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Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies
Open accessAbstract
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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“in line with the higher prevalence of women who make use of mental healthcare services”
From Patients requesting and receiving euthanasia for psychiatric disorders in the Netherlands (2023) · cites this paper as [12]
In the citing paper
“In Europe, only about 25% of people with mental disorders receive professional treatment (Wittchen and Jacobi, 2005).”
From Feasibility of a Software agent providing a brief Intervention for Self-help to Uplift psychological wellbeing (“SISU”). A single-group pretest-posttest trial investigating the potential of SISU to act as therapeutic agent (2021) · cites this paper as Wittchen and Jacobi, 2005
In the citing paper
“It is the case that many with anxiety disorders have no diagnosis nor seek treatment [29,30].”
From Low-intensity internet-delivered treatment for generalized anxiety symptoms in routine care: protocol for a randomized controlled trial (2014) · cites this paper as [30]
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Greenberg, P. E., Sisitsky, T., Kessler, R. C., Finkelstein, S. N., Berndt, E. R., Davidson, J. R. T., Ballenger, J. C., & Fyer, A. J. (1999) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v60n0702 · Cited by 1,242 · cited 1×
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BackgroundMethodCost of disorders of the brain in Europe
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“Overall, the table indicates that some countries have been more active than others, e.g. Germany (6 studies), The Netherlands (4 studies) and the UK (5 studies).”
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“…of these individual studies have already been critically reviewed elsewhere, for example in the context of international diagnosis-specific reviews (Andrade et al., 2000, 2003; Bijl et al., 2003; Coulter andMagee, 2003; Fryers et al., 2004; Kessler, 2004; Sartorius et al., 1993; Vega et al., 2002;…”
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The US National Comorbidity Survey Replication (NCS‐R): design and field procedures
Kessler, R. C., Berglund, P. A., Chiu, W. T., Demler, O., Heeringa, S. G., Hiripi, E., Jin, R., Pennell, B., Walters, E. E., Zaslavsky, A. M., et al. (2004) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.167 · Cited by 858 · cited 1×
“(6) Unlike the long US tradition of fairly regular, large-scale community and general population studies with uniform methods and designs (i.e. ECA, Robins and Regier, 1991; NCS, Kessler et al., 1994; NCS-R, Kessler et al., 2004), there is no such tradition yet in the EU.”
BackgroundPrevalence of mental disorders and psychosocial impairments in adolescents and young adults
WITTCHEN, H.-U., NELSON, C. B., & LACHNER, G. (1998) · Psychological Medicine · doi:10.1017/s0033291797005928 · Cited by 821 · cited 2×
“The most frequently used diagnostic instrument (16 out of 27) across all studies is the Composite International Diagnostic Interview (CIDI; WHO, 1978; Wittchen, 1994; Wittchen et al., 1998a) or variants thereof (DIS, DISSI, MCIDI; Wittchen et al., 2001).”
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Narrow, W. E., Rae, D. S., Robins, L. N., & Regier, D. A. (2002) · Archives of General Psychiatry · doi:10.1001/archpsyc.59.2.115 · Cited by 807 · cited 1×
“Such data have not only muchdisputed major public health and policy implications (Narrow et al., 2002; Kessler et al., 2003), but are also essential for estimating the cost burden.”
