Epidemiology and Psychiatric The cost of mental disorders:

Sciences
a systematic review
cambridge.org/eps
M. K. Christensen1,2, C. C. W. Lim3,4, S. Saha4, O. Plana-Ripoll1, D. Cannon4,
F. Presley4, N. Weye1, N. C. Momen1, H. A. Whiteford4,5, K. M. Iburg2
and J. J. McGrath1,3,4
Special Article
1
National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; 2Department of Public Health,
Cite this article: Christensen MK et al (2020).
Aarhus University, Aarhus, Denmark; 3Queensland Brain Institute, University of Queensland, St Lucia, Queensland,
The cost of mental disorders: a systematic
review. Epidemiology and Psychiatric Sciences Australia; 4Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland,
29, e161, 1–8. https://doi.org/10.1017/ Australia and 5School of Public Health, University of Queensland, Herston, Queensland, Australia
S204579602000075X
Abstract
Received: 4 June 2020
Revised: 20 July 2020 Aims. To identify and synthesise the literature on the cost of mental disorders.
Accepted: 22 July 2020 Methods. Systematic literature searches were conducted in the databases PubMed, EMBASE,
Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and
Key words:
cost-of-illness studies; economic burden; mental disorders. Searches were restricted to January 1980–May 2019. The inclusion criteria
mental disorders; systematic review were: (1) cost-of-illness studies or cost-analyses; (2) diagnosis of at least one mental disorder;
(3) study population based on the general population; (4) outcome in monetary units.
Author for correspondence: The systematic review was preregistered on PROSPERO (ID: CRD42019127783).
John McGrath,
E-mail: j.mcgrath@uq.edu.au Results. In total, 13 579 potential titles and abstracts were screened and 439 full-text articles
were evaluated by two independent reviewers. Of these, 112 articles were included from the
systematic searches and 31 additional articles from snowball searching, resulting in 143
included articles. Data were available from 48 countries and categorised according to nine
mental disorder groups. The quality of the studies varied widely and there was a lack of studies
from low- and middle-income countries and for certain types of mental disorders (e.g. intel-
lectual disabilities and eating disorders). Our study showed that certain groups of mental
disorders are more costly than others and that these rankings are relatively stable between
countries. An interactive data visualisation site can be found here: https://nbepi.com/econ.
Conclusions. This is the first study to provide a comprehensive overview of the cost of mental
disorders worldwide.

Introduction
Mental disorders are prevalent worldwide. Estimates indicate that one in three individuals will
develop a mental disorder during their lifetime (Chesney et al., 2014; Steel et al., 2014; Vigo
et al., 2016). While many mental disorders respond well to treatment, having a mental dis-
order can result in a considerable burden for the individual because of the health loss experi-
enced, as well as the stigma and marginalisation that can be associated with having a mental
disorder (Schofield et al., 2011). In 2017, mental disorders and substance use disorders con-
stituted 14.4% of the global disability and were the second largest of any group (Institute for
Health Metrics and Evaluation, 2020a).
Those with mental disorders may have periods of reduced ability to participate in the
labour force, which can result in a lack of income for the individual (Schofield et al., 2011).
The lack of participation in the labour force can also contribute to substantial societal cost
because of production loss and reduced income taxation – besides the direct treatment cost
© The Author(s), 2020. Published by (Schofield et al., 2011). In addition to epidemiological measures such as morbidity and mor-
Cambridge University Press. This is an Open tality, the importance of mental disorders can also be investigated through cost-of-illness stud-
Access article, distributed under the terms of
the Creative Commons Attribution-
ies within health economics. Previous systematic reviews have documented the cost for various
NonCommercial-NoDerivatives licence (http:// mental disorders (Luppa et al., 2007; Fajutrao et al., 2009; Konnopka et al., 2009; Stuhldreher
creativecommons.org/licenses/by-nc-nd/4.0/), et al., 2012; Chong et al., 2016; Jin and Mosweu, 2017). Most reviews have focused on common
which permits non-commercial re-use, mental disorders (e.g. depression, anxiety) and on schizophrenia and eating disorders, but the
distribution, and reproduction in any medium,
cost of some mental disorders such as developmental disorders and intellectual disability dis-
provided the original work is unaltered and is
properly cited. The written permission of orders has not yet been examined in a systematic review. Additionally, past systematic reviews
Cambridge University Press must be obtained have focused on a specific country or a region and not on the economic burden worldwide and
for commercial re-use or in order to create a some are more than a decade old, resulting in a significant gap in the current literature.
derivative work. The aims of this systematic review were to identify cost-of-illness studies for mental disor-
ders worldwide and to explore the distribution of the cost between disorders. To explore the
cost distribution, we extracted data on key parameters such as types of mental disorder, meth-
odology, cost categories, geographical location, etc., and assessed the study quality of the
included studies. In particular, we focused on prevalence-based studies reporting the societal

