Depression cited as the top cause of medical disability

The disease takes a toll, not just personally but economically, reports a U.S. mental health expert.

By Susan J. Landers — Posted April 2, 2007

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Thomas Insel, MD, director of the National Institute of Mental Health, attended the annual meeting of the World Economic Forum in Davos, Switzerland, in late January, where he caused a stir with a presentation on the high cost of depression.

He recently spoke with AMNews about his remarks.

Question: How big a burden is depression?

Answer: It's the leading source of nonfatal medical disability among people ages 15 to 44 in developed countries like the U.S. and Canada. It is the leading cause by far. Nothing else is even close. In the whole world it is the second or third greatest cause of disability. It costs the United States $53 billion annually in direct treatment costs, mortality and lost productivity.

Q: How are those figures arrived at?

A: You can calculate it in one of two ways: either as a source of disability for people in that age bracket, 15 to 44, or, the way the World Health Organization likes to do it, with a DALY, or disability-adjusted life years. That's the years lost to disability.

Q: It seems a surprisingly high figure.

A: Yes. It doesn't comport with what most of us would think about if we thought about the big killers: heart disease, cancer and stroke. Those are the three big killers, but they aren't the ones that cause the most disability. They cause mortality.

Disability is caused by chronic illness, and that's depression. There are a lot of chronic illnesses, Alzheimer's disease and osteoarthritis are chronic illnesses. But what makes depression different from the others is that it's common and it starts early in life. So most people with depression have symptoms in their 20s and even in their teens, meaning that in terms of disability you have a perfect storm -- chronic illness and a disabling condition that starts early.

Q: Did you intend to elevate the profile of depression with your presentation?

A: The hope was that in a place like the World Economic Forum you add items to the agenda so people recognize problems they might not have been aware of. The forum has been focused on AIDS and on climate change and the problems of Africa and underdeveloped nations. We thought it would be important to note that there are other issues, like depression, that have been less recognized yet have a significant global impact.

Q: What was your reception there?

A: It was surprising. It was a sell-out crowd. I didn't think many people would show up -- unless they thought I was talking about an economic depression and not a medical one. There was a surprising amount of interest in the topic that wasn't there before.

One of the questions in our session was from a person who runs the U.S. Postal Service. He said that according to the data I was presenting, 50,000 of his employees will be depressed each year. He asked, 'What should I do for them?' That's the kind of recognition we are looking for. That people begin to realize that this has an effect on the marketplace. Aside from its emotional cost, depression has a very significant financial cost. And we have numbers that show what it costs and ways of demonstrating the economic benefits of treatment.

Q: What did you tell the person from the postal service?

A: I said it was worth paying for treatment. The best evidence-based treatments would cost him more than he is now spending but he would make that all back in the second year. If he looks at a five-year overview of what it means to treat 50,000 people, there's no question that he comes out way, way ahead. So it is economically a good idea to treat this rather than to ignore it and have people who are more prone to accidents or don't show up for work or who show up for work and can't perform.

This isn't new information. The figures are from the 2002 WHO report on the global burden of disease. But it is underrecognized. And unlike many other forms of disability, this is treatable. We don't have cures, but we do have good treatments in the form of medications and behavioral interventions like cognitive therapy. What's most astonishing is that even in the presence of highly effective treatments, this is still a disabling illness.

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Disability toll

Depression is a major cause of disability among people 15 to 44 years old living in the industrialized nations of North America, Europe and Asia, a World Health Organization report found. WHO attributed the percentages of the total number of years lost to disabilities from mental health or behavioral conditions as follows:

Unipolar depression 24%
Alcohol use 14%
Drug use 5%
Bipolar disorder 5%
Schizophrenia 4%
Panic disorder 2%

Note: Percentages do not include physical illnesses.

Source: "The Global Burden of Disease in 2002," The World Health Organization, December 2003

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External links

"Global Burden of Disease, 2002: data sources, methods and results," World Health Organization, December 2003 (revised February 2004), in pdf (link)

World Economic Forum (link)

National Institute of Mental Health on depression (link)

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