BackgroundSize of burden of schizophrenia and psychotic disorders
Wulf Rössler, A., Salize, H. J., van Os, J., & Riecher‐Rössler, A. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.009 · Cited by 776 · cited 2×
“Beyond these core findings (for disorder specific details see Berr et al., 2005; Fehm et al., 2005; Goodwin et al., 2005; Lieb et al., 2005; Paykel et al., 2005; Pini et al., 2005; Rehm et al., 2005a,b; Rössler et al., 2005; Von Campenhausen et al., 2005) and our attempt to estimate the size and burden with greater pr…”
ResultComorbidity of substance use disorders with mood and anxiety disorders
Merikangas, K. R., Mehta, R. L., Molnar, B. E., Walters, E. E., Swendsen, J. D., Aguilar‐Gaxiola, S., Bijl, R. V., Borges, G. L. G., Caraveo-Anduaga, J. J., DeWit, D. J., et al. (1998) · Addictive Behaviors · doi:10.1016/s0306-4603(98)00076-8 · Cited by 747 · cited 2×
“(4) Quantitatively and in accordance with most other recent international comparison studies (i.e. Andrade et al., 2000; Merikangas et al., 1998; Weissman et al., 1996, 1997; Wittchen, 1994), anxiety disorders rank as the most frequent (12-month prevalence median: 12%; 36.”
ResultInfluentialGeneralized anxiety disorder: prevalence, burden, and cost to society
Wittchen, H.-U. (2002) · Depression and Anxiety · doi:10.1002/da.10065 · Cited by 733
The impact of psychiatric disorders on work loss days
Kessler, R. C., & Frank, R. G. (1997) · Psychological Medicine · doi:10.1017/s0033291797004807 · Cited by 716 · cited 4×
“Consistent with numerous earlier studies for specific diagnoses (Bijl and Ravelli, 2000a; Jacobi et al., 2004b; Greenberg et al., 1996, 1999; Kessler and Frank, 1997; Rice and Miller, 1998; Spijker et al., 2004; Wittchen, 2002) and expert-based WHO projections (i.e. Murray and Lopez, 1996; Olesen…”
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The Cross National Epidemiology of obsessive-compulsive disorder
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Wittchen, H.-U., Lachner, G., Wunderlich, U., & Pfister, H. (1998) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s001270050095 · Cited by 668 · cited 2×
“The most frequently used diagnostic instrument (16 out of 27) across all studies is the Composite International Diagnostic Interview (CIDI; WHO, 1978; Wittchen, 1994; Wittchen et al., 1998a) or variants thereof (DIS, DISSI, MCIDI; Wittchen et al., 2001).”
BackgroundMethodGender differences in depression
Angst, J., Gamma, A., Gastpar, M., L�pine, J.-P., Mendlewicz, J., & Tylee, A. (2002) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-002-0381-6 · Cited by 629
Mental Illness in the Community: The Pathway to Psychiatric Care.
Higgins, A. C., Goldberg, D. P., & Huxley, P. J. (1982) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2068429 · Cited by 627
Prevalence and incidence of Parkinson's disease in Europe
von Campenhausen, S., Bornschein, B., Wick, R., Bötzel, K., Sampaio, C., Poewe, W. H., Oertel, W. H., Siebert, U., Berger, K., & Dodel, R. C. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.007 · Cited by 624 · cited 2×
“…Fehm et al., 2005; Goodwin et al., 2005; Lieb et al., 2005; Paykel et al., 2005; Pini et al., 2005; Rehm et al., 2005a,b; Rössler et al., 2005; Von Campenhausen et al., 2005) and our attempt to estimate the size and burden with greater precision and validation than was done in the past, our…”
ResultMENTAL ILLNESS IN THE COMMUNITY: THE PATHWAY TO PSYCHIATRIC CARE
Hannay, D. (1981) · PubMed Central · Cited by 598
A Norwegian Psychiatric Epidemiological Study
Kringlen, E., Torgersen, S. O., & Cramer, V. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.7.1091 · Cited by 594
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Depressive disorders in Europe: prevalence figures from the ODIN study
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International Classification of Diseases, 10th Revision
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Lépine, J., Gastpar, M., Mendlewicz, J., & Tylee, A. (1997) · International Clinical Psychopharmacology · doi:10.1097/00004850-199701000-00003 · Cited by 483
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Weissman, M. M. (1996) · JAMA · doi:10.1001/jama.276.4.293 · Cited by 452
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The Cross-national Epidemiology of Panic Disorder
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“…in the context of international diagnosis-specific reviews (Andrade et al., 2000, 2003; Bijl et al., 2003; Coulter andMagee, 2003; Fryers et al., 2004; Kessler, 2004; Sartorius et al., 1993; Vega et al., 2002; Weissman et al., 1992, 1994, 1996, 1997, 1999; Wittchen et al., 2003; Wittchen, 2004).”
