Counting the cost of anxiety and depression

Four-fold return on investment

A new WHO-led study has estimated for the first time both the health and economic benefits of investing in treatment of the most common forms of mental illness.¹ The authors calculated the likely treatment costs and health outcomes in 36 countries between 2016 and 2030. A linear increase in treatment coverage and a modest 5% increase in ability to work and productivity as a result of treatment were factored into the model.

The calculated cost of scaling up the treatment of anxiety and depression may appear huge - an estimated US $147 billion. But this is a good investment because every dollar spent yields a return of four dollars in better health and ability to work.

Speculate to accumulate

Between countries, there were slight variations: the investment return ranged from 3.3 to 4-fold. It appears that countries with lower-incomes gained less return on investment. But it’s not just about the money. For the overall investment, 43 million EXTRA years of healthy life are anticipated over the period 2016-2030. And that must be good news for patients.

How governments respond to this news remains to be seen. But, as the authors state, the information contained in their paper “can contribute to a balanced investment case for common mental disorders and the health sector more generally.”

Depression - misunderstood

Should we be optimistic and anticipate whole-hearted support for investment in mental illnesses? Possibly not -- unless there is a major change in perception. In the UK, for example, neither funding bodies nor the general public perceive mental health to be as worthwhile - in terms of the money contributed to its investigation - as cancer.

Consider the following²:

• For every UK cancer patient in 2011, there was £1571 spent on research. For every patient with mental ill-health, this spend was just £9.75.
• For every £1 spent by the government on cancer research, the public donated £2.75. For every £1 the government spent on mental health, the public donated £0.003.
• The vast majority of funding for mental health supports basic research. Considerably less funding goes to the prevention, detection and screening, or the development of treatments for mental illness.
• A comparison of the research spend within mental health (from least spent to most spent) runs: eating disorders, anxiety, OCD, depression, autism and - way out on top - psychosis (bipolar disorder and schizophrenia).

Per patient, depression gets only one fortieth of the amount spent on psychosis. Presumably, this reflects perceived severity. Clearly, depression is in need of a huge PR campaign.

One therapy – two hits

If anxiety and the anxiety disorders are risk-factors as well as precursors to secondary depression^3,4, the benefit gained from investing in mental health programmes could potentially exceed four-fold. Why? Because managing anxiety, e.g. through exposure CBT, is also an effective antidepressant therapy for comorbid depression in adults.⁵

And it has been suggested that if the anxiety could be prevented in the first place, ideally in childhood, secondary depression could also be avoided.

MARI study ongoing

As a first step, the ongoing Maternal Anxiety in Relation to Infant development (MARI) study⁶ aims to prospectively investigate the development of the offspring of women with and without anxiety disorders prior to conception. The study covers early pregnancy to early infancy. One focus is offspring outcomes that may be early indicators of later anxiety disorders. The results are expected to provide insights and clues for targeted prevention and early intervention in anxiety and depression and are keenly awaited.