Mental disorders impair economic success in developed countries

(Press-News.org) Philadelphia, PA, July 31, 2012 – Mental disorders that emerge in childhood and adolescence, including attention-deficit disorder, depression, anxiety and substance abuse, constitute significant challenges to cognitive, emotional, and social development. As a result, it is perhaps not surprising that earnings and income are substantially reduced among people diagnosed with mental disorders.

Is the association between mental disorders and earnings a correlation, or is low income a consequence of a disorder? Are mental disorders universally associated with reduced economic/social class or does economic standing reflect a complex interplay of individual capacities and societal demands? Answers to these questions have been unclear until now.

A group of researchers used the World Health Organization World Mental Health Surveys to specifically examine the association between early-onset mental disorders and adult household income. These surveys collected information on income earnings, employment status, education, and demographics. In addition, interviews were conducted to diagnose 15 different mental disorders among participants.

Restricting the surveys to individuals aged 18 to 64 who were neither students nor retired, data was available from 37,741 respondents in 22 different countries. The countries were classified by their income level, with 11 high income, five upper-middle income, and six low/lower-middle income.

They found that early-onset mental disorders are associated with significantly reduced household income in high and upper-middle income countries but not low/lower-middle income countries. These associations were consistently stronger among women than men. These data make clear that the disability associated with mental disorders is more clearly evident in the most economically developed countries.

"These new data suggest that the increased demands of economically advanced societies 'unmask' functional deficits that are not evident when the same problems emerge in less developed societies," commented Dr. John Krystal, Editor of Biological Psychiatry. "These important data highlight the importance of understanding how adaptation breaks down in our society so that rehabilitative and pharmacologic strategies might be developed to help affected individuals adapt."

These results indicate that the capacity of disordered individuals to cope with the demands placed on citizens in economically advanced countries is compromised. This would suggest that policy makers should consider the societal effects of such reduced income when making health care and resource allocation decisions.

Dr. Norito Kawakami, Chair of the Department of Mental Health in the School of Public Health at the University of Tokyo, Japan, and the study's lead author, noted that "health policy makers often fail to appreciate the enormous human capital costs associated with untreated early-onset mental disorders."

"As a result," says Kawakami, "investments in early interventions for childhood-onset mental disorders are woefully inadequate."

Dr. Ronald Kessler, from Harvard Medical School and another of the study's authors, noted that "the amount of lost adult income associated with early-onset mental disorders is so great that the costs of implementing early interventions for these disorders would be more than paid back even if they led to only a small proportional decrease in this lost adult income."

### The article is "Early-Life Mental Disorders and Adult Household Income in the World Mental Health Surveys" by Norito Kawakami, Emad Abdulrazaq Abdulghani, Jordi Alonso, Evelyn J. Bromet, Ronny Bruffaerts, José Miguel Caldas-de-Almeida, Wai Tat Chiu, Giovanni de Girolamo, Ron de Graaf, John Fayyad, Finola Ferry, Silvia Florescu, Oye Gureje, Chiyi Hu, Matthew D. Lakoma, William LeBlanc, Sing Lee, Daphna Levinson, Savita Malhotra, Herbert Matschinger, Maria Elena Medina-Mora, Yosikazu Nakamura, Mark A. Oakley Browne, Michail Okoliyski, Jose Posada-Villa, Nancy A. Sampson, Maria Carmen Viana, and Ronald C. Kessler (doi: 10.1016/j.biopsych.2012.03.009). The article appears in Biological Psychiatry, Volume 72, Issue 3 (August 1, 2012), published by Elsevier.

Notes for editors Full text of the article is available to credentialed journalists upon request; contact Rhiannon Bugno at +1 214 648 0880 or Biol.Psych@utsouthwestern.edu. To schedule an interview, contact:

Ronald C. Kessler, Ph.D.
Harvard Medical School
Phone: +1 617 432 3587
Email: kessler@hcp.med.harvard.edu

Journalists wishing to obtain comment from additional, independent experts may contact:

David Satcher, M.D., Ph.D.
Morehouse School of Medicine
Phone: +1 404 752 8654
Email: dsatcher@msm.edu

Philip S. Wang, M.D., Dr.P.H.
National Institute of Mental Health
Phone: +1 301 443 3673
Email: Philip.WangNIMH@mail.nih.gov

The authors' affiliations, and disclosures of financial and conflicts of interests are available in the article.

John H. Krystal, M.D., is Chairman of the Department of Psychiatry at the Yale University School of Medicine and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial and conflicts of interests are available here.

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Media contact Rhiannon Bugno
Editorial Office, Biological Psychiatry
+1 214 648 0880
biol.psych@utsouthwestern.edu