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 2 M. K. Christensen et al.

cost per patient by mental disorder, study quality and by country cost studies. A detailed description is available in Online Resource
in our investigation and examined the percentages of the direct 1. The systematic searches were conducted between May and June
cost and indirect cost. 2019 in the databases PubMed, EMBASE, Web of Science,
EconLit, NHS York Database and PsychInfo. In order to make
the study tractable, the searches were restricted to studies pub-
Methods
lished between 1980 and May 2019. Animal studies and clinical
Within the field of health economics, a wide range of trials were excluded. No restrictions regarding geographical loca-
economic analyses are available (e.g. cost-of-illness analysis, tion or language were used. Covidence (Kellermeyer et al., 2018),
cost-effectiveness analysis, cost-utility analysis and cost-benefit an online tool to assist the systematic review workflow, was used
analysis), supporting decision making and mental health practices for the title/abstract screening. Two independent reviewers
(Knapp and Wong, 2020). Cost-of-illness studies aim to estimate screened all titles/abstracts for eligibility, followed by full-text
the total cost or excess cost of people diagnosed with a disease of screening for potentially relevant articles according to the prede-
interest (Akobundu et al., 2006). Historically, there are three fined inclusion and exclusion criteria. Any conflicts were resolved
broad types of cost categories: direct cost, indirect cost and intan- by consensus. We developed a hierarchy to force a study to have
gible cost. Direct cost refers to health care resources such as diag- only one exclusion reason for the purpose of PRISMA reporting.
nostic, treatment and rehabilitation and non-health care resources However, some studies could have been excluded by more than
such as transportation, household expenses and community- one criterion. If a full publication was not available from online
based services. Indirect cost refers to costs related to production searching, a request to the university library was made. If a full
loss from morbidity and mortality borne by the individual, society publication was not available before the 6th of September 2019,
and/or the employer. Intangible cost refers to the psychological the study was excluded.
pain experienced by people with mental disorders and their fam-
ilies but these costs are seldom included in cost-of-illness studies
Snowball searches
(Tarricone, 2006; Jo, 2014). The perspective used in a
cost-of-illness study defines which cost categories to include. The systematic searches were supplemented with snowball
The broadest perspective is the ‘societal’ where all costs in a soci- searches. First, the reference lists from reviews and systematic
ety are examined regardless of who pays the costs. Therefore, both reviews on this topic were screened (by title) in order to identify
direct and indirect cost have to be included and preferably also additional potentially relevant articles. Full texts were retrieved
intangible cost, but not all studies report the direct and indirect and screened by two independent reviewers. The same snowball
cost disaggregated from the societal cost. Cost-of-illness studies procedure was used on the reference lists from the included stud-
can use either a prevalence or an incidence approach (Jo, 2014). ies from the systematic searches until no additional candidate
Prevalence-based studies, the most common approach of studies were identified.
cost-of-illness studies, provide useful information for health plan-
ners (e.g. which disorders are associated with larger cost, what are
Quality reporting assessment
the major cost categories, how are health investments distributed).
Incidence-based studies can be used in cost-effectiveness evalua- A modified version of the quality reporting checklist from
tions of preventive initiatives and disease management (Jo, 2014). Stuhldreher et al. (2012) was used to assess the reporting quality
of the included studies (see eTable 1 in Online Resource 2). The
revised checklist consisted of 14–15 items scored yes/no (only
Eligibility criteria
studies with a time period greater than 1 year could be allocated
This systematic review was carried out in accordance with the the item related to discounting (item number 7)). An objective
Preferred Reporting Items for Systematic Reviews and and reliable assessment of study quality can be difficult.
Meta-Analyses (PRISMA) statement (Moher et al., 2009). The However, reporting certain features and principles is thought to
project protocol was preregistered at the website International correlate with reliable outcomes (Frederix, 2019). The quality
prospective register of systematic reviews (PROSPERO) before reporting scores were standardised to a 10-point scale.
commencement (registration number CRD42019127783).
A PICO (Participants, Interventions, Comparisons, Outcomes)
Data extraction and management
framework (Schardt et al., 2007) was used to develop the inclusion
and exclusion criteria. The predefined inclusion criteria were: A data dictionary was developed to guide the extraction process.
(1) cost-of-illness studies or cost-analyses, (2) diagnosis of at Information about author(s), publication year, title, country,
least one mental disorder according to any published criteria city, diagnosis, diagnostic criteria, sample size, age, sex, data
(excluding dementia to follow the definitions of mental and sub- sources, study perspective, study period, reference year, currency,
stance use by the Global Burden of Disease Study (Institute for costing approach, cost categories, discount rate, production loss
Health Metrics and Evaluation, 2020b)), (3) the sampling frame method and cost unit was extracted from every study. Different
was based on the general population (e.g. not restricted by any- assumptions and decisions were made during the data extraction
thing other than age and geographical location), (4) original phase. Some studies reported estimates for more than one time
results and (5) results reported in monetary units. period (e.g. cost for the year preceding index diagnosis, a year
after diagnosis, 2 years after diagnosis, etc.). In that case, we
only extracted the latest, most comprehensive estimates. If a
Systematic searches
study did not report the reference year, it was set to 1 year
The search strings for the systematic searches contained two parts. prior to the publication date. If a cost estimate was not explicitly
One part with comprehensive key terms for different mental dis- stated in the text/table/figure, the study was excluded based on the
order groups and another part with comprehensive key terms for lack of availability of a result in monetary unit. If the cost