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Size and burden of social phobia in Europe
Fehm, L., Pélissolo, A., Furmark, T., & Wïttchen, H. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.002 · Cited by 413 · cited 3×
“This is because of the critical combination of their high prevalence, the associated impairments and disabilities, the frequent early onset as early as in childhood or adolescence and the substantial degree of persistence and comorbidity over the life-span (Fehm et al., 2005).”
BackgroundResultThe Changing Rate of Major Depression
Weissman, M. M. (1992) · JAMA · doi:10.1001/jama.1992.03490210080039 · Cited by 410
OECD factbook, 2005: economic, environmental and social statistics
(2005) · Choice Reviews Online · doi:10.5860/choice.43-0688 · Cited by 383
Prevalence and burden of bipolar disorders in European countries
Pini, S., de Queiroz, V., Pagnin, D., Pezawas, L., Angst, J., Cassano, G. B., & Wïttchen, H. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.011 · Cited by 375 · cited 2×
“Beyond these core findings (for disorder specific details see Berr et al., 2005; Fehm et al., 2005; Goodwin et al., 2005; Lieb et al., 2005; Paykel et al., 2005; Pini et al., 2005; Rehm et al., 2005a,b; Rössler et al., 2005; Von Campenhausen et al., 2005) and our attempt to estimate the size and burden with greater pr…”
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“…of the six-country study ESEMeD/MHEDEA 2000 (2004c) provides, however, some benchmark data, that appear by and large consistent with several individual national and regional studies (Bijl and Ravelli, 2000b; Bijl et al., 2003; Jacobi et al., 2004a,b; ten Have et al., 2004; Wittchen, 2000).”
BackgroundResultMild Disorders Should Not Be Eliminated From the DSM-V
Kessler, R. C., Merikangas, K. R., Berglund, P., Eaton, W. W., Koretz, D. S., & Walters, E. E. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.11.1117 · Cited by 348 · cited 1×
“Such data have not only muchdisputed major public health and policy implications (Narrow et al., 2002; Kessler et al., 2003), but are also essential for estimating the cost burden.”
BackgroundThe epidemiology of generalized anxiety disorder
Kessler, R. C., Keller, M. B., & Wittchen, H.-U. (2001) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(05)70204-5 · Cited by 337
The Prevalence Of Treated And Untreated Mental Disorders In Five Countries
Bijl, R. V., de Graaf, R., Hiripi, E., Kessler, R. C., Kohn, R., Offord, D. R., Üstün, T. B., Vicente, B., Vollebergh, W., Walters, E. E., et al. (2003) · Health Affairs · doi:10.1377/hlthaff.22.3.122 · Cited by 332 · cited 8×
“Some of these individual studies have already been critically reviewed elsewhere, for example in the context of international diagnosis-specific reviews (Andrade et al., 2000, 2003; Bijl et al., 2003; Coulter andMagee, 2003; Fryers et al., 2004; Kessler, 2004; Sartorius et al., 1993; Vega et al., 2002; Weissman et al.…”
BackgroundResultInfluentialAn International Study of Psychological Problems in Primary Care
Sartorius, N. (1993) · Archives of General Psychiatry · doi:10.1001/archpsyc.1993.01820220075008 · Cited by 321 · cited 2×
“…in the context of international diagnosis-specific reviews (Andrade et al., 2000, 2003; Bijl et al., 2003; Coulter andMagee, 2003; Fryers et al., 2004; Kessler, 2004; Sartorius et al., 1993; Vega et al., 2002; Weissman et al., 1992, 1994, 1996, 1997, 1999; Wittchen et al., 2003; Wittchen, 2004).”
