risk of experiencing domestic abuse than men; this can result in high rates of anxiety and depression, symptoms of post-traumatic stress, and subsequent difficulty in establishing and maintaining relationships. Women living in poverty and women from minority groups are at a higher risk for victimisation by violence. Similarly, women living on a low income for an extended period can experience stress, difficulty in personal and family relationships and can be left feeling isolated and depressed. Individuals most at risk of social isolation and anxiety are female lone parents and retired women living alone10. Moreover, women are more likely to approach their primary care physician for help. Doctors are more likely to diagnose depression in women compared to men, even when before similar scores on standardised measures of depression or identical symptoms. Female gender is also a significant predictor of being prescribed mood altering psychotropic drugs. Men are more likely to seek specialist mental health care and are the main users of inpatient care11,12. Women’s social roles as primary carers for children and/or other dependants, can result in “role overload”, where women undertake both employment and household/childbearing responsibilities. This contributes to social isolation and further impacts on mental health.

 

Four of the six leading causes of years lived with disability are due to neuropsychiatric disorders. The most common forms of mental ill health in the EU are anxiety disorders and depression. Projections from 1990 to 2020 suggest that the portion of the global burden of disease attributable to mental and brain disorders will rise to %13. By 2020, it is expected that depression will be the highest-ranking cause of disease in the developed world14.

 

Mental health services in Europe have been identified as a key policy challenge by the World Health Organisation and the European Commission. One in four people suffer from mental ill-health in their lifetime, costing the EU27 countries an estimated total of €300 billion every year in ill-health and lost productivity. Yet despite this staggering burden, mental healthcare services are often inadequate, outdated, and highly stigmatised, despite the availability of modern, effective treatments. Better policies and provision of services are urgently needed to ensure that people with severe mental illness are adequately provided and cared for. For example, countries in the European Region spend on average around 6% of their health budgets on mental health, while mental ill-health represents 20% of the burden of disease.

 

The lifetime incidence of severe mental illnesses such as schizophrenia, bipolar and other psychotic disorders is over 1%, corresponding to around 5 million people in the EU27. But despite their lower prevalence, the associated burden of ill-health on individuals and their families is much greater.

 

The burden of ill health can be reduced by addressing factors that have an impact on mental health and wellbeing such as social relationship, poverty, and discrimination, by raising awareness of mental issues relevant to older people, such as depression and dementia and by increasing the provision of psychotherapeutic and psychosocial interventions for older people.

 

Some countries support people with severe mental problems in paid employment, though in most countries economic inactivity remains the rule. It is estimated that only around 15% of working-age people with long-term mental health problems are working, a lower number than any other group of disabled people. Unemployment, a lack of adequate housing and social networks may result in people becoming seriously isolated and excluded from society.

 

Some Member States endeavour to protect the rights of individuals with mental health problems. Countries such as Italy and the UK have moved care into community settings, giving individuals a better chance to access integrated services while using inpatient beds in general hospitals for short term treatment. There are still many countries which continue to incarcerate people for long periods. Care homes or “asylumsaccommodate large numbers of people in some Eastern European countries, but also in Belgium and the Nethe rlands.

 

Depression: The EURODEP Programme explored geographical variation of depression in older people, risk factors, detection and treatment and preliminary evidence showed higher proportions of depression in women than in men in almost all studies15.

 

Only cardiovascular disease has a greater toll on morbidity and mortality than depression. Yet depression remains under-recognised and highly stigmatised across Europe. Depression affects 10-15% of people over 65. Older people with depression are 2-3 times more likely to have 2 or more chronic illnesses and 2-6 times more likely to have at least one limitation in their daily life activities. More appropriate medical training, increased social awareness and better access to treatment options are necessary to prevent, diagnose and treat late-life depression. The higher risk of depression in older women and in people of lower socio economic status requires particular attention16.

 

The burden of depression includes a higher burden on social security systems and brings a loss of quality of life for those affected and their families, a loss of productivity for firms, and an increased risk of unemployment for individuals. The Global Burden of Disease Study17, judged depression in women as the leading cause of disease burden worldwide.

