The State of Mental Health in the European Union
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EUROPEAN COMMISSION The State of Mental Health in the European Union The State of Mental Health in the European Union EUROPEAN COMMISSION Neither the European Commission nor any person acting on its behalf is responsible for any use that might be made of the following information. The information contained in this publication does not necessarily reflect the opinion or the position of the European Commission. Reproduction is authorised, except for commercial purposes, provided the source is acknowledged Europe Direct is a service to help you find answers to your questions about the European Union New freephone number: 00 800 6 7 8 9 10 11 A great deal of additional information on the European Union is available on the Internet. It can be accessed through the Europa server (http://europa.eu.int). ISBN 92-894-8320-2 © European Communities, 2004 Photo cover page: © European Communities, reproduction authorised until 2012, provided the source is acknowledged. Printed by the services of the European Commission THE STATE OF MENTAL HEALTH IN THE EUROPEAN UNION Contents List of contributors 5 Executive summary 6 1 Introduction 8 1.1 Mental health and mental illness 8 1.2 Burden of mental illness 9 1.3 Why publish a European report on mental health? 10 2 Comparing mental health in Europe 12 2.1 Context of mental health in Europe 12 2.2 Methodology for comparing mental health in Europe 15 3 Mental health status in Europe 20 3.1 Positive mental health 20 3.2 Negative mental health: psychological distress 20 and psychiatric disorders 3.3 Suicide 25 3.4 Alcohol, tobacco and drug related problems 28 4Protective and risk factors 34 4.1 Gender and mental health 34 4.2 Age and mental health 38 4.3 Marital status 43 4.4 Social factors - poverty, unemployment and deprivation 44 4.5 Rural-urban differences in mental health 48 4.6 Migration and mental health 51 5 Responses to mental health problems across Europe 54 5.1 General description 54 5.2 Psychiatric inpatient care 54 5.3 Community services, facilities and support 56 5.4 Mental health in primary health care 56 5.5 Staffing issues 57 5.6 Patient and family involvement 58 5.7 Use of psychotropic drugs 59 5.8 Survey results: Seeking help for mental health problems 61 6 Conclusions and recommendations 64 6.1 Summary of findings 64 6.2 Conclusions 66 6.3 Recommendations 66 Annex I Details of studies used in survey of surveys References 1 THE STATE OF MENTAL HEALTH IN THE EUROPEAN UNION Figures Figure 1 Determinants of mental health 11 Figure 2 Population density in the EU and Norway 12 Figure 3 Urban population in the EU and Norway 12 Figure 4 Population aged over 65 in the EU and Norway 13 Figure 5 Gross domestic product, unemployment and percentage of population at risk of poverty 14 Figure 6 Health expenditure in EU countries and Norway 14 Figure 7 Positive mental health in ten EU countries 20 Figure 8 Psychological distress in ten EU countries 22 Figure 9 Psychological Distress in seven EU countries (6 ESEMeD, plus UK) 22 Figure 10 Any mental disorder in the last 12 months in six EU countries 23 Figure 11 Any mood disorder in the last 12 months in six EU countries 23 Figure 12 Anxiety disorders in the last 12 months in six EU countries 23 Figure 13 Total suicide mortality rates across Europe, 1997 25 Figure 14 Male deaths from suicide, events of undetermined intent and unknown and unspecified causes 25 Figure 15 Female deaths from suicide, events of undetermined intent and unknown and unspecified causes 25 Figure 16 Trends in male suicide by country 26 Figure 17 Trends in female suicide by country 26 Figure 18 Suicide and old age in males across Europe 27 Figure 19 Suicide and old age in females across Europe 27 Figure 20 Suicides in young people across Europe 27 Figure 21 Suicide, risk of poverty and unemployment 27 Figure 22 Alcohol consumption across Europe 28 Figure 23 Trend in alcohol consumption 1980–2001 29 Figure 24 Trends in alcohol related death 1980–1997 29 Figure 25 Occurrence of alcohol disorders in men and in women in the last 12 months six European countries 25 Figure 26 Effect of country on relative risk of lifetime alcohol disorders 26 Figure 27 Cigarettes consumed per person per year in EU countries and Norway 27 Figure 28 Deaths from smoking related causes in the EU and Norway 28 Figure 29 Recent use of cannabis among young adults (15–34 years) in European Countries, measured by national surveys 29 Figure 30 Evolution of recent cannabis and cocaine use in some EU countries 32 Figure 31 Trends in acute drug-deaths in some EU countries, 1985-99 33 Figure 32 Positive mental health in men and women 34 Figure 33 The effect of gender on the risk of poor mental health 35 Figure 34 Relative risk of psychological