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 Epidemiology and Psychiatric Sciences 3

estimates were reported only for subgroups (e.g. by sex or age studies were included after full-text review. An additional 31 stud-
group) and if these subgroups were mutually exclusive and com- ies were subsequently identified from snowballing reference lists,
prehensively exhaustive, the cost estimates were extracted by sum- resulting in a total of 143 included studies. The references for
ming the costs across the different strata. If estimates for a these studies can be found in Online Resource 1, where we also
disorder of interest were aggregated with unknown disorders or provide reference details for the included studies sorted by coun-
disorders not of interest, the estimates were excluded. In cases try, disorder group and cost category (direct, indirect or both).
where the lower age limit was stated with ‘less than’, the limit The majority of studies were excluded because they were not
was assumed to be the earliest onset of the disease (see full publications (e.g. conference abstracts only), contained no
eTable 2 in Online Resource 2), and in cases where an age diagnostic criteria, and were not representative of the general
group was reported with ‘ + ’ (e.g. 65 + years), the age limit 99 population (e.g. veterans, only private insurance members or spe-
years was assumed. Transfer payments were not extracted since cial facilities residents) (Fig. 1).
these are not a cost for society but a redistribution of resources.
If estimates included transfer payment, the amount was sub-
Description of studies
tracted and if it was not possible to subtract because of lack of
information of the size of the transfer payment, the estimate Studies from all countries and territories were included, but the
was not extracted. If two or more studies reported estimates vast majority were from high-income countries – the most com-
from the same dataset with an overlap in time, only the study mon countries were the USA (24 studies), UK (23 studies) and
with the most comprehensive estimates was kept. Germany (23 studies). Three studies reported estimates for an
For the prevalence-based studies, the extracted estimates were African country (Ghana, Nigeria and South Africa) and only
recalculated into yearly cost, adjusted for inflation within the one study reported estimates for South America (Colombia).
country until year 2018 and adjusted by the country’s purchasing The number of studies by country is available in eTable 4 in
power parity (PPP) rate to the US price level. The PPP adjustment Online Resource 2.
attempts to equalise the purchasing power between countries by The disorder group most often investigated was mood disor-
removing price-level differences (OECD, 2020), which makes ders (54 studies), followed by schizophrenia (40 studies) and
international comparison possible, but with the limitation that neurotic disorders (28 studies). Four of the nine disorder groups
the PPP estimates do not reflect the real spending within a coun- were investigated in fewer than ten studies worldwide and the dis-
try. Inflation rates from the International Money Fund order group least examined was intellectual disabilities, followed
(International Monetary Fund, 2020) and PPP conversion rates by eating disorders (six and seven studies, respectively).
for 2018 from the Organisation for Economic Co-operation and Additionally, 21 studies reported estimates for multiple disorder
Development (OECD) Data (OECD, 2020) were used for the groups and six studies reported estimates on a combination of