 

Eating disorders: It is likely that eating disorders are caused by a combination of psychological, genetic, environmental and social factors. An individual with a family history of mood disorders such as depression may be especially affected. Eating disorders are often associated with feeling of helplessness, sadness, anxiety and the need to be perfect. According to Makino et al18, the prevalence rates in Western countries for anorexia nervosa in female subjects range from 0.1% to 5.7%, whilst for bulimia it ranges from 0.3% to 7.3% in women and from 0.1% to 2.1% in males. There is often doubt about the reliability of data on eating disorders, particularly as research is often limited to the under-25s, with older women excluded because bulimia and anorexia nervosa are considered to be a “young girlscondition.

 

Dementia: Dementia does not solely affect older people, but rates increase with age, doubling every four years over 65. After the age of 85 years rates of Alzheimer’s Disease (AD) increase in women but not in men19. The EURODEM studies also noted that the rates of AD were higher among women of lower education, but that education was not a significant risk factor in men.

 

Schizophrenia in the EU has a prevalence of about 1% equivalent to some 3.7 million people. The disease usually first affects young adults. Three-quarters of them continue to experience symptoms throughout their lives, needing constant treatment. This creates distress for families and places a huge burden on health care resources. More data on this condition are not readily available.

 

Epilepsy: The prevalence of epilepsy in the EU varies between 3 and 6 per 1.000 inhabitants. Data, though limited, suggest that the incidence and mortality of epilepsy are declining. The estimated number of children and adolescents in Europe with active epilepsy is 0.9 million (prevalence 4.5-5.0 per 1000), 1.9 million aged 20-64 (prevalence six per 1000) and 0.6 million aged 65 or older (prevalence seven per 1000). Approximately 20-30% of the epilepsy population have more than one seizure per month .

 

There is evidence that suicide can be prevented through adequate treatment of psychiatric disorders and earlier detection and treatment of psychiatric illnesses in the general population. Treatment with medications for depression, bipolar disorders, schizophrenia and other psychotic illnesses can prevent both suicide and attempted suicide. Behavioural therapies have shown encouraging results in reducing the repetition of suicide attempts.


The Community’s health policy has covered mental health since 1997 through specific projects and policy initiatives20. The EU 2003-2008 Public Health Programme provides limited resources for action. Further related priorities addressed the misuse of drugs and the harm caused by alcohol. Initiatives under the Community’s social and employment policy targeted the non-discrimination of people with mental ill health, the social inclusion of people with mental disabilities and the prevention of stress at the workplace, including: (i) The adoption of directive 2000/78/EC which prohibits inter alia discrimination on the ground of disability in the field of employment; (ii) Actions under the European Year for People with Disabilities in 2003; and (iii) The adoption of a European Framework Agreement on work-related Stress between social partners in 2004.

 

The Community’s Framework Programme for Research has been and continues to be an important source of funding for European research on mental health21. An example is the “MHEDEA-2000”-project, which carried out a European assessment of mental health disability; Information society and media policy supported the development of Information and Communication Technology (ICT) -based tools for use in prevention, diagnosis and care; Regional policy supports infrastructure investments in the health sector that is beneficial to the regions' structural adjustment; Educational policy addresses mental health as part of its policy work (e.g. on key competences for the knowledge society) and through projects; as part of the Community’s freedom, justice and security policy, the DAPHNE II programme combats violence against children, young people and women. Such violence can cause mental health problems.

 

However, a comprehensive strategy on mental health, which would link all these activities, does not yet exist at Community level. Such a strategy would be helpful in strengthening the coherence and effectiveness of current and future initiatives.

 

A number of policy documents adopted by the Council of Ministers since 1999 , signalled a willingness of Member States to use the EU-level for cooperation in the field of mental health. The Council Conclusions adopted in June 2005 reinforced this message by inviting Member States to give due attention to the implementation of the results of the WHO European Ministerial Conference on Mental Health. The Commission was invited to support the implementation.

 

In 2005, the European Commission launched a Green Paper on 'Promoting the Mental Health of the Population' which marked the beginning of an extensive consultation to develop a EU strategy on mental health. The document outlined the relevance of mental health for some of the EU's strategic policy objectives, proposed the development of a strategy on mental health at Community-level and brought forward possible priorities and suggestions. The consultation period ended in May 2006; in December 2006 the European Commission issued a report on the responses to the Green Paper22.

 

In the meantime, European networks of patientsorganizations (e.g. Mental Health Europe, EUFAMI, EnterMentalHealth,) have developed programmes which aim at:

 

·       Protection of human rights of people with mental ill health

·       Prevention of mental distress

·       Promotion of positive mental health

·       Achieving a continuous improvement throughout Europe in mental health, the quality of care and welfare for people with a mental illness, and the level of support for their family and friends.

