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Burden of Mental Illness


  • According to the World Health Organization, unipolar depression was the third most important cause of disease burden worldwide in 2004. Unipolar depression was in “eighth place in low-income countries, but at first place in middle- and high-income countries.”1
  • In a nationally representative face-to-face household survey, 6.7% of U.S. adults experienced a major depressive episode in the past 12 months.2
  • Significantly greater percentages of lifetime major depression have been reported among women (11.7%) than men (5.6%).3
  • Examining ethnic differences reveals lifetime percentages of depression of 6.52% among whites and 4.57% among blacks and 5.17% among Hispanics.4


  • Anxiety disorders, which include panic disorder, generalized anxiety disorder, post-traumatic stress disorder, phobias, and separation anxiety disorder, are the most common class of mental disorders present in the general population.5
  • The estimated lifetime prevalence of any anxiety disorder is over 15%, while the 12-month prevalence is more than 10%.5
  • Prevalence estimates of anxiety disorders are generally higher in developed countries than in developing countries.5
  • Most anxiety disorders are more prevalent in women than in men.6
  • One study estimated the annual cost of anxiety disorders in the United States to be approximately $42.3 billion in the 1990s, a majority of which was due to non-psychiatric medical treatment costs. This estimate focused on short-term effects and did not include the effect of outcomes such as the increased risk of other disorders.7

Bipolar Disorder:

  • The National Comorbidity Study reported a lifetime prevalence of nearly 4% for bipolar disorder. Bipolar disorder is more common in women than men, with a ratio of approximately 3:2. The median age of onset for bipolar disorder is 25 years,8 with men having an earlier age of onset than women.8
  • In an insured population, 7.5% of all claimants with behavioral health care coverage filed a claim, of which 3.0% had bipolar disorder.9 Persons with bipolar disorder incurred $568 in annual out-of-pocket expenses—more than double the expenses incurred by all claimants. Annual insurance payments were greater for medical services for persons with bipolar disorder than for patients with other behavioral healthcare diagnoses.9
  • The inpatient hospitalization rate of bipolar patients (39.1%) was greater than the 4.5% characterizing all other patients with behavioral health care diagnoses.
  • Bipolar disorder has been deemed the most expensive behavioral health care diagnosis,9 costing more than twice as much as depression per affected individual.10 Total costs largely arise from indirect costs and are attributable to lost productivity, in turn arising from absenteeism and presenteeism.10
  • For every dollar allocated to outpatient care for persons with bipolar disorder, $1.80 is spent on inpatient care, suggesting early intervention and improved prevention management could decrease the financial impact of this illness.9


  • Worldwide prevalence estimates range between 0.5% and 1%. Age of first episode is typically younger among men (about 21 years of age) than women (27 years). Of persons with schizophrenia, by age 30, 9 out of 10 men, but only 2 out of 10 women, will manifest the illness.11
  • Persons with schizophrenia pose a high risk for suicide. Approximately one-third will attempt suicide and, eventually, about 1 out of 10 will take their own lives.11
  • A Canadian study found that the direct health care and non-health care costs of schizophrenia were estimated to be 2.02 billion Canadian dollars in 2004. This, combined with a high unemployment rate due to schizophrenia and an added productivity and morbidity and mortality loss of 4.83 billion Canadian dollars, yielded a total cost estimate of 6.85 billion in U.S. and Canadian dollars.12
  • The economic burden of schizophrenia is particularly great during the first year following the index episode, relative to the third year onwards. This finding suggests the need for improved monitoring of persons with schizophrenia upon initial diagnosis.13

Frequent Mental Distress:

Frequent mental distress is defined based on the response to the following quality of life question, ‘‘Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?’’ Frequent mental distress is identified as a report of 14 or more days of poor mental health in the past 30 days.

  • 9.4% of U.S. adults experienced Frequent Mental Distress (FMD) for the combined periods 1993-2001 and 2003-2006.14
  • The Appalachian and the Mississippi Valley regions had high and increasing FMD prevalence, and the upper Midwest had low and decreasing FMD prevalence during this same time period.14

Alzheimer’s Disease:

  • Alzheimer’s disease is the sixth leading cause of death in the United States and is the fifth leading cause among persons age 65 years and older.15
  • Up to 5.3 million Americans currently have Alzheimer’s disease.16
  • By 2050, the number is expected to more than double due to the aging of the population.16

± References

  1. World Health Organization. The Global Burden of Disease: 2004 Update. Geneva, Switzerland: WHO Press, 2008.
  2. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:617–627.
  3. Ford DE, Erlinger TP. Depression and C-reactive protein in US adults: Data from the third National Health and Nutrition Survey. Arch Intern Med 2004;164:1010–1014.
  4. Oquendo MA, Lizardi D, Greenwald S, Weissman MM, Mann JJ. Rates of lifetime suicide attempt and rates of lifetime major depression in different ethnic groups in the United States. Acta Psychiat Scand 2004;110:446–451.
  5. Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, Ustün TB, Wang PS. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc 2009;18(1):23–33.
  6. McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res 2011; Mar23.
  7. Greenberg PE, Sisitsky T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR, Ballenger JC, Fyer AJ. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 1999;60(7):427–35.
  8. Andreasen NC, Black DW. (4th ed.). Introductory Textbook of Psychiatry (4th ed.). Washington, DC: American Psychiatric Publishing, Inc., 2006.
  9. Peele PB, Xu Y, Kupfer DJ. Insurance expenditures on bipolar disorder: Clinical and parity concerns. Am J Psychiatry 2003;160:1286–1290.
  10. Laxman KE, Lovibond KS, Hassan MK. Impact of bipolar disorder in employed populations. Am J Manag Care 2008;14:757–784.
  11. Andreasen NC, Black DW. Introductory Textbook of Psychiatry (4th ed.). Washington, DC: American Psychiatric Publishing, Inc., 2006.
  12. Goeree R, Farahati F, Burke N, Blackhouse G, O’Reilly D, Pyne J, Tarride JE. The economic burden of schizophrenia in Canada in 2004. Curr Med Res Opin 2005;21:2017–2028.
  13. Nicholl D, Akhras KS, Diels J, Schadrack J. Burden of schizophrenia in recently diagnosed patients: Healthcare utilization and cost perspective. Curr Med Res Opin 2010;26:943–955.
  14. Moriarty DG, Zack MM, Holt JB, Chapman DP, Safran MA. Geographic patterns of frequent mental distress: U.S. adults, 1993–2001 and 2003–2006. Am J Prev Med 2009;46:497–505.
  15. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: final data for 2007. National Vital Statistics Report 2010;58(19).
  16. Hebert LE, Scherr PA, Bienas JL, Bennett DA, Evans DA. Alzheimer’s disease in the U.S. population: prevalence estimates from the 2000 census. Arch Neurol 2003;60:1119–22.