PPP adjustment, and if the PPP rates were not available, we two or more disorder groups. A figure showing the number of
used other sources (The World Bank, 2019; Quandl, 2020). The studies per disorder group is presented in eFig. 1 in Online
incidence-based studies with a lifetime perspective were not recal- Resource 3.
culated due to a lack of information about the time period. The majority of studies (130 studies; 90.9%) used a prevalence-
All estimates were divided into broad disorder groups based on based approach, 12 studies (8.4%) used an incidence-based
diagnosis: ‘substance use disorders’, ‘schizophrenia’, ‘mood disor- approach and one study used both (0.7%) (shown in eTable 3a
ders’, ‘neurotic disorders’, ‘eating disorders’, ‘personality disorders’, and b in Online Resource 2). A total of 2884 cost estimates
‘intellectual disabilities’, ‘developmental disorders’, ‘behavioural dis- from the included studies were extracted. The number of esti-
orders’ and ‘more than one mental disorder group’ (International mates extracted from each study varied substantially, since one
Classification of Diseases 8 and 10 codes in eTable 2 in Online study could include estimates for more than one country, more
Resource 2). than one disorder group and for several cost categories.
To explore the distribution of the costs between mental disor- Fifty-five studies reported only direct cost, five studies reported
ders, we performed a descriptive analysis (mean, median, range only indirect cost (the production loss) and the majority, 80 stud-
and interquartile range) focusing on prevalence-based studies ies, reported societal cost. Furthermore, three studies reported
reporting societal cost per patient by disorder group. In the post- intangible cost besides direct and indirect cost.
hoc analyses, we examined the distribution according to quality The included studies reported costs in various measures, e.g.
reporting score and the influence of two multi-site studies. cost per patient, national cost and excess cost per patient (com-
Additionally, we display the distributions of the costs graphically, paring individuals with v. without the disorder of interest). The
and for studies that provided sufficient data to fractionate the dir- focus in the remaining part of the Results section is on societal
ect cost and indirect cost, we estimated the average percentages of cost per patient, but all estimates are available online (https://
direct cost and indirect cost of the societal cost. An interactive nbepi.com/econ). Consequently, all cost estimates presented
website is available at https://nbepi.com/econ, where all estimates from now are an aggregate of direct cost and indirect morbidity
and reference details are available for download. All analyses were and mortality cost.
performed in R version 3.5.1.
Societal cost per patient
Results Figure 2 shows the distribution of societal cost by country and
mental disorder, ranked by societal cost per patient (619 esti-
Included studies
mates). Based on data from 34 countries, the data showed an
In total, the systematic searches resulted in 13 579 candidate stud- expected distribution, with high-income nations ranking in the
ies after the removal of duplicates. In total, 439 studies were top part of the distribution (e.g. Australia, USA and UK). The
deemed potentially relevant based on their title/abstract and 112 same picture is seen without the PPP adjustment (eFig. 2 in

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 4 M. K. Christensen et al.

Fig. 1. PRISMA1 diagram.