·        Enabling member associations to combine their efforts and act jointly at European level.

·        Strengthening and assisting the member associations in their efforts to improve health conditions in their own areas.

 

These organizations are advocating the patientsneeds in areas regarding the development of policies and programmes; development of best practice; promoting the empowerment of patients and their families; the development of training courses for health and social care professionals; combating stigma and promoting social inclusion.

An internet tool (www.implementis.eu) has been developed to help Users, Carers and families touched by severe mental illness, NGOs, Healthcare professionals and Government policy makers in finding key facts and evidence base, areas for actions, guidance material and best practice examples.

 





8 European Commission (2004): The State of Mental Health in the European Union. Directorate General for Health and Consumer Protection. [on-line publication available at: http://ec.europa.eu/health/ph_projects/2001/monitoring/fp_monitoring_2001_frep_06_en.pdf].



9 Gabriel P and Liimatainen M-R (2000): Mental health in the workplace: Introduction. Geneva: International Labour Office. [on-line publication available at:  http://www.ilo.org/public/english/employment/skills/disability/download/execsums.pdf]



10 Myers F, McCollam A, Woodhouse A (2005): Equal minds. Scottish development centre for mental health. Available at: http://www.sdcmh.org.uk/publications/pubs%20downloads/projectreports/0019049.pdf.



11 Austbury J. (2002): Mental Health: Gender Bias, Social Position, and Depression. In: Sen. G., A. George, and P. Östlin (eds.) Engendering International Health: The Challenge of Equity. MITPress, Cambridge.



12 Hallstrom, T. (2001) Gender differences in mental health. In P. Östlin, M. Danielsson, F. Diderichsen, A. Härenstam and G. Lindberg (eds) Gender Inequalities in Health (Boston: Harvard School of Public Health, 117-135).



13 WHO (2002): Mental Health: Responding to the Call to Action. Report by the Secretariat to the 55th WHA. Doc A55/18 [on-line publication available at: http://ftp.who.int/gb/archive/pdf_files/WHA55/ea5518.pdf]



14 WHO (2001): World Health Report 2001. [on-line publication available at: http://www.who.int/whr/2001].



15 Copeland JRM, Beekman ATF, Braam AW, Dewey ME, Delespaul P, Fuhrer R, Hooijer C, Lawlor BA, Kivela S-L, Lobo A, Magnusson H, Mann AH, Meller I, Prince MJ, Reischies F, Roelands M, Skoog I, Turrina C, deVries MW, Wilson KCM (2004): Depression among older people in Europe: the EURODEP studies. World Psychiatry, 3:4549.



16 International Longevity Center (2006): Ageism in America. New York: International Longevity Center.



17 Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL (2006): Global Burden of Disease and Risk Factors [on-line publications available at: http://files.dcp2.org/pdf/GBD/GBD.pdf



18 Makino M, Tsuboi K, Dennerstein L.(2004): Prevalence of eating disorders: a comparison of Western and non-Western countries.MedGenMed.6:49.



19 Fratiglioni L, Launer LJ, Andersen K, Breteler MM, Copeland JR, Dartigues JF, Lobo A, Martinez-Lage J, Soininen H, Hofman A (2000): Incidence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Stockholm Gerontology Research Center and Division of Geriatric Medicine, NEUROTEC, Karolinska Institutet, Sweden.



20 European Commission (2004): Action for Mental Health. Activities co-funded from European Community Public health Programmes 1997-2004. http://europa.eu.int/comm/health/ph_determinants/life_style/mental_health_en.htm. A list of all completed and ongoing such projects can be found under: http://europa.eu.int/comm/health/ph_projects/project_en.htm



21 Fifth Framework Programme for research, technological development and demonstration activities (1998 to 2002), Decision No 182/1999/EC of the European Parliament and of the Council of 22.12.1998, Official Journal L26/1 of 01.02.1999,.Sixth Framework Programme for research, technological development and demonstration activities covering the period 2002-2006, Decision 1513/2002/EC of the European Parliament and of the Council of 27.06.2002, Official Journal L232/1 of 29.08.2002; Official Journal L294/1 of 29.10.02.



22 http://ec.europa.eu/health/ph_determinants/life_style/mental/green_paper/mentalgp_report.pdf.