1. Epidemiology and Burden
Major Depressive Disorder (MDD)

2. Depression is a highly prevalent disorder
Depression is a chronic, recurring, and progressive disorder affecting
million people worldwide1,2
The percentage of people suffering from MDD worldwide was 4.4% (4.1–4.7%) in
The prevalence of MDD remained very consistent between 1990 (4.4% (95% uncertainty: 4.2–4.7%)), (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 Available at: Accessed April (2) Ferrari AJ, et al PLoS One. 2013a;8(7):e69637

3. Depression is a highly prevalent disorder
It is estimated that each year, 6.9% of the EU population suffers from MDD1
The lifetime prevalence of MDD is 6.5–21%, depending on the country2-4
Mean lifetime prevalence of major depressive episode4
USA
19%
Mexico 8%
Colombia
13%
5–10%
>10–15%
>15–20%
>20%
Brazil
18.8%
South Africa
9.7%
India 9%
Shenzen, China 7%
Japan
9.8%
New Zealand
Ukraine
14.5%
Lebanon
11.2%
Israel
10%
Italy
Spain
11%
France
21%
Belgium
14%
Netherlands
18.5%
Germany
*Total high income countries = 14.6%; total low to middle income countries = 11.1%
Only data for countries in the WHO study are presented
MDD
6.5 – 21 %
Lifetime prevelance: The proportion of individuals in a population that at some point in their life up to the time of assessment have experienced MDD
(1) Wittchen HU et al. Eur Neuropsychopharmacol 2011;21:655-79; (2) Hasin DS et al. Arch Gen Psychiatry 2005;62: ; (3) Kessler RC et al. Arch Gen Psychiatry 2005;62: ; (4) Bromet E et al. BMC Med 2011;9:90

4. 12 month prevelance of mental disorders in Europe in 2011#
This slide provides data on the current (2011) size of mental disorders and neurological disorders for the EU. 12 month prevalence data are based on a complex interdisciplinary effort, structured literature reviews, re-analyses of existing data sets, and appraisals. The report covers the 27 EU countries plus Switzerland, Norway, and Iceland and with its broad range of psychiatric and neurological diagnoses and age range extents a previous report from 2005 (Wittchen and Jacobi 2005).
Overall, these data highlights that in every year over a third of the total EU population suffers from mental disorders. The true size of “disorders of the brain” including neurological disorders is even considerably larger. No indications for increasing overall rates of mental disorders were found since The authors conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century.
* Comments and further details:
Opioid dependence: shown pevalence is from the age group: 15–34: 0.4%. Prevalence is older age groups is lower: age group: 35–44: 0.3%, age group: 45–54: 0.2%, age group: 55–64: 0.1%. (see table 2, page 663, in Wittchen et al., 2011)
OCD = Obsessive Compulsive Disorders (see figure 1, page 668, in Wittchen et al., 2011)
Bipolar Depression (see figure 1, page 668, in Wittchen et al., 2011)
Eating disorder (see figure 1, page 668, in Wittchen et al., 2011). Prevalence of eating disorders are also detailed in table 2, page 663 to be for anorexia nervosa at age range 14–17: 0.54% and at age range 18–65: 0.21% and for bulimia nervosa at age range 14–17: 0.86% and at age range 18–65: 0.14%.
Mental retardation: (see table 3, page 664, in Wittchen et al., 2011)
Cannabis dependence: Data presented are taken from figure 1, page 668, in Wittchen et al., However, varying prevalence is reported depending on the age range: ages 14–17: 1.8% and ages 18–64: 0.3% (see table 2, page 663, in Wittchen et al., 2011)
Psychotic disorders: Data based on 8 studies, while four studies use narrow schizophrenia definition, four studies a broader definition of psychotic syndromes (see table 2, page 663 and figure 1, page 668, in Wittchen et al)
Personality disorders (PD): see figure 1, page 668, in Wittchen et al., 2011 for overall prevalence. PD includes diagnosis for borderline PD (0.7% prevalence) and dissocial/antisocial PD (0.6% prevalence) (table 3, page 664, in Wittchen et al., 2011)
PTSD: Post-traumatic stress disorder. Data presented are taken from figure 1, page 668, in Wittchen et al., However, varying prevalence is reported depending on the age range: ages 14–34: 2.9%, ages 35–65: 1.3% and over an age of 66: 1.1% (see table 2, page 663, in Wittchen et al., 2011)
Conduct disorders: (see figure 1, page 668, in Wittchen et al., 2011)
Alcohol dependence:(see figure 1, page 668, in Wittchen et al., 2011)
Somatorform disorders: Without headache (estimate reduced by cases with headache as main somatoform symptom in order to avoid double count with
headache diagnosis in EBC “cost of disorders of the brain” report) (see table 2, page 663, in Wittchen et al., 2011)
ADHD: Hyperkinetic dis./attention-deficit hyperactivity disorder (ADHD), Prevalence given refers only to age group 2–17, while the age group adjusted prevalence to reflect total population is reported to be 0.6% (table 4, page 666, in Wittchen et al., 2011)
Major depression: see table 2, page 663, in Wittchen et al., Note that in the figure 1 on page 666 the term unipolar depression is used.
Anxiety disorders: Aggregate from one reference study (Jacobi et al., 2004a) because in different studies different anxiety disorders were included; therefore no Md and IQR were calculated; 95% confidence interval is 13.4–15.6%.
Sources:
(1) Wittchen, H.-U., Jacobi, F., Size and burden of mental disorders in Europe — a critical review and appraisal of 27 studies. Eur. Neuropsychopharmacol. 15 (4), 357–376.
(2) Wittchen, H.-U. et al, The size and burden of mental disorders and other disorders of the brain in Europe 2010 Eur. Neuropsychopharmacology (2011) 21, 655–679
(3) Jacobi, F. et al Prevalence, comorbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey
(GHS). Psychol. Med. 34, 597–611.
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, Eur. Neuropsychopharmacology (2011) 21, 655–679

