Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys
Open accessAbstract
Background: Burden-of-illness data, which are often used in setting healthcare policy-spending priorities, are unavailable for mental disorders in most countries. Aims: To examine one central aspect of illness burden, the association of serious mental illness with earnings, in the World Health Organization (WHO) World Mental Health (WMH) Surveys. Method: The WMH Surveys were carried out in 10 high-income and 9 low- and middle-income countries. The associations of personal earnings with serious mental illness were estimated. Results: Respondents with serious mental illness earned on average a third less than median earnings, with no significant between-country differences (χ 2(9) = 5.5–8.1, P = 0.52–0.79). These losses are equivalent to 0.3–0.8% of total national earnings. Reduced earnings among those with earnings and the increased probability of not earning are both important components of these associations. Conclusions: These results add to a growing body of evidence that mental disorders have high societal costs. Decisions about healthcare resource allocation should take these costs into consideration.
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Among people occupying social and productive roles, major depressive disorder predicts substantial declines in role functioning, including poorer marital quality, lower work performance, and lower earnings.
“Among people with specific social and productive roles, MDD is found to predict significant decrements in role functioning (e.g., low marital quality, low work performance, low earnings).”
From The Costs of Depression (2012) · cites this paper as [70]
Personal earnings and household income of people with major depressive disorder are substantially lower than those without depression, but it is unclear whether depression is primarily a cause, consequence, or both because of reciprocal causation; previous studies have not controlled for reciprocal effects, making the size of adverse effects uncertain; childhood-adolescence depression predicts
“One of most striking aspects of the impairment associated with MDD is that the personal earnings and household income of people with MDD are substantially lower than those of people without depression.68–73 However, it is unclear whether depression is primariry a cause, consequence, or both in these associations due to the possibility of reciprocal causation between income-earnings and MDD.74”
From The Costs of Depression (2012) · cites this paper as [70]
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- Authors
- Levinson, D., Lakoma, M. D., Petukhova, M., Schoenbaum, M., Zaslavsky, A. M., Angermeyer, M., Borges, G., Bruffaerts, R., de Girolamo, G., de Graaf, R., Gureje, O., Haro, J. M., Hu, C., Karam, A. N., Kawakami, N., Lee, S., Lepine, J.-P., Browne, M. O., Okoliyski, M., Posada-Villa, J., Sagar, R., Viana, M. C., Williams, D. R., & Kessler, R. C.
- Affiliations
- Israel Ministry of Health (IL)
- Harvard University (US)
- National Institute of Mental Health (US)
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
- KU Leuven (BE)
- University of Ibadan (NG)
- Centro de Investigación Biomédica en Red de Salud Mental (ES)
- The University of Tokyo (JP)
- Chinese University of Hong Kong (HK)
- All India Institute of Medical Sciences (IN)
- Corresponding author
- Kessler, Ronald C.
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2010-08
- Volume
- 197
- Issue
- 2
- Pages
- 114-121
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC2913273
- OpenAlex
- W2111980323
- Cited by
- 211
- References
- 46
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 8 · 2023: 12 · 2022: 11 · 2021: 25 · 2020: 11 · 2019: 12 · 2018: 6 · 2017: 47 · 2016: 7 · 2015: 5 · 2014: 9 · 2013: 14 · 2012: 12
- FWCI
- 14.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Scientific Electronic Library Online (São Paulo Research Foundation, Latin American and Caribbean Center on Health Sciences Information, Conselho Nacional de Desenvolvimento Científico e Tecnológico) (publishedVersion)
- eCite Digital Repository (University of Tasmania) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- John D. and Catherine T. MacArthur Foundation (R01 DA016558, R13-MH066849)
- John W. Alden Trust (R01-MH069864, R13-MH066849)
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- Sanofi
- World Health Organization
- European Commission (1999-01042, QLG5–1999-01042, SANCO2004123, 2004123)
- Fundação de Amparo à Pesquisa do Estado de São Paulo (03/00204-3, 03/00204?)
- Generalitat de Catalunya (01042, RETICS RD06/0011 REM-TAP, CB06/02/0046)
- Bundesministerium für Gesundheit
- National Insurance Institute of Israel (H13-SHOGAI-023, H16-KOKORO-013, H14-TOKUBETSU-026)
- Ministry of Health, Labour and Welfare (H16-KOKORO-013, H14-TOKUBETSU-026, H13-SHOGAI-023)
- Shire
- Jawaharlal Institute Of Postgraduate Medical Education and Research
- Regione Piemonte
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Substance Abuse and Mental Health Services Administration (044708)
- Pfizer Foundation (R01‐MH069864, R01-DA016558, R13-MH066849, R03-TW006481)
- Pan American Health Organization (FIRCA R03-TW006481)
- Instituto de Salud Carlos III (CB06/02/0046, RETICS RD06/0011 REM-TAP, RETICS RD06/0011, RD06/0011, CIBER CB06/02/0046)
- Departament de Salut, Generalitat de Catalunya (CB06/02/0046, RETICS RD06/0011 REM-TAP)
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, U01-MH-60220, R01MH059575, MH60220, HHSN271200700030C, MH069864, U13MH066849, MH066849, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558, U01-MH60220)
- Fogarty International Center (FIRCA R03TW006481, R03TW006481)
- Cilag
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- severe mental illness, earnings, economic burden of mental disorders, disease burden, unemployment, income loss, healthcare resource allocation, low- and middle-income countries
- MeSH terms
- Adolescent, Adult, Mental Disorders, Employment, Health Surveys, Humans, Income, Middle Aged, Regression Analysis, Risk Factors, Severity of Illness Index, Global Health, World Health Organization, Cost of Illness, Age Distribution, Sex Distribution, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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