distress for women compared to men in some EU countries 35 Figure 35 Psychological distress in males and females in some EU countries 35 Figure 36 The effect of gender on the risk of depression 36 Figure 37 Effect of gender for the risk of any disorders in ESEMeD 00 Figure 38 Effect of gender for the risk of anxiety disorders in six EU countries 36 Figure 39 Effect of gender for the risk of any disorders in six EU countries 37 Figure 40 Ratio of male to female deaths from suicide in EU countries 37 Figure 41 Ratio of male to female suicides across Europe, 1987 and 1997 38 Figure 42 Relative risk of psychological distress for young people 38 Figure 43 Psychological distress in seven EU countries 39 Figure 44 Relative risk of any mental health disorders in young people in six EU countries 39 Figure 45 Relative risk of anxiety disorders in young people in six EU countries 39 Figure 46 Risk of psychological distress in older people 40 Figure 47 Psychological distress in older people 40 2 THE STATE OF MENTAL HEALTH IN THE EUROPEAN UNION Figures Figure 48 Relative risk of mood disorders in older people 41 Figure 49 Relative risk of anxiety disorders in older people 42 Figure 50 Relative risk of psychological distress by marital status across Europe 43 Figure 51 Mental health and living arrangements in six European countries 43 Figure 52 Relative risk of mood disorders according to living arrangements 44 Figure 53 Relative risk of psychological distress by employment status 47 Figure 54 Psychological distress and unemployment in seven European countries 47 Figure 55 Relative risk of any mood disorder in the last 12 months for unemployed people by country 47 Figure 56 Relative risk of psychological distress by low income 48 Figure 57 Psychological distress in rural and urban areas 50 Figure 58 Comparison of any mental disorders in the last 12 months for people living in urban and rural areas 50 Figure 59 Migration rates across Europe 51 Figure 60 Psychological distress and migrants in five European countries 53 Figure 61 Psychiatric hospital beds in European countries 55 Figure 62 Numbers of psychiatrists in EU countries 57 Figures 63 Numbers of GPs in EU countries 63 Figure 64 Pharmaceutical expenditure across Europe 59 Figure 65 People seeking help for a mental health problem 61 Figure 66 Relative risk of seeking help for a mental health problem among cases of mental ill-health by country 61 Figure 67 Probability of seeking help with a mental health problem 62 Figure 68 People seeking help for mental health problems from any health provider 68 Figure 69 Types of providers consulted in case of mental health problems in the last year 69 Figure 70 People seeking help from different providers in six ESEMeD countries 63 Figure 71 Referrals from a family doctor to a mental health specialist 63 Figure 72 Prescriptions of Drug for Individuals with any mental health disorder 63 3 THE STATE OF MENTAL HEALTH IN THE EUROPEAN UNION Tables Table 1 Prevalence rates of depressive disorders in selected major European studies 21 Table 2 Prevalence of schizophrenia in the Nemesis study 24 Table 3 Lifetime prevalence estimates of WMH-CIDI / DSM-IV mood disorders in Europe for individuals aged 65+, ESEMeD project 41 Table 4 Anxiety disorder in people aged over 65 in six European countries 42 Table 5 Alcohol disorders in people aged over 65 in six European countries 43 Table 6 Studies reporting associations with higher rates of the common mental disorders, by indicators of less privileged social position 44 Table 7 Impact of work on mental health 46 Table 8 Depression in rural and urban areas in males and females 49 Table 9 Consumption of antidepressants in 14 different European Union countries 60 Table 10 Consumption of anxiolytics and hypnotics in 14 different European Union countries 60 Acknowledgements Many thanks to Frederic Capuano, Jocelyne Gagnon, Maria Carolina Hardoy, Trevor Hill, Zoe Morgan, Nick Taub, and Jane Smith for their help with this report. 4 THE STATE OF MENTAL HEALTH IN THE EUROPEAN UNION Participants and contributors Project leader Viviane Kovess MGEN Foundation of Public Health, Paris 5 University, France Co-ordinating board Terry Brugha University of Leicester, UK Mauro Giovanni Carta University of Cagliari, Italy Ville Lehtinen STAKES, National Research and Development Centre for Welfare and Health, Finland Topic experts Matthias C Angermeyer (Older people) University of Leipzig, Germany Mariola Bernal (Immigrants) Sant Joan de Deu-SSM, Spain Miguel Xavier (Substances) Faculty Medical Sciences of Lisbon, Portugal France Kittel (Gender) ESP ULB Campus Erasme, Belgium Tom Fryers (Deprivation) University of Leicester, UK National experts Bairbre Nic Aongusa Department of Health and Children, Ireland Claes-Goran Stefansson The National Board of Health and Welfare, Sweden