5. Burden of Major Depressive Disorder (MDD)

6. “Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease”
Depression. Factsheet no Available at: Accessed April 2016.
WHO Fact Sheet No Reviewed April 2016

7. MDD is a leading cause of burden
MDD has a worldwide prevalence estimate of 4.4%1
MDD is the second leading cause of years lived with disability (YLDs)2
The Global Burden of Disease Study 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
Ten leading causes of YLDs worldwide, Global Burden of Disease Study 20104
Disorder
Rank
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
Source (slide): 1. Ferrari et al. PLoS One 2013; 8 (7): e69637; page 9 (‘Final prevalence output’ section); 2. Ferrari et al. PLoS Med 2013; 10 (11): e ; page 5 (‘Direct burden of depressive disorders’ section); 3. WHO. The Global Burden of Disease 2004 update: page 50 (‘Halving the contribution of Group 1 causes‘ section) and Figure 27; 4. Vos et al. Lancet 2012; 380: 2163–2196; Figure 4.
Source (notes): Ferrari et al., PLoS One 2013 p9; Ferrari et al., PLoS Med 2013 p4/5; WHO, 2008 p50.
MDD has a worldwide prevalence of 4.4%, corresponding to 298 million people (estimate from 2010 Global Burden of Disease Study [GBDS]).(Ferrari et al., PLoS One 2013) Overall, prevalence is higher in females (5.5%) than in males (3.2%), corresponding to 187 million females and 111 million males worldwide.(Ferrari et al., PLoS One 2013) Prevalence peaks between the ages of 20 and 64 years; the highest number of prevalent cases is in the age group 25–34 years (57 million cases).(Ferrari et al., PLoS One 2013)
Disease burden can be compared across diseases and injuries using the ‘disability-adjusted life-year’ (DALY). One DALY represents the loss of one healthy year of life; it is the sum of the years of life lived with disability (YLD) and years of life lost due to premature mortality.(Ferrari et al., PLoS Med 2013) MDD accounts for 2.5% of global DALYs, making it the eleventh leading cause of disease burden worldwide (estimate from 2010 GBDS).(Ferrari et al., PLoS Med 2013) By 2030, unipolar depressive disorders including MDD are predicted to become the leading cause of DALYs (estimate from 2004 GBDS; not re-estimated following 2010 GBDS).(WHO, 2008) In terms of YLDs, MDD is the second leading cause of burden (accounting for 8.2% of global YLDs), after lower back pain (estimate from 2010 GBDS).(Ferrari et al., PLoS Med 2013)
References:
Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study PLoS Med 2013; 10 (11): e
Ferrari AJ, Charlson FJ, Norman RE, et al. The epidemiological modelling of major depressive disorder: application for the Global Burden of Disease Study PLoS One 2013; 8 (7): e69637.
Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study Lancet 2012; 380 (9859): 2163–2196.
World Health Organization (WHO). The global burden of disease: 2004 update. © World Health Organization 2008.
COPD=chronic obstructive pulmonary disease
DALY=disability-adjusted life-year
(1) Ferrari AJ, et al PLoS One. 2013;8(7):e69637; (2) Ferrari et al. PLoS Med 2013;10(11):e ; (3) WHO. Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level Retrieved from: Accessed April 2016; (4) Vos et al. Lancet 2012; 380: 2163–2196.

8. 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
Amongst the classes of non-communicable disease, neuropsychiatric disorders are the largest contributor to the global disease burden, accounting for 28% of disability-adjusted life years (DALYS) – ahead of cardiovascular disease (22%) and cancer (11%).1 Latest estimates indicate that depression accounts for approximately one third of this neuropsychiatric burden and, by the year 2030, depression is projected to be the largest contributor to the global burden of disease.1,2
Reference
1. Prince M, Patel V, Saxena S, et al. No health without mental health. Lancet 2007; 370: 859–877.
2. World Health Organization (WHO). Global Burden of Disease, 2004 Update. Published 2008.
Dis = Disorder/s; Neurol = Neurologic;
Neuropsych = Neuropsychiatric
Prince et al. Lancet 2007; 370: 859–877

9. 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
Years of reduced function
Years of life lost
Years
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

10. 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
Women
Both
Diagnosis
Total DALYs* 1
Alcohol Use Disorders
1669k
Major Depression
2892k
4320k 2
1428k
Dementias
1477k
2237k 3
Stroke
783k
793k
2040k 4
760k
Migraine
491k
1577k
The DALY is a health gap measure for burden of disease, capturing both years of life lost due to premature mortality and years of life lost due to living with disability. Overall, the burden of disease in mental and other disorders of the brain is mainly due to disability, i.e., these disorders impact on the daily functioning of people, rather than leading to premature mortality compared to cancer or cardiovascular d
In the EU, mental and other disorders of the brain are responsible for a huge proportion of overall burden of disease: almost 1 in 3 of all years of life lost due to premature mortality in women, and almost 1 in 4 in men are due to disorders of the brain.
The three most important contributors to burden of disease are depression (7.2% of the overall burden of disease in Europe), Alzheimer's disease/dementia (3.7%) and alcohol use disorders (3.4%). There are clear gender differences: women were disproportionally affected by depression (one in 10 healthy years of life lost is due to this disorder, or 10.3% of all the DALYs), while formen alcohol use disorders are the biggest relative contributor to the disease burden in Europe (5.3% of all the DALYs).
Sources:
(1) Wittchen, H.-U. et al, The size and burden of mental disorders and other disorders of the brain in Europe 2010 Eur. Neuropsychopharmacology (2011) 21, 655–679
* 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

11. Depression has detrimental effects on overall health
100 80 60 40 20
Mean Health Score (0–100)
90.6
80.3
79.6
79.3
78.9
72.9
67.1
65.8
65.4
58.5
71.8
56.1
Depression adds to the burden of asthma, angina, arthritis, or diabetes
No chronic condition
Asthma only
Angina only
Arthritis only
Diabetes only
Depression only
Depression and arthritis
Depression and angina
Depression and asthma
Depression and diabetes
≥2 chronic conditions
Depression and ≥2 chronic conditions
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.

12. Depression is associated with significant personal and societal consequences
The leading cause of psychiatric disability worldwide2,3
1 in 20 people reported having an episode of depression in the previous year3
Decreased ability to interact with friends, family, and colleagues1,3
High morbidity and mortality2,3
3,000 suicide deaths every day, worldwide3
Severe economic burden for patients and society2
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 Accessed April 16, 2014.

13. 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
Physical health
Finances
Work performance
Personal earnings and household income of people with MDD are substantially lower than those without depression1
People with MDD have the highest number of days away from work of any physical or mental disorder1
1. Kessler RC. Psychiatr Clin North Am 2012;35(1):1–14. 2

14. MDD has significant costs to society
Predicted to be leading cause of disease burden by 20301
Estimated number of people with moderate or severe disability due to depression in 20042
98.7 million
Percentage of the global burden of disease (DALYs) represented by depression in 20042
4.3%
1.4x
Increased risk of mortality for people with depression compared with the general population1
2nd
53%
This slides illustrates the global social burden of MDD. The data are based on a systematic review of epidemiological data by Ferrari et al For this data were pooled using a Bayesian meta-regression. These weights were used to calculate years lived with disability (YLDs) and disability adjusted life years (DALYs). Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders
Country data for key countries also exist.
References:
World Health Organization (WHO). Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level Accessed June 2015
WHO. The Global Burden of Disease 2004 Update. ease/2004_report_update/en/. Accessed July 2015
Ferrari AJ et al. PLoS Medi 2013;10:e
Leading cause of years lived with disability in 20133
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 Retrieved from: Accessed April 2016; (2). WHO The Global Burden of Disease Update. ease/2004_report_update/en/. Accessed April Global Burden of Disease Study Collaborators. Lancet 2015;386(9995):743–800

15. MDD has significant costs to society: EU
Estimated costs of depression1
€ 92 billion*
Percentage of the cost of depression comes from workplace absenteeism and presenteeism1
50%
€ 54 billion*
Non-healthcare-related costs of depression in 2010 (e.g. loss of work productivity)1
50%
>⅓
This slides illustrates European burden of MDD with a focus on costs inferred due to impact on work. Note that: Absenteeism = lost days of work. Presenteeism = low performance while at work, which is transformed into lost day equivalents
References:
(1) Hughes S. MEP: Depression in the Workplace. Accessed July 2015
Percentage of patients being treated for depression who take employment sick leave1
Proportion of patients on employment sick leave taking over 26 weeks off work1
(1) Hughes S. MEP: Depression in the Workplace. Accessed July 2015

16. 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. Major depressive disorder
8,2% (10)
6,3% (7,7)
3,9% (4,8)
3,6% (4,4)
3,4% (4,2)
3,0% (3,7)
3,0% (3,6)
2,6% (3,1)
DALY, disability-adjusted life-year; COPD, chronic obstructive pulmonary disease
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: ; (4) World Health Organization. Available at: = 1. Accessed June 2016

17. Cost per patient of brain disorders in Europe in 2010#
#27 EU countries plus Switzerland, Norway, and Iceland
Mood Disorders*
This slide shows the cost per patients of selected mental disorders in Europe in The report covers the 27 EU countries plus Switzerland, Norway, and Iceland. The wider spectrum of mood disorders (also labeled affective disorders), include two particularly important diagnoses with large societal costs; namely major depression and bipolar disorder.
Variations in the epidemiological data covering mood disorders across studies from various European countries are primarily explained by varying study designs whereas the true differences across countries are small. Therefore, data are based on the median European best estimates of the prevalence rates for all countries. That is, 6.9% for major depression (age 18+) and 0.9% for bipolar disorder (age 18–65).
Source: (1) Gustavsson et al., Cost of disorders of the brain in Europe 2010 Eur Neuropsychopharm (2011)21,
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,

18. Cost per per patient of mental disorders in Europe in 2010#
#27 EU countries plus Switzerland, Norway, and Iceland
Mood Disorders*
This slide shows the cost per patients of selected mental disorders in Europe in The report covers the 27 EU countries plus Switzerland, Norway, and Iceland. The wider spectrum of mood disorders (also labeled affective disorders), include two particularly important diagnoses with large societal costs; namely major depression and bipolar disorder.
Variations in the epidemiological data covering mood disorders across studies from various European countries are primarily explained by varying study designs whereas the true differences across countries are small. Therefore, data are based on the median European best estimates of the prevalence rates for all countries. That is, 6.9% for major depression (age 18+) and 0.9% for bipolar disorder (age 18–65).
Source: (1) Gustavsson et al., Cost of disorders of the brain in Europe 2010 Eur Neuropsychopharm (2011)21,
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,

19. Number of persons with disorders of the brain in Europe 2010#
#27 EU countries plus Switzerland, Norway, and Iceland
Mood Disorders*
This slide shows the number of persons with disorders of the brain in Europe. The report covers the 27 EU countries plus Switzerland, Norway, and Iceland. The wider spectrum of mood disorders (also labeled affective disorders), include two particularly important diagnoses with large societal costs; namely major depression and bipolar disorder.
Variations in the epidemiological data covering mood disorders across studies from various European countries are primarily explained by varying study designs whereas the true differences across countries are small. Therefore, data are based on the median European best estimates of the prevalence rates for all countries. That is, 6.9% for major depression (age 18+) and 0.9% for bipolar disorder (age 18–65).
The total number of persons with any of the disorders of the brain was estimated at 260 million. In the 27 EU countries plus Norway, Iceland and Switzerland
a population of 514 million people was estimated.
Source: (1) Gustavsson et al., Cost of disorders of the brain in Europe 2010 Eur Neuropsychopharm (2011)21,
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,

20. Mood disorders bears the highest total costs of brain disorders in Europe 2010#
#27 EU countries plus Switzerland, Norway, and Iceland
This slide shows the cost per diagnosis of selected mental disorders in Europe in Due to the relative high number of persons diagnosed and the relative high cost per patient, mood disorders ranks as number 1 of the diseases contributing to the total costs of mental or neurological disorders in Europe.
The report covers the 27 EU countries plus Switzerland, Norway, and Iceland. The wider spectrum of mood disorders (also labeled affective disorders), include two particularly important diagnoses with large societal costs; namely major depression and bipolar disorder.
Variations in the epidemiological data covering mood disorders across studies from various European countries are primarily explained by varying study designs whereas the true differences across countries are small. Therefore, data are based on the median European best estimates of the prevalence rates for all countries. That is, 6.9% for major depression (age 18+) and 0.9% for bipolar disorder (age 18–65).
In the 27 EU countries plus Norway, Iceland and Switzerland with a population of 514 million people, the total cost of disorders of the brain was estimated to be €798 billion per year. This cost burden corresponds to 25% of the direct health care expenses and the non-medical direct cost as well as the indirect costs, such as lost work time, are higher than for most other diseases due to the persisting nature of many brain diseases. In total, probably one third of all health related expenses are caused by brain disorders. Mood disorders was the largest contributor with costs estimated to be € million (ppp).
Source: (1) Gustavsson et al., Cost of disorders of the brain in Europe 2010 Eur Neuropsychopharm (2011)21,
Mood Disorders*
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,

21. Mood disorders bears the highest total costs of mental disorders in Europe 2010#
#27 EU countries plus Switzerland, Norway, and Iceland
This slide shows the cost per diagnosis of selected mental disorders in Europe in Due to the relative high number of persons diagnosed and the relative high cost per patient, mood disorders ranks as number 1 of the diseases contributing to the total costs of mental or neurological disorders in Europe.
The report covers the 27 EU countries plus Switzerland, Norway, and Iceland. The wider spectrum of mood disorders (also labeled affective disorders), include two particularly important diagnoses with large societal costs; namely major depression and bipolar disorder.
Variations in the epidemiological data covering mood disorders across studies from various European countries are primarily explained by varying study designs whereas the true differences across countries are small. Therefore, data are based on the median European best estimates of the prevalence rates for all countries. That is, 6.9% for major depression (age 18+) and 0.9% for bipolar disorder (age 18–65).
In the 27 EU countries plus Norway, Iceland and Switzerland with a population of 514 million people, the total cost of disorders of the brain was estimated to be €798 billion per year. This cost burden corresponds to 25% of the direct health care expenses and the non-medical direct cost as well as the indirect costs, such as lost work time, are higher than for most other diseases due to the persisting nature of many brain diseases. In total, probably one third of all health related expenses are caused by brain disorders. Mood disorders was the largest contributor with costs estimated to be € million (ppp).
Source: (1) Gustavsson et al., Cost of disorders of the brain in Europe 2010 Eur Neuropsychopharm (2011)21,
Mood Disorders*
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,

22. Mean Proportion of Time DSM-IV Symptom Cluster Is Present
Depressive symptoms persist during periods of remission and subsequent depressive episodes
1.00
0.80
0.60
0.40
0.20
Mean Proportion of Time DSM-IV Symptom Cluster Is Present
0.00 1 9 17 25 33 41 49 65 73 81 89 97
105
113
121
129
137
145
Weeks of Follow-up
Cognitive problems
Core symptoms: depressed mood/
diminished interest
Lack of energy
Sleeping problems
Worthlessness/guilt
Eating problems
Psychomotor problems
Death ideations 57
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.

23. Cognitive impairment is among the most common residual symptoms in MDD*
Persistent depressive symptoms in STAR*D responders
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.

24. Cognitive deficits are clinically important1,3
Patients with cognitive symptoms of depression often have deficits in overall functioning1,2
Deficits in almost every domain of cognitive functioning2
Deficits associated with functional domains2
Learning
Attention
Motor Skills
Verbal
knowledge
Non-Verbal
Executive
Functioning
Working
Memory
Episodic
Work
Social
Interaction
Family Life
Cognitive Deficits are clinically important1,3
Poor concentration, often described as poor memory, is a core symptom, associated with an inability to make decisions and the patients ‘mind go blank’
Cognitive symptoms are often mistaken for attention-deficit disorder in older patients, dementia
Processing
Speed
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: ; (3) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: APA 2013.

25. Depression costs more to employers than is spent on managing it
Depression costs for employers in selected regions:
€7.5 billion
in Australia3
€54 billion
in the EU1
€37 billion
in the US2
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 Retrieved from: Accessed May 2015

26. 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.