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Epidemiology and Burden Major Depressive Disorder (MDD) Depression is a highly prevalent disorder Depression is a chronic, recurring, and progressive disorder affecting 300-350 million people worldwide1,2 • The percentage of people suffering from MDD worldwide was 4.4% (4.1–4.7%) in 2010.2 • The prevalence of MDD remained very consistent between 1990 (4.4% (95% uncertainty: 4.2–4.7%)), 2005 (4.4% (4.1–4.7%) and 2010. • Prevalence in 2010 was higher in females at 5.5% (5.0–6.0%) compared to males at 3.2% (3.0–3.6%). 2 • Across the lifespan, prevalence of MDD increases steadily between 3 and 19 years; peaks between 20 and 64 years; decreased between 65 to 74 years. (1) Depression. Factsheet no. 369. Available at: http://www.who.int/mediacentre/factsheets/fs369/en/. Accessed April 2016. (2) Ferrari AJ, et al. 2010. PLoS One. 2013a;8(7):e69637 Depression is a highly prevalent disorder It is estimated that each year, 6.9% of the EU population suffers from MDD1 Mean lifetime prevalence of major depressive episode4 The lifetime prevalence of MDD is 6.5–21%, depending on the country2-4 MDD 6.5 – 21 % Netherlands 18.5% Germany 9.8% Ukraine Belgium 14.5% 14% France 21% Italy Spain Lebanon 9.8% 11% Israel 11.2% 10% USA 19% Mexico 8% Shenzen, China 7% India 9% Colombia 13% 5–10% Japan 9.8% Brazil 18.8% >10–15% >15–20% South Africa 9.7% >20% *Total high income countries = 14.6%; total low to middle income countries = 11.1% Only data for countries in the WHO study are presented (1) Wittchen HU et al. Eur Neuropsychopharmacol 2011;21:655-79; (2) Hasin DS et al. Arch Gen Psychiatry 2005;62:1097-106; (3) Kessler RC et al. Arch Gen Psychiatry 2005;62:593-602; (4) Bromet E et al. BMC Med 2011;9:90 New Zealand 7% 12 month prevelance of mental disorders in Europe in 2011# Opioid dependence OCD Bipolar disorder Eating disorder Mental retardation Cannabis dependence Psychotic disorders Personality disorders PTSD Conduct disorder Alcohol dependence Somatoform disorders ADHD Major depression Anxiety disorders 0.4 (1.0) 0.7 (2.9) 0.9 (3.0) 0.9 (1.5) 1.0 (4.2) 1.0 (1.4) 1.2 (5) 1.3 (4.3) 2.0 (7.7) 3.0 (2.1) 3.4 (14.6) 4.9 (20.4) 5.0 (3.3) 6.9 (30.3) 14 (61.5) 0 2 4 6 8 10 12 12-month prevalence in percent (no. persons affected) Prevalence ”best estimate”, conducted in EU-27 countries, plus Iceland, Norway and Switzerland * More details available in the speaker notes # Wittchen, H.-U. et al, 2011. Eur. Neuropsychopharmacology (2011) 21, 655–679 14 Burden of Major Depressive Disorder (MDD) ” “Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease” WHO Fact Sheet No. 369 - Reviewed April 2016 MDD is a leading cause of burden • MDD has a worldwide prevalence estimate of 4.4%1 Ten leading causes of YLDs worldwide, Global Burden of Disease Study 20104 Rank • MDD is the second leading cause of years lived with disability (YLDs)2 • The Global Burden of Disease Study 2010 found that MDD accounted for 8.2% of global YLDs • Unipolar depressive disorders are predicted to become the leading cause of burden (DALYs) by 20303 Lower back pain 1 Major depressive disorder 2 Iron-deficiency anaemia 3 Neck pain 4 COPD 5 Other musculoskeletal disorders 6 Anxiety disorders 7 Migraine 8 Diabetes 9 Falls 10 COPD=chronic obstructive pulmonary disease DALY=disability-adjusted life-year (1) Ferrari AJ, et al. 2010. PLoS One. 2013;8(7):e69637; (2) Ferrari et al. PLoS Med 2013;10(11):e1001547; (3) WHO. Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. 