Studies Show Mental Disorders Major Cause of Lost Productivity Worldwide

By Erika Gebel

In an international collaboration, the World Health Organization (WHO), the World Bank and Harvard University gathered a large amount of data in the Global Burden of Disease study and found that mental illness accounts for more than 15 percent of disease burden - more than cancer - in established market economies like the United States.

"Depression is the leading cause of years lost due to disability, the burden being 50 percent higher for females than males," according to a recent assessment of the global burden of disease released by WHO October 27. "In both low- and middle-income countries, and high-income countries, alcohol dependence and problem use are among the 10 leading causes of disability."

A series on mental health in the medical journal The Lancet came to a similar conclusion, estimating that mental disorders make up 14 percent of the global disease burden.

The series was produced in collaboration with WHO, which launched a new global program to combat mental disorders on World Mental Health Day, October 10. This program, called the Mental Health Gap Action Programme (mhGAP) and involves scaling up care for mental, neurological and substance use disorders, is a response to a vast treatment gap for those who suffer from mental illness in the developing world.

Mental health is defined by WHO as not merely the absence of a disorder but "a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community."

The causes of mental illnesses are believed to be a combination of environmental and genetic factors. Generally, mental disorders are characterized by some combination of abnormal thoughts, emotions, behavior and relationships. A few examples of mental disorders are schizophrenia, depression, mental retardation and disorders due to drug or alcohol abuse. Suicide - a leading killer of young people - is sometimes the outcome of mental illness.

HIGHLY TREATABLE

Despite their global prevalence, mental disorders are highly treatable through a combination of medication and counseling. Treatments for mental disorders can be fairly inexpensive, but less than 25 percent of people with mental problems receive care in the developing world. One goal of mhGAP is to improve accessibility to these treatment options for people suffering from mental disorders in the developing world.

Mental disorders do their share of damage in developed countries as well, often as a result of depression or substance abuse.

According to the National Institutes of Mental Health (NIMH), part of the National Institutes of Health (NIH) and the world's largest mental health organization, one in four Americans 18 and older suffer from a diagnosable mental disorder. Mental disorders are also the leading cause of disability in the United States for ages 15-44.

The NIMH supports a group of researchers at the NIH laboratories in Bethesda, Maryland, and awards grants to external researchers and institutions across the United States.

NIMH grant recipient Dr. Barbara Geller, a researcher at Washington University in St. Louis, Missouri, studies children with bipolar disorder, a disease characterized by unusually erratic shifts in behavior. Children and adults with bipolar disorder display "very dangerous behavior," Geller said. "They are sure they can cross highways and think the cars can't hit them."

In a recent study, Geller showed that 44 percent of children with bipolar disorder display manic episodes into adulthood.

"When you get the early onset, you get a more severe illness," she said.

A disturbing trend, Geller added, is an apparent increase in the numbers of children with mental illnesses - like bipolar disorder, autism, anxiety and hyperactivity - not only in the United States but globally.

"One of the questions," she said, "is whether there is more mental illness or we've just become more sophisticated in identifying children with problems."

INTERNATIONAL APPROACH

WHO recognizes that battling mental disorders requires an international approach and a common understanding of disease definitions and classifications.

To this end, WHO organized an international advisory group to help revise the section on mental and behavioral disorders for the 10th edition of the International Classification of Diseases. Doctors and researchers from all over the world met in Geneva in March to help standardize mental illness definitions.

Another global collaboration initiated by WHO is Project Atlas: Resources for Mental Health. Using information from WHO member states, the project provides resources on mental health policies, programs, financing, services, professionals, treatment and medicines, information systems and organizations worldwide.

The goal is that the resources be used to obtain services and care for people with mental health problems.

With this and other data, the new mhGAP program has the capacity to determine what is needed and what is available in the parts of the globe where easily treated mental disorders go without care.

(This is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://www.america.gov)