Perspectives: an international review of the national cost estimates of mental illness, 1990-2003.

BACKGROUND: Mental illness is a major group of disorder that can lead to both physical and emotional disability. Policymakers need to learn not only the epidemiological indicators of mental illness, such as prevalence rate and incidence rate, but also the size of its negative impact on the economy. AIMS OF THE STUDY: This study is to review international publications on cost of major mental illness literature, from 1990 to 2003, focusing on the concepts, methods, and future perspective of cost illness studies. Reviewing the status quo on costs of mental illness can provide further information about gaps, limitations, and future needs on this topic.
METHOD: This review searched all major international journals in psychiatry, clinical psychology, health economics, and mental health policy published since 1990. All national or aggregate cost of mental illness studies were included in the review. All were individually reviewed using a conceptual framework of cost of illness methodology.
RESULTS: A large majority of published cost of mental illness studies were conducted in the US and UK. Cost of illness studies were lacking from Africa, Asia, Eastern Europe, and Latin America. Empirical results from the reviewed studies indicate that the negative economic consequences of mental illness far exceed the direct costs of treatment, thus making it important to treat mental illness. Direct treatment costs for each mental disorder (i.e. depression, schizophrenia, dementia, etc.) is between 1% and 2% of total national health care costs. DISCUSSION: The studies reviewed indicate great variation in cost estimates even for the same mental disorder during the same time period within a country. These wide variations may be due to differences in disorder classification, definition of cost categories, sample populations, data sources, and discounting rate. Given the limitations of the cost of illness studies reviewed, one should be careful in interpreting and using these estimated results. IMPLICATIONS FOR HEALTH SERVICES: These cost studies can be useful for understanding the magnitude of treating an illness of economic consequences or economic consequences of an illness for purposes of planning or budgeting. Such studies are one way to inform policymakers about economic consequences of mental illness.