Online Resource 3). Within each country, disorders such as Two multi-site studies (Andlin-Sobocki et al., 2005;
schizophrenia and intellectual disabilities were generally asso- Gustavsson et al., 2011) contributed a substantial proportion of
ciated with higher societal cost compared to neurotic disorders the estimates for societal cost per patient (9.7%). Because the
and eating disorders. The distribution of societal cost by mental two studies applied uniform costing rules (and thus, were not
disorder and study together with separate plots for the different truly independent observations), we undertook post-hoc analyses
disorder groups and cost per disorder ranked by USD PPP are by describing the distribution of estimates with these two
presented in eFigs 3–5 in Online Resource 3, respectively. multi-site studies excluded. None of the other included studies
The mean, median and interquartile range for societal cost per had estimates for societal cost per patient for the disorder
patient by disorder group in USD PPP are presented in Table 1. group intellectual disabilities or a combination of disorder groups.
Developmental disorders only had two estimates and was left In general, the cost distributions shifted to the right and were
out in the following comparison because of the lack of data. more costly in this subset of estimates (eTable 6 in Online
The disorder group associated with the highest median societal Resource 2). Schizophrenia was still associated with the highest
cost per patient worldwide was schizophrenia with 13 256 USD median societal cost per patient (34 588 USD PPP) and eating
PPP (mean 18 313; IQR = 13 671; range 3255–96 466). The dis- disorders was still the least costly according to median societal
order group associated with the lowest median societal cost per cost (859 USD PPP). The cost distributions of this subset can
patient was eating disorders with 547 USD PPP (mean 1629; be found in eFigs 6 and 7 in Online Resource 3.
IQR = 364; range 41–38 183). Among 14 studies that reported dir-
ect and indirect cost separately from the societal cost per patient,
Reporting quality of included studies
the average contribution from indirect cost was almost half of the
total with variation between the disorder groups (eTable 5 in The median quality reporting score for the included studies was 7
Online Resource 2). (based on the standardised 10-point scale). Scores by study and

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 Epidemiology and Psychiatric Sciences 5

Fig. 2. Societal cost per patient in US dollars adjusted by country’s purchasing power parity and inflation until year 2018 (USD PPP 2018) by disorder group and
country, ranked by USD PPP 2018.

item are available in eTable 7 in Online Resource 2. Most studies Konnopka et al., 2009; Stuhldreher et al., 2012; Chong et al.,
contained information about the study objectives and key cost- 2016; Jin and Mosweu, 2017), our systematic review confirmed
related items. In contrast, the items most often omitted were that mental disorders constitute a substantial economic burden
reports related to the handling of missing data and sensitivity ana- for societies and, additionally, that there was between-disorder
lysis (only 20 and 28% of studies, respectively, reported these variation in societal cost per patient. As expected, when examined
items). When we examined the distribution of the estimates for by disorder and by country, overall patterns emerge, which are
studies in the top half ranked by quality reporting score, there underpinned by many independent estimates. For example, in
was little change in the overall pattern of findings. The descriptive eFig. 5, we see that the distribution is underpinned by several
analysis is presented in eTable 8 in Online Resource 2, with the hundred estimates (i.e. the distribution is ‘information rich’).
associated plots in eFigs 8–10 in Online Resource 3. These plots together with the summary statistics provide weight
to the hypothesis that certain groups of mental disorders are
more costly than others and that these rankings are relatively per-
Discussion
sistent between countries.
We found 143 cost-of-illness studies that covered 48 countries and While only based on two studies, we note that the top median
many types of mental disorders. The majority of these studies societal cost per patient (PPP adjusted) were developmental disor-
used a prevalence-based approach in accordance with ders (which includes autism spectrum disorders), followed by
the previous literature (Drummond, 1992), but they varied widely schizophrenia and intellectual disabilities. However, it is import-
by study perspective, cost categories, time period and reporting ant to note that while disorders such as mood, neurotic and sub-
quality. stance use disorders were less costly according to societal cost per
In line with earlier systematic reviews which focused on single patient, these disorders are much more prevalent and thus would
mental disorders (Luppa et al., 2007; Fajutrao et al., 2009; contribute substantially to the total national cost in a country, as

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 6 M. K. Christensen et al.

Table 1. Societal cost per patient in US dollars adjusted by country’s purchasing power parity and inflation until year 2018 (USD PPP 2018) by disorder group

Societal cost per patient (USD PPP 2018)

Disorder group N Median Mean Min. Max. 1st Qu. 3rd Qu.