BackgroundObsessive-compulsive severity spectrum in the community: prevalence, comorbidity, and course
Angst, J., Gamma, A., Endrass, J., Goodwin, R. D., Ajdacic‐Gross, V., Eich, D., & Wulf Rössler, A. (2004) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-004-0459-4 · Cited by 279
Size and burden of depressive disorders in Europe
Paykel, E. S., Brugha, T. S., & Fryers, T. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.008 · Cited by 272 · cited 2×
“Beyond these core findings (for disorder specific details see Berr et al., 2005; Fehm et al., 2005; Goodwin et al., 2005; Lieb et al., 2005; Paykel et al., 2005; Pini et al., 2005; Rehm et al., 2005a,b; Rössler et al., 2005; Von Campenhausen et al., 2005) and our attempt to estimate the size and burden with greater pr…”
BackgroundResultThe burden of brain diseases in Europe
Olesen, J., & Leonardi, M. (2003) · European Journal of Neurology · doi:10.1046/j.1468-1331.2003.00682.x · Cited by 269 · cited 6×
“The lack of such EU-wide information is also a core obstacle to the adequate estimation of (a) the total burden associated with these disorders (Olesen and Leonardi, 2003), (b) the degree of met and unmet needs for treatment and intervention, (c) the patterns and costs of treatment and (d) the…”
BackgroundMethodInfluentialBIJL, R. V., & RAVELLI, A. (2000) · Psychological Medicine · doi:10.1017/s0033291799001841 · Cited by 265 · cited 3×
“…of the six-country study ESEMeD/MHEDEA 2000 (2004c) provides, however, some benchmark data, that appear by and large consistent with several individual national and regional studies (Bijl and Ravelli, 2000b; Bijl et al., 2003; Jacobi et al., 2004a,b; ten Have et al., 2004; Wittchen, 2000).”
BackgroundResultHealth economics and cost implications of anxiety and other mental disorders in the United States
Rice, D. P., & Miller, L. S. (1998) · The British Journal of Psychiatry · doi:10.1192/s0007125000293458 · Cited by 261 · cited 2×
“Consistent with numerous earlier studies for specific diagnoses (Bijl and Ravelli, 2000a; Jacobi et al., 2004b; Greenberg et al., 1996, 1999; Kessler and Frank, 1997; Rice and Miller, 1998; Spijker et al., 2004; Wittchen, 2002) and expert-based WHO projections (i.”
BackgroundResultAngst, J., Dobler-Mikola, A., & Binder, J. (1984) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/bf00432878 · Cited by 260
Prevalence of major depression and stress indicators in the Danish general population
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The epidemiology of panic disorder and agoraphobia in Europe
Goodwin, R. D., Faravelli, C., Rosi, S., Cosci, F., Truglia, E., de Graaf, R., & Wïttchen, H. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.006 · Cited by 255 · cited 2×
“Beyond these core findings (for disorder specific details see Berr et al., 2005; Fehm et al., 2005; Goodwin et al., 2005; Lieb et al., 2005; Paykel et al., 2005; Pini et al., 2005; Rehm et al., 2005a,b; Rössler et al., 2005; Von Campenhausen et al., 2005) and our attempt to estimate the size and burden with greater pr…”
BackgroundResultThe epidemiology of generalized anxiety disorder in Europe
Lieb, R., Becker, E. S., & Altamura, C. A. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.010 · Cited by 247 · cited 2×
“Beyond these core findings (for disorder specific details see Berr et al., 2005; Fehm et al., 2005; Goodwin et al., 2005; Lieb et al., 2005; Paykel et al., 2005; Pini et al., 2005; Rehm et al., 2005a,b; Rössler et al., 2005; Von Campenhausen et al., 2005) and our attempt to estimate the size and burden with greater pr…”
BackgroundResultPrevalence of dementia in the elderly in Europe
Berr, C., Wancata, J., & Ritchie, K. A. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.003 · Cited by 241 · cited 1×
“Beyond these core findings (for disorder specific details see Berr et al., 2005; Fehm et al., 2005; Goodwin et al., 2005; Lieb et al., 2005; Paykel et al., 2005; Pini et al., 2005; Rehm et al., 2005a,b; Rössler et al., 2005; Von Campenhausen et al., 2005) and our attempt to estimate the size and…”
BackgroundThe prevalence of major depressive and bipolar disorders in Hungary
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“…in the context of international diagnosis-specific reviews (Andrade et al., 2000, 2003; Bijl et al., 2003; Coulter andMagee, 2003; Fryers et al., 2004; Kessler, 2004; Sartorius et al., 1993; Vega et al., 2002; Weissman et al., 1992, 1994, 1996, 1997, 1999; Wittchen et al., 2003; Wittchen, 2004).”