2011. Retrieved from: http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_9-en.pdf. Accessed April 2016; (4) Vos et al. Lancet 2012; 380: 2163–2196. Contribution of Non-communicable diseases disability-adjusted life years By 2013, depression is projected to be the largest contributor to the global burden of disease1 Other Non-communicable Diseases 7% Digestive Disorders 6% Musculoskeletal Disorders 4% Endocrine 4% Rispiratory Disease 8% Unipolar Affective Dis 10% Sense Organ Impairement 10% Neuropsychiatric Disorders 29% Schizophrenia 2% Bipolar Affective Dis 2% Dementia 2% Substance-use Dis 4% Other Mental Dis 3% Epilepsy 1% Other Neurol Dis 2% Cardiovascular Disease 22% Other Neuropsych Dis 3% Cancer 11% Dis = Disorder/s; Neurol = Neurologic; Neuropsych = Neuropsychiatric Prince et al. Lancet 2007; 370: 859–877 The burden associated with depression is large and increasing Health-adjusted life years (HALYs) - A combination of years lived with less than full function and years lost to early death.1 Depression Bipolar Disorder Alcohol Schizophrenia Years of reduced function 0 50 100 150 Years Years of life lost 200 250 In terms of disability-adjusted life-years lost, depression is the most burdensome disorder of all brain diseases in the EU2 (1) Ratnasingham S et al. Opening Eyes, Opening Minds: The Ontario Burden of Mental Illness and Addictions Report. Institute for Clinical Evaluative Sciences and Public Health Ontario, 2012; (2) Wittchen HU et al. Eur Neuropsychopharmacol 2011;21:655-79 Depression is the most burdensome disorder of all brain diseases in the EU Rankings of DALY estimates (age 15+) by selected mental and neurological disorders for the EU-27 population Rank Men Diagnosis Women Total DALYs* Diagnosis Both Total DALYs* Diagnosis Total DALYs* 1 Alcohol Use Disorders 1669k Major Depression 2892k Major Depression 4320k 2 Major Depression 1428k Dementias 1477k Dementias 2237k 3 Stroke 783k Stroke 793k Alcohol Use Disorders 2040k 4 Dementias 760k Migraine 491k Stroke 1577k * Total DALYs in thousands(k) DALYs = disability-adjusted life-years lost Major depression contributes 7.2% of the overall burden of disease in Europe, making it the number 1 contributor directly before Alzheimer's disease/dementia and alcohol use disorders. 2) Wittchen HU et al. Eur Neuropsychopharmacol 2011;21:655-79 Depression has detrimental effects on overall health Mean Health Score (0–100) 100 90.6 80.3 80 79.6 79.3 78.9 72.9 67.1 65.8 71.8 65.4 58.5 56.1 60 40 20 Depression adds to the burden of asthma, angina, arthritis, or diabetes 0 Depression is associated with poorer overall health scores than arthritis or diabetes and significantly adds to the burden of other chronic conditions Adapted from Moussavi S, et al. Lancet. 2007;370:851-8. Depression is associated with significant personal and societal consequences Decreased ability to interact with friends, family, and colleagues1,3 High morbidity and mortality2,3 The leading cause of psychiatric disability worldwide2,3 3,000 suicide deaths every day, worldwide3 1 in 20 people reported having an episode of depression in the previous year3 Largely driven by workplace productivity losses2 (1) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Health Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013; (2) Krol M, et al. Pharmacoeconomics. 2011;29(7):601–19; (3) Marcus M, et al. 2012. http://www.who.int/mental_health/management/depression/who_paper_depression_wfmh_2012.pdf?ua=1 Accessed April 16, 2014. Severe economic burden for patients and society2 The personal burden of MDD can be significant and wide-ranging Marital dissatisfaction/discord and negative parenting behaviours are strongly related to symptoms of depression1 MDD is significantly associated with chronic physical disorders including arthritis, asthma, cancer, diabetes, cardiovascular disease and pain1 Family Finances Personal earnings and household income of people with MDD are substantially lower than those without depression1 1. Kessler RC. Psychiatr Clin North Am 2012;35(1):1–14. 2 Physical health Work performance People with MDD have the highest number of days away from work of any physical or mental disorder1 MDD has significant costs to society Predicted to be leading cause of disease burden by 20301 98.7 million Percentage of the global burden of disease (DALYs) represented by depression in 20042 Estimated number of people with moderate or severe disability due to depression in 20042 4.3% 1.4x 2nd Leading cause of years lived with disability in 20133 Increased risk of mortality for people with depression compared with the general population1 53% Median percentage increase in disability associated with depression 1990–20133 (1) WHO. Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. 2011. Retrieved from: http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_9-en.pdf. Accessed April 2016; (2). WHO The Global Burden of Disease 2004 Update. http://www.who.int/healthinfo/global_burden_dis ease/2004_report_update/en/. Accessed April 2016. 3. Global Burden of Disease Study 2013 Collaborators. Lancet 2015;386(9995):743–800 MDD has significant costs to society: EU € 92 billion* Percentage of the cost of depression comes from workplace absenteeism and presenteeism1 Estimated costs of depression1 € 54 billion* 50% 50% Percentage of patients being treated for depression who take employment sick leave1 Non-healthcare-related costs of depression in 2010 (e.g. loss of work productivity)1 >⅓ Proportion of patients on employment sick leave taking over 26 weeks off work1 (1) Hughes S. MEP: Depression in the Workplace. http://www.enwhp.org/fileadmin/user_upload/pdf/Policy_recommendations_depression_at_the_workplace.pdf. Accessed July 2015 Depression is associated with significant economic costs • Major depression is the leading cause of global disease burden among mental, neurological and substance-use disorders1 • The total annual cost of depression in Europe was estimated at €118 billion in 2004, which corresponds to a cost of €253 per inhabitant2 • $44 billion cost to US employers in 1 year3 Burden of disease (DALYs): Leading causes in high-income countries 1. Majordepressive depressivedisorders disorder 1. Unipolar 8,2% (10) 8.2 6,3% (7,7) 6.3 2. Ischaemic heart disease 3,9% (4,8) 3.9 3. Cerebrovascular disease 3,6% (4,4) 3.6 4. Alzheimer and other dementias 5. Alcohol use disorders 3,4% (4,2) 3.4 6. Hearing loss, adult onset 3,4% (4,2) 3.4 7. COPD 33,0% (3,7) 8. Diabetes mellitus 33,0% (3,7) 9. Trachea, bronchus, lung cancers 33,0% (3,6) 10. Road traffic accidents 2.6 2,6% (3,1) 0 DALY, disability-adjusted life-year; COPD, chronic obstructive pulmonary disease 1 2 3 4 5 6 7 8 9 Percent of total DALYs (million DALYs) (1) Collins PY, et al. Nature. 2011;475:27–30; (2) Sobocki P, et al. J Ment Health Policy Econ. 2006;9:87-98; (3) Stewart WF, et al. JAMA. 2003; 289: 313544; (4) World Health Organization. Available at: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part4.pdf?ua = 1. Accessed June 2016 Cost per patient of brain disorders in Europe in 2010# #27 Headache Eating disorders Sleep disorders Somatoform disorder Anxiety disorders Mood MoodDisorders* disorders Child/Adolescent disorders Addiction Epilepsy Personality disorders Stroke Traumatic Brain Injury Mental Retardation Parkinsons disease Dementia Psychotic disorders Brain tumor Multiple sclerosis Neuromuscular disorders EU countries plus Switzerland, Norway, and Iceland 285 559 790 1037 1077 3406 3595 4227 5221 6328 7775 8809 10334 11153 16584 18796 21590 26974 30052 0 5000 10000 15000 20000 Cost per patient (€ PPP 2010) * Mood disorders includes major depression and (prevalence 6.9%) and bipolar (prevalence 0.9%) PPP = purchasing power parity Gustavsson et al., Eur Neuropsychopharm (2011)21,718-779 25000 30000 35000 Cost per per patient of mental disorders in Europe in 2010# #27 Eating disorders EU countries plus Switzerland, Norway, and Iceland 559 Somatoform disorder 1037 Anxiety disorders 1077 Mood Disorders* disorders Mood 3406 Child/Adolescent disorders 3595 Addiction 4227 Personality disorders 6328 Mental Retardation 10334 Psychotic disorders 18796 0 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 Cost per patient (€ PPP 2010) * Mood disorders includes major depression and (prevalence 6.9%) and bipolar (prevalence 0.9%) PPP = purchasing power parity Gustavsson et al., Eur Neuropsychopharm (2011)21,718-779 Number of persons with disorders of the brain in Europe 2010# #27 Brain Tumor Neuromuscular disorder Multiple Sclerosis Parkinson's disease Eating disorders Epilepsy Traumatic Brain Injury Mental Retardation Personality disorders Psychotic disorders Child/Adolescent disorders Dementia Stroke Addiction Somatoform disorder Mood MoodDisorders* disorders Sleep disorders Anxiety disorders Headache EU countries plus Switzerland, Norway, and