Substance use 95 4681 5069 798 11 944 2997 6511

Schizophrenia 72 13 256 18 313 3255 96 466 8171 21 842
Mood disorders 101 4492 5703 158 40 044 2852 7081
Neurotic disorders 217 956 1180 128 13 861 568 1502
Eating disorders 34 547 1629 41 38 183 327 691
Personality disorders 33 5834 5828 1637 10 051 3547 7573
Intellectual disabilities 30 10 105 9762 3052 22 040 6431 12 174
Developmental disorders 2 16 783 16 783 4236 29 330 10 509 23 056
Behavioural disorders 5 2151 5347 840 12 588 1867 9290
Developmental disorders & behavioural disorders 30 3564 3672 1368 9472 2621 4142
N, number of estimates (note one study can include several estimates for different countries); Qu, interquartile range.
Note: See eTable 3a in Online Resource 2 for study-by-study level detail about the cost reported

found in economic studies estimating the national burden of productivity or increased health care consumption as a result of
mental disorders in European countries (Gustavsson et al., the individuals’ growth in health (Department of Health
2011) and in China (Xu et al., 2016). Our analysis examining Systems Financing Health Systems and Services: World Health
the percentages between direct and indirect cost of the total soci- Organization, 2009).
etal cost per patient showed that almost half of the total cost was Our systematic review has several additional limitations. First,
driven by indirect cost related to morbidity and mortality and despite our rigorous search strategy, we cannot rule out that some
thereby not direct resource consumption. Previous studies also relevant publications were not identified and included in our
showed that at least half of the total cost was related to indirect study. Another limitation has been the lack of standardisation
cost (Luppa et al., 2007; Chong et al., 2016; Jin and Mosweu, for cost-of-illness studies and with that substantial heterogeneity
2017). This highlights the need for research to develop more cost- in methodology, perspective, cost categories and health care sys-
effective interventions related to prevention and treatment to tem. This has restricted the types of cross-study comparisons
reduce the health loss experienced and the premature mortality that could be made in the systematic review. We have tried to
among people with mental disorders to reduce their economic accommodate this by only comparing studies according to soci-
burden in a society. etal cost per patient, but there were still variations in the studies’
Our systematic review revealed gaps in the empirical level of detail. Additionally, our analyses adjusted by PPP facili-
literature – there were relatively few studies examining the tated between-country comparisons, but this type of cost estimate
economic cost associated with intellectual disabilities, eating does not reflect the actual spending within a country. Last, this
disorders, personality disorders and developmental disorders. review excluded papers with comorbidity between mental disor-
Worryingly, there is a lack of studies from low- and ders and general medical conditions. How comorbidity affects
middle-income countries which affected our ability to make a the economic burden for the investigated mental disorders is
comprehensive overview of the economic burden worldwide. therefore out of scope for this systematic review. However,
Furthermore, there is a need for future economic studies to comorbidity within mental disorders is pervasive (Plana-Ripoll
improve how they report their studies. For example, we found et al., 2019) and people with mental disorders also have an
that the majority of the included studies did not report crucial increased risk for general medical conditions (Momen et al.,
information (e.g. whether sensitivity analyses were done). 2020). Future cost-of-illness studies should explore both the cost
Previous systematic reviews of the cost-of-illness in mental of mental disorders and the additional cost of comorbid medical
disorder have also commented on this issue (Fajutrao et al., conditions. This paper has focused on cost-of-illness studies and
2009; Stuhldreher et al., 2012). has explored the economic burden for mental disorders world-
This review has been restricted to cost-of-illness studies, which wide. Cost-of-illness studies do not include information about
have been criticised for not providing an adequate picture of a dis- the benefits produced from the resources used and cannot be
ease on a macroeconomic level and for not giving a meaningful or used to prioritise the scarce resources in societies. Consequently,
desirable alternative scenario (Department of Health Systems future research should conduct cost-effectiveness or cost-benefit
Financing Health Systems and Services: World Health analyses to investigate where the money is best spent within
Organization, 2009). They value an individual’s life in terms of each country.
the individual’s production to society and ignore other dimen- In conclusion, our systematic review has identified many high-
sions that might be more valued by the individual – and they quality studies on the cost of mental disorders, and we confirm
do not traditionally give value to people outside the workforce. that mental disorders are costly for societies worldwide. The
In addition, the studies seldom include future economic impacts median cost varies by mental disorder type and also varies
such as changed demographic composition and increased labour between countries. We believe that this review provides a solid