BackgroundThe European Patient Of The Future
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“Wittchen, F. Jacobi / European Neuropsychopharmacology 15 (2005) 357–376 358”
BackgroundAlcohol use disorders in EU countries and Norway: An overview of the epidemiology
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“In interpreting this finding, it should be noted that this disorder is considerably more frequent (2–4 times) in adolescents and young adults (up to age 30), but rare in older persons; in addition, it remains unclear whether dependence of prescribed sedatives or other drugs has been assessed with sufficient integrity…”
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OECD Factbook 2005: Economic, Environmental and Social Statistics
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“…in the ESEMeD project (ESEMeD/MHEDEA 2000 Investigators, 2002), the Mental Health Supplement of the German National Health Interview and Examination Survey (GHSMHS; Jacobi et al., 2002; Wittchen et al., 2000), and a study from Norway (OsLof study, unpublished data provided by I. Sandanger).”
BackgroundSelf-citationSpijker, J., de Graaf, R., Bijl, R. V., Beekman, A. T. F., Ormel, J., & Nolen, W. A. (2004) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2004.00335.x · Cited by 158 · cited 2×
“…for specific diagnoses (Bijl and Ravelli, 2000a; Jacobi et al., 2004b; Greenberg et al., 1996, 1999; Kessler and Frank, 1997; Rice and Miller, 1998; Spijker et al., 2004; Wittchen, 2002) and expert-based WHO projections (i.e. Murray and Lopez, 1996; Olesen and Leonardi, 2003), there is thus little…”
BackgroundResultThe National Psychiatric Morbidity Surveys of Great Britain – strategy and methods
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“…is considerably more frequent (2–4 times) in adolescents and young adults (up to age 30), but rare in older persons; in addition, it remains unclear whether dependence of prescribed sedatives or other drugs has been assessed with sufficient integrity in the surveys covered (Rehm et al., 2005).”
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“…of the six-country study ESEMeD/MHEDEA 2000 (2004c) provides, however, some benchmark data, that appear by and large consistent with several individual national and regional studies (Bijl and Ravelli, 2000b; Bijl et al., 2003; Jacobi et al., 2004a,b; ten Have et al., 2004; Wittchen, 2000).”
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The size and burden of mental disorders and other disorders of the brain in Europe 2010
Wittchen, H. U., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jönsson, B., Olesen, J., Allgulander, C., Alonso, J., Faravelli, C., et al. (2011) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2011.07.018 · Cited by 3,754
“…conducted by the coordinating center with a restricted set of mental health disorders reported in Table 1, to estimate comorbidity rates, treatment rates, age and gender effects by diagnoses, and to provide an overall estimate of having any disorder (for details, see Wittchen and Jacobi, 2005).”
BackgroundMethodInfluentialSelf-citationClement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. S. L., & Thornicroft, G. (2015) · Psychological Medicine · doi:10.1017/s0033291714000129 · Cited by 3,152
The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013
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Metadata
- 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)
- 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
- 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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