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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.