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 Epidemiology and Psychiatric Sciences 7

evidence-base to inform health planners and funding agencies Frederix GWJ (2019) Check your checklist: the danger of over- and underesti-
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Acknowledgements. Thanks to Dr Dan Chisholm for his insightful com- Institute for Health Metrics and Evaluation (2020a) GBD Results Tool.
ments on this manuscript and to Dr Carson Sievert for developing the inter- Available at http://ghdx.healthdata.org/gbd-results-tool (Accessed November
active website. 2019).
Institute for Health Metrics and Evaluation (2020b) Global Burden of
Author contributions. Dr McGrath and Christensen had full access to all Disease Study 2017 (GBD 2017) Causes of Death and Nonfatal Causes
the data in the study and take responsibility for the integrity of the data and Mapped to ICD Codes. Available at http://ghdx.healthdata.org/record/
the accuracy of the data analysis. Concept and design: McGrath, ihme-data/gbd-2017-cause-icd-code-mappings (Accessed July 15).
Christensen, Plana-Ripoll, Iburg. Acquisition, analysis or interpretation of International Monetary Fund (2020) Inflation rate, average consumer prices.
data: McGrath, Christensen, Lim, Saha, Cannon, Presley, Plana-Ripoll. Available at https://www.imf.org/external/datamapper/PCPIPCH@WEO/
Drafting of the manuscript: Christensen, McGrath, Plana-Ripoll, Iburg. WEOWORLD/VEN (Accessed January 2020).
Critical revision of the manuscript for important intellectual content: All Jin H and Mosweu I (2017) The societal cost of schizophrenia: a systematic
authors. Statistical analysis: Christensen, Plana-Ripoll, McGrath. Obtained review. Pharmacoeconomics 35, 25–42.
funding: McGrath. Administrative, technical or material support: Lim, Saha, Jo C (2014) Cost-of-illness studies: concepts, scopes, and methods. Clinical
Cannon, Presley. Supervision: McGrath, Plana-Ripoll, Iburg. and Molecular Hepatology 20, 327–337.
Kellermeyer L, Harnke B and Knight S (2018) Covidence and Rayyan.
Financial support. The project is supported by the Danish National
Journal of the Medical Library Association 106, 580–583.
Research Foundation (Niels Bohr Professorship to John McGrath). John
Knapp M and Wong G (2020) Economics and mental health: the current
McGrath is employed by The Queensland Centre for Mental Health
scenario. World Psychiatry 19, 3–14.
Research which receives core funding from the Queensland Health. Oleguer
Konnopka A, Leichsenring F, Leibing E and Konig HH (2009)
Plana-Ripoll has received funding from the European Union’s Horizon 2020
Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders:
research and innovation programme under the Marie Sklodowska-Curie
a systematic review. Journal of Affective Disorders 114, 14–31.
grant agreement No 837180.
Luppa M, Heinrich S, Angermeyer MC, Konig HH and Riedel-Heller SG
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submit the manuscript for publication. reporting items for systematic reviews and meta-analyses: the PRISMA
statement. BMJ 339, 1–8.
Conflict of interest. The authors declare that they have no conflict of Momen NC, Plana-Ripoll O, Agerbo E, Benros ME, Børglum AD,
interest. Christensen MK, Dalsgaard S, Degenhardt L, de Jonge P, Debost
J-CPG, Fenger-Grøn M, Gunn JM, Iburg KM, Kessing LV, Kessler RC,
Ethical standards. The manuscript does not contain clinical studies or Laursen TM, Lim CCW, Mors O, Mortensen PB, Musliner KL,
patient data. Nordentoft M, Pedersen CB, Petersen LV, Ribe AR, Roest AM, Saha S,
Schork AJ, Scott KM, Sievert C, Sørensen HJ, Stedman TJ,
Vestergaard M, Vilhjalmsson B, Werge T, Weye N, Whiteford HA,
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