Iceland 0.2 0.3 0.5 1.2 1.5 2.6 3.7 4.2 4.3 5 5.9 6.3 8.2 15.5 20.4 33.3 44.9 69.1 152.8 0 20 40 60 80 100 120 Number of diagnoses in million * Mood disorders includes major depression and (prevalence 6.9%) and bipolar (prevalence 0.9%) Gustavsson et al., Eur Neuropsychopharm (2011)21,718-779 140 160 180 Mood disorders bears the highest total costs of brain disorders in Europe 2010# #27 Eating disorders Brain tumor Neuromuscular disorders Epilepsy Parkinsons disease Multiple sclerosis Somatoform disorder Child/Adolescent disorders Personality disorders Traumatic brain injury Sleep disorders Mental Retardation Headache Stroke Addiction Anxiety disorders Psychotic disorders Dementia MoodDisorders* disorders Mood EU countries plus Switzerland, Norway, and Iceland 827 5174 7726 13800 13933 14559 21169 21326 27345 33013 35425 43301 43514 64053 65684 74380 93927 105163 113405 0 20000 40000 60000 80000 Total cost per disorder (million € PPP 2010) * Mood disorders includes major depression and (prevalence 6.9%) and bipolar (prevalence 0.9%) PPP = purchasing power parity Gustavsson et al., Eur Neuropsychopharm (2011)21,718-779 100000 120000 Mood disorders bears the highest total costs of mental disorders in Europe 2010# #27 Eating disorders EU countries plus Switzerland, Norway, and Iceland 827 Somatoform disorder 21169 Child/Adolescent disorders 21326 Personality disorders 27345 Mental Retardation 43301 Addiction 65684 Anxiety disorders 74380 Psychotic disorders 93927 MoodDisorders* disorders Mood 113405 0 20000 40000 60000 80000 Total cost per disorder (million € PPP 2010) * Mood disorders includes major depression and (prevalence 6.9%) and bipolar (prevalence 0.9%) PPP = purchasing power parity Gustavsson et al., Eur Neuropsychopharm (2011)21,718-779 100000 120000 Mean Proportion of Time DSM-IV Symptom Cluster Is Present Depressive symptoms persist during periods of remission and subsequent depressive episodes 1.00 Cognitive problems 0.80 Core symptoms: depressed mood/ diminished interest Lack of energy 0.60 Sleeping problems Worthlessness/guilt 0.40 Eating problems 0.20 Psychomotor problems 0.00 Death ideations Weeks of Follow-up Mean proportion of time symptoms are present during 3-year follow-up period (N=267) Conradi HJ, et al. Psychol Med. 2011;41:1165–1174. Cognitive impairment is among the most common residual symptoms in MDD* Persistent depressive symptoms in STAR*D responders Pre-treatment Post-treatment 100 Patients (%) 80 60 40 20 0 Mid-nocturnal insomnia Decreased concentration / decision-making Suicidal ideation Negative self-view Symptoms present in patients with MDD who responded but did not remit (N=428) McClintock SM, et al. J Clin Psychopharmacol. 2011;31:180-6. Patients with cognitive symptoms of depression often have deficits in overall functioning1,2 Learning Attention Motor Skills Deficits in almost every domain of cognitive functioning2 Verbal knowledge Non-Verbal knowledge Episodic Memory Working Memory Processing Speed Deficits associated with functional domains2 Executive Functioning Work Family Life Social Interaction Cognitive deficits are clinically important1,3 (1) Marazziti D, et al. Eur J Pharmacol. 2010;626:83-86; (2) Millan MJ, et al. Nat Rev Drug Discov. 2012;11:141-168; (3) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: APA 2013. Depression costs more to employers than is spent on managing it Depression costs for employers in selected regions: €7.5 billion in €37 billion Australia3 in the US2 €54 billion in the EU1 Direct medical costs of managing depression in the EU: €38 billion1 (1) Olesen J, et al. Eur J Neurol. 2012;19:155–162. (2) Stewart WF, et al. JAMA. 2003;289(23):3135–3144. (3) Perkins M, Back A. Mental health failing costs business $11b. 2014. Retrieved from: http://www.smh.com.au/national/mental-healthfailing-costs-business-11b-20140519-38k5r.html. Accessed May 2015 Depression directly impacts working time One out of 10 people have taken time off work for depression Taken an average of 36 days per period IDEA: Impact of Depression at Work in Europe Audit Final report. Ipsos Healthcare. October 2012.