PARIS – The overall burden of mental health remains steady in Europe, but patients continue to struggle to receive appropriate treatment, according to a new report.
"There has been tremendous improvement in terms of recognition, but recognition is senseless, if no appropriate treatment follows," lead author Dr. Hans-Ulrich Wittchen said in an interview. "And there’s no indication that the rate of minimally adequate treatment has been improving over the last 10 years."
It is estimated that 38.2% or 164.8 million Europeans suffer each year from at least one mental disorder, according to the 2011 report by the European College of Neuropsychopharmacology (ECNP) and European Brain Council (EBC). Still, despite all efforts, only 10% are treated.
When the group published its initial report in 2005, the annual burden was 27.4%, representing 82 million affected adults, aged 18-65 years, among 301.7 million European Union (EU) residents.
The increased prevalence today is attributable to a larger EU reference population of 514 million residents, and the inclusion of 14 additional disorders covering children/adolescents and the elderly, Dr. Wittchen explained at the annual congress of the ECNP where the data were presented. Without the additional diagnoses, the overall prevalence rate would have been comparable, at 27.1%.
The current figures are a conservative estimate since many disorders could not be included, and only cases meeting full diagnostic criteria were considered, he said.
Anxiety disorders were the most common, affecting 14% of the population, followed by insomnia (7%), major depression (6.9%), somatoform disorders (6.3%), alcohol and drug dependence (less than 4%), attention-deficit/hyperactivity disorders among the young (5%), and dementia at 1% among those 60-65 years, but 30% in those 85 and older.
The lack of adequate treatment is particularly worrisome for affected children and adolescents. Notably, the first onset of anxiety disorders is almost invariably in childhood or adolescence, but with early recognition the risk of later onset depression can be reduced by more than 50%, said Dr. Wittchen, chair and director of the Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies at Dresden University of Technology in Dresden, Germany
He suggests that the poor provision of mental health services is likely tied to underrecognition of the scope of mental and neurologic disorders, scarce resources and an inadequate number of providers with sufficient expertise.
"It would be unacceptable to other disciplines in medicine like cardiology if such complex treatment plans that we have developed for most mental disorders would be simply applied by primary care," Dr. Wittchen said.
Immediate ECNP past-president Prof. David Nutt said that with some disorders, patients have to overcome three hurdles in order to receive adequate care. Many patients do not know they are ill or think it’s their fault, their primary care provider fails to provide adequate treatment, or there is no approved therapy once the see a psychiatrist and the proper diagnosis is made.
Current political winds may only worsen the situation for patients with mental disorders in the United States and Europe, often envied by Americans for its universal insurance coverage. Both men cited proposed legislation in Denmark that would require only those patients with mental disorders to pay for their treatment. In Britain, the conservative government wants to redefine addiction as a lifestyle choice, said Dr. Nutt, professor of neuropsychopharmacology at the Imperial College in London.
"If we lose, we’re going to go back into the dark ages," he said. "It could set us back 30, 40 years."
The authors note that frequent and high degrees of impairment and disability can be directly linked to deficient treatment provision. Unlike other diseases, mental disorders are costly because of high indirect costs and not because of direct treatment costs.
The report, which covers residents in all 27 countries in the EU plus Switzerland, Iceland, and Norway, includes recommendations for political action. They include strengthening and broadening existing programs, improving allocation of scarce resources to mental disorders, boosting research and research support from industry and investors, and training for all health professions on disorders of the brain and their appropriate treatments.
The report was simultaneously published in the September issue of the journal, European Neuropsychopharmacology (2011;21:655-79).
Dr. Wittchen and Dr. Nutt reported no disclosures.