Cited by 1,503Mental Health Treatment and AccessHealth and Medical StudiesPsychiatric care and mental health services

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Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies

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Wittchen, Hans-Ulrich, Jacobi, Frank·2005·European Neuropsychopharmacology

DOI 10.1016/j.euroneuro.2005.04.012

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Abstract

Epidemiological data on a wide range of mental disorders from community studies conducted in European countries are presented to determine the availability and consistency of prevalence, disability and treatment findings for the EU. Using a stepwise multimethod approach, 27 eligible studies with quite variable designs and methods including over 150,000 subjects from 16 European countries were identified. Prevalence: On the basis of meta-analytic techniques as well as on reanalyses of selected data sets, it is estimated that about 27% (equals 82.7 million; 95% CI: 78.5-87.1) of the adult EU population, 18-65 of age, is or has been affected by at least one mental disorder in the past 12 months. Taking into account the considerable degree of comorbidity (about one third had more than one disorder), the most frequent disorders are anxiety disorders, depressive, somatoform and substance dependence disorders. When taking into account design, sampling and other methodological differences between studies, little evidence seems to exist for considerable cultural or country variation. Disability and treatment: despite very divergent and fairly crude assessment strategies, the available data consistently demonstrate (a) an association of all mental disorders with a considerable disability burden in terms of number of work days lost (WLD) and (b) generally low utilization and treatment rates. Only 26% of all cases had any consultation with professional health care services, a finding suggesting a considerable degree of unmet need. The paper highlights considerable future research needs for coordinated EU studies across all disorders and age groups. As prevalence estimates could not simply be equated with defined treatment needs, such studies should determine the degree of met and unmet needs for services by taking into account severity, disability and comorbidity. These needs are most pronounced for the new EU member states as well as more generally for adolescent and older populations.

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Comorbidity of common mental disorders with cancer and their treatment gap: findings from the World Mental Health Surveys: Cancer, mental health and treatment gap
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“It exceeds 50% worldwide, and it approaches 90% in the least resourced countries for common mental disorders [27–31].”
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“Higher MDE prevalences are also found when other European countries and studies are considered, especially in Northern and Eastern Europe (Bromet et al., 2005; Kringlen et al., 2001; Pirkola et al., 2005; Wittchen and Jacobi, 2005).”
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“Their 2004 study on ‘The Cost of Brain Disorders’ estimated that across 28 European countries (the EU plus Iceland, Norway and Switzerland) with a total population of 466 million, 127 million people or 27 per cent are affected by at least one brain disease and that the total cost of brain disorders amounted to 386 bil…”
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Comorbidity of Allergic and Autoimmune Diseases Among Patients With ADHD
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“…interest and concern since the 1980s, though with controversial results, because the increase in the prevalence of allergic diseases (i.e., atopic dermatitis [AD], asthma, and allergic rhinitis [AR]) has been matched by a worldwide increase in ADHD diagnoses (Belfer, 2008; Wittchen & Jacobi, 2005).”
Result
Pain associated with specific anxiety and depressive disorders in a nationally representative population sample
Beesdo‐Baum, K., Jacobi, F., Hoyer, J., Low, N. C. P., Höfler, M., & Wïttchen, H. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0045-1 · Cited by 116
Self-citation
Mapping Cortical and Subcortical Asymmetry in Obsessive-Compulsive Disorder: Findings From the ENIGMA Consortium
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“44. van den Heuvel OA, van Wingen G, Soriano-Mas C, Alonso P, Chamberlain SR, Nakamae T, et al. (2016): Brain circuitry of compulsivity.”
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“The total annual cost of brain disorders in Europe was estimated to €386 billion in 2004.”
BackgroundInfluential
Adult attachment and social anxiety: The mediating role of emotion regulation strategies
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“Background Depressive disorders affect about one fifth of the population over the life course [1,2] and are associated with impairments in daily functioning and work [3].”
Background
A systematic review of adult attachment and social anxiety
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“It is also associated with impairments to quality of life (Wittchen & Jacobi, 2005), romantic relationships (Sparrevohn & Rapee, 2009) and friendships (Davila & Beck, 2002).”
Background
Brain structural effects of treatments for depression and biomarkers of response: a systematic review of neuroimaging studies
Enneking, V., Leehr, E. J., Dannlowski, U., & Redlich, R. (2019) · Psychological Medicine · doi:10.1017/s0033291719003660 · Cited by 113
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“Major depressive disorder (MDD) is considered to be the most prevalent psychiatric disorder, with considerable functional and social impairment (Ustun et al., 2004; Wittchen and Jacobi, 2005).”
Background
Effects of pharmacotherapy and psychotherapy in depressed primary-care patients: a randomized, controlled trial including a patients' choice arm.
Hegerl, U., Hautzinger, M., Mergl, R., Kohnen, R., Schütze, M., Scheunemann, W., Allgaier, A., Coyne, J., & Henkel, V. (2010) · International Journal of Neuropsychopharmacology · doi:10.1017/s1461145709000224 · Cited by 120
Meta-analysis of BDNF Val66Met polymorphism association with treatment response in patients with major depressive disorder
Zou, Y.-F., Ye, D.-Q., Feng, X.-L., Su, H., Pan, F.-M., & Liao, F.-F. (2010) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2009.12.005 · Cited by 104
Prevalence of psychiatric disorders in sick listed chronic low back pain patients
Reme, S. E., Tangen, T., Moe, T., & Eriksen, H. R. (2011) · European Journal of Pain · doi:10.1016/j.ejpain.2011.04.012 · Cited by 104
“Similar rates were found in a review of epidemiological studies from 16 European countries, where a 12 months prevalence of 27% were reported (Wittchen and Jacobi, 2005).”
Result
Effect of 5‐HT1A gene polymorphisms on antidepressant response in major depressive disorder
Kato, M., Fukuda, T., Wakeno, M., Okugawa, G., Takekita, Y., Watanabe, S., Yamashita, M., Hosoi, Y., Azuma, J., Kinoshita, T., et al. (2008) · American Journal of Medical Genetics Part B Neuropsychiatric Genetics · doi:10.1002/ajmg.b.30783 · Cited by 106
Measurement equivalence of the CES-D 8 depression-scale among the ageing population in eleven European countries.
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“This leads to a disability burden corresponding to 25–30% of the total disability-adjusted life years (DALYs) lost in Europe (1).”
BackgroundInfluential
Gender Differences in Axis I and Axis II Comorbidity in Patients with Borderline Personality Disorder
Tadić, A., Wagner, S., Höch, J., Başkaya, Ö., von Cube, R., Skaletz, C., Lieb, K., & Dahmen, N. (2009) · Psychopathology · doi:10.1159/000224149 · Cited by 110
Galanin, Galanin Receptor Subtypes and Depression-Like Behaviour
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The societal cost of depression: Evidence from 10,000 Swedish patients in psychiatric care
Ekman, M., Granström, O., Omérov, S., Jacob, J., & Landén, M. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.03.003 · Cited by 101
“Although there is variability in the epidemiological literature, the 12-month prevalence in a number of relatively large studies varied from 2.1 to 10.1% (Wittchen and Jacobi, 2005).”
BackgroundInfluential
The design and methods of the mental health module in the German Health Interview and Examination Survey for Adults (DEGS1‐MH)
Jacobi, F., Mack, S., Gerschler, A., Scholl, L., Höfler, M., Siegert, J., Bürkner, A., Preiss, S., Spitzer, K., Busch, M. A., et al. (2013) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1387 · Cited by 103
Self-citation
Prevalence of distress, comorbid conditions and well being in the general population
Wiltink, J., Beutel, M. E., Till, Y., Ojeda, F., Wild, P. S., Münzel, T. F., Blankenberg, S., & Michal, M. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.10.041 · Cited by 108
“Depressive and panic disorders rank among the disorders with the strongest impact (Wittchen and Jacobi, 2005).”
BackgroundInfluential
Predictors of return to work in employees sick-listed with mental health problems: findings from a longitudinal study
Nielsen, M. B. D., Madsen, I. E. H., Bültmann, U., Christensen, U., Diderichsen, F., & Rugulies, R. (2010) · European Journal of Public Health · doi:10.1093/eurpub/ckq171 · Cited by 100
Use of Health Care Services by People With Mental Illness
Gäebel, W., Kowitz, S., Fritze, J., & Zielasek, J. (2013) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2013.0799 · Cited by 104
Lifetime comorbidity of obsessive-compulsive disorder and sub-threshold obsessive-compulsive symptomatology in the community: impact, prevalence, socio-demographic and clinical characteristics
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“Th e lifetime prevalence of these disorders is substantially greater in females than males (Wittchen and Jacobi 2005).”
Background
Problematic drug use and drug use disorders in EU countries and Norway: An overview of the epidemiology
Rehm, J. T., Room, R., van den Brinkt, W., & Kraus, L. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.004 · Cited by 100
Mind and heart: Heart rate variability in major depressive disorder and coronary heart disease - a review and recommendations
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“Comorbid anxiety is particularly common in people with depression (Clark et al., 1994) and occurs in about 30–40% of people with MDD between the ages of 18 and 65 years (Wittchen and Jacobi, 2005).”
Background
Professional Fields and Truth Regimes: In Search of Alternative Approaches
Brante, T. (2010) · Comparative Sociology · doi:10.1163/156913310x522615 · Cited by 97
Traumatic Experiences and Posttraumatic Stress Disorder in Soldiers Following Deployment Abroad
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Perceived social support helps, but does not buffer the negative impact of anxiety disorders on quality of life and perceived stress
Panayiotou, G., & Karekla, M. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-012-0533-6 · Cited by 80
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A Cross-Cultural Study in Germany, Russia, and China: Are Resilient and Social Supported Students Protected Against Depression, Anxiety, and Stress?
Brailovskaia, J., Schönfeld, P., Zhang, X. C., Bieda, A., Kochetkov, Y., & Margraf, J. (2017) · Psychological Reports · doi:10.1177/0033294117727745 · Cited by 112
“Therefore, depression and anxiety disorders belong to the most prevalent diagnoses (Trumpf et al., 2010; Wittchen & Jacobi, 2005).”
Background
Barriers in the mind: promoting an economic case for mental health in low‐ and middle‐income countries
McDaid, D., Knapp, M. R. J., & Raja, S. (2008) · World Psychiatry · doi:10.1002/j.2051-5545.2008.tb00160.x · Cited by 93
Serotonin norepinephrine reuptake inhibitors (SNRIs) in anxiety disorders: a comprehensive review of their clinical efficacy
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Authors: Wittchen, H.-U., & Jacobi, F.
Affiliations: Max Planck Institute of Psychiatry (DE)
ORCID: Jacobi, Frank
Venue: European Neuropsychopharmacology
Publisher: Elsevier BV
Published: 2005-08
Volume: 15
Issue: 4
Pages: 357-376
ISSN: 0924-977X (ISSN-L)
DOI: 10.1016/j.euroneuro.2005.04.012
OpenAlex: W2107900025
Cited by: 1,503
References: 140
Citations by year: 2026: 14 · 2025: 31 · 2024: 43 · 2023: 64 · 2022: 48 · 2021: 46 · 2020: 57 · 2019: 58 · 2018: 64 · 2017: 75 · 2016: 83 · 2015: 84 · 2014: 103 · 2013: 110 · 2012: 121
FWCI: 96.18
Type: journal article
Language: en
Open access: green
tud.qucosa.de
Licence: other-oa
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: European Neuropsychopharmacology (publishedVersion)
PubMed (publishedVersion)
Max Planck Institute for Plasma Physics (submittedVersion)
Qucosa (Saxon State and University Library Dresden) (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health and Medical Studies
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords: mental illness, prevalence, disability burden, treatment utilization, unmet needs, comorbidities, anxiety disorders, depression, somatoform disorders, substance dependence, lost workdays, European Union, cross-national comparison, adolescent mental health, older adults
MeSH terms: Absenteeism, Adolescent, Adult, Age Factors, Aged, Mental Disorders, Disability Evaluation, Europe, Female, Humans, Male, Mental Health Services, Middle Aged, Quality of Life, Residence Characteristics, Review Literature as Topic, Sex Factors, Comorbidity, Prevalence, Cost of Illness, Diagnosis, Dual (Psychiatry), Quality-Adjusted Life Years

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Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies

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