The Cost of Mental Illness: Side Effects

In developed countries, mental illness causes more disability than any other disease group, including cancer. In 2004, 25% of adult Americans reported having a mental illness in the previous year2. As a consequence, the cost of mental illness is astronomical; it was approximately $300 billion in 2002 in the US alone2, accounting for 6.2% of US healthcare spending. That amounts to about $1,000 a year for every American5. However, if that price is the prescription for mental illness, it’s got plenty of side effects, because the sum, while staggering, only represents a fraction of the actual cost of mental illness. The true tally is much higher and harder to calculate, and includes the toll of mental illness on society, the ill and their families.

Social side effects

Mental illness and resulting discrimination impair the abilities of the ill to participate in society, and rob communities of their contributions. The cost of the work hours and wages lost due to the absence of the ill is referred to as productivity loss. In the UK, depression results in productivity losses that are 23 times as great as the associated healthcare costs, and is the most important cause of absenteeism from the workplace4. Mental illness can also relegate the suffering to the outskirts of society, with severe consequences. In the US, 22% of the incarcerated and 1/3 of the adult homeless population are mentally ill5, and it is estimated that for every £1 of healthcare spending on those referred for addiction treatment in the UK, £3 is spent on them by the criminal justice system, and £10 by the victims of crime4. The mentally ill are also less likely to be hired or be rented to, and more likely to be falsely charged with a violent crime3.

mental illness
For reference: this is what $1 billion in $100 bills looks like.

This social segregation has insidious effects. Working is not just a means to an economic end; it also imparts self-esteem to the employee, and expands their social network4. The benefits of social inclusion are sorely needed by the mentally ill, and could aid in their treatment and recovery. Being ostracized may actually prolong illness or contribute to relapse by lowering self-worth, perpetuating the cause of unemployment and exclusion, and creating a terrible feedback loop.

Personal side effects

While the cost of mental illness to society is very dear, it pales in comparison to the price paid by the afflicted and their families. The mentally ill shoulder physical, emotional, and social burdens as a result of their illness. Serious mental illnesses, such as schizophrenia, cause poor personal care and lifestyle choices (e.g. a high fat diet), which can negatively affect overall health and self-esteem, and act as barrier to social acceptance. The seriously mentally ill smoke 44% of cigarettes used in the US5, and are more likely to be overweight; 40-60% of people with schizophrenia are overweight or obese, which in turn makes them more likely to suffer from diabetes and cardiovascular disease7.

Unfortunately, seeking help isn’t without its own consequences. The treatment for mental illness often includes medication that can have serious side effects. Antidepressants can cause gastrointestinal (e.g. nausea, vomiting) and neuropsychiatric (e.g. drowsiness and dizziness) issues, and negatively interact with other drugs8. Antipsychotics can contribute to weight gain, and those that do put the patient at a greater risk for type II diabetes. Some antipsychotics may also increase the risk of movement disorders, cataracts, and cardiac dysfunction, such as arrhythmias7. Depression and schizophrenia, as well as their respective treatments, are also associated with negative sexual effects, meaning they impair sexual function and satisfaction1.

Stigma and its corollaries, prejudice and discrimination, are pervasive issues for the mentally ill, and mental illnesses have become increasingly stigmatized over the past few decades. These interactions depend on an ‘us’ and ‘them’ mentality perpetuated by stereotypes, and a social, economic, or political power imbalance between the groups. With that dynamic in place, the mentally ill are subjected to both everyday and structural discrimination. Stigma can also be internalized by the ill, a phenomena called self-stigmatization. Stigma strains familial ties; 20% of respondents to a family survey reported lower self-esteem and tenser relationships with other family members as a result of stigma3. The impact of stigma is profound, and can cause the ill to shun treatment, in order to avoid the label of mental illness and its resulting social repercussions6.

The social backlash against mental illness is contingent in part on the idea that it is rare. It isn’t; it’s incredibly common. And while the burden of its symptoms and their treatment is unavoidable, the sting of stigma is not. Acceptance and understanding of mental illness can lighten the load. Mental illness will never be painless, but we might be able to make it a little less expensive.

References

1. Baldwin, D, & A Mayers. (2003). Sexual side-effects of antidepressant and anti-psychotic drugs. Advances in Psychiatric Treatment, 9:202-210.

2. CDC Mental Illness Surveillance. Centers for Disease Control and Prevention. 2 December 2013. Web. 27 April 2014. http://www.cdc.gov/mentalhealthsurveillance/faqs.html

3. Corrigan, PW. (1998). The impact of stigma on severe mental illness. Cognitive and Behavioral Practice, 5:201-222.

4. Knapp, M. (2003). Hidden costs of mental illness. British Journal of Psychiatry, 183:477-478.

5. Insel, TR. (2008). Assessing the economic costs of serious mental illness. American Journal of Psychiatry, 165(6):663-665.

6. Rüsch, N, MC Angermeyer, & PW Corrigan. (2005). Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20:529-539.

7. Üçok, A, & W Gaebel. (2008). Side effects of atypical antispychotics: a brief overview. World Psychiatry, 7(1):58-62.

8. Wilson, K, & P Mottram. (2004). A comparison of side effects of selective serotonin reuptake inhibitors and tricyclic antidepressants in older depressed patients: a meta-analysis. International Journal of Geriatric Psychiatry, 19:754-762.

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Schizophrenia: The Cost of Care

Aliases: schizophrenia

For the theme of economics, it made sense (cents?) to write about the most expensive suite of diseases: mental illnesses. Of these, schizophrenia may be the costliest4. The total overall cost (the cumulative cost, not annual) of schizophrenia in the US in 2002 was estimated to be $62.7 billion, encompassing 2.5% of US healthcare spending3. This astronomical sum is the result of a multitude of causes, the most obvious of which is the large number of people that the illness affects. About 1% of American adults have schizophrenia1; as the US adult population is approximately 241,838,562, this amounts to about 2,418,386 people.

Schizophrenia is chronic, an ailment that persists or recurs throughout life. Because of the early age of onset (most commonly in the late teens or twenties), the illness results in decades of continuous care. The long duration and pervasive social impact of the disease is reflected in the breakdown of the overall cost. While direct health care costs, such as medication and long term care, are high, totaling to approximately $22.7 billion in the US in 2002, the majority of the expense is due to indirect costs (approximately $32.4 billion), with direct non-health care costs, such as living offsets, making up the difference (approximately $7.6 billion)3.

Indirect costs quantify the affect of schizophrenia on society. As it turns out, the single costliest aspect of this illness is not what it demands from the community (i.e. care), but what it withholds. People burdened with schizophrenia are often unable to work, and unemployment, what economists call productivity loss, is the greatest driver behind the rising cost of schizophrenia, both in the US and abroad2,3,4. Of course these facts, like so many of their ilk, are simplistic renderings of a more complex reality. They do not account for the emotional costs incurred by those most affected by schizophrenia: the friends, families and, most importantly, the ill.

schizophrenia
Care: it’s not exactly dollars and cents.

Cause: The underlying causes of schizophrenia remain unclear, but it most likely results from a combination of genetic and environmental factors, meaning the disease requires a genetic predisposition that interacts with the surrounding environment (i.e. prenatal exposure to a virus) to result in illness. Imbalanced brain chemistry, specifically in the neurotransmitters dopamine and glutamate, and abnormal brain development and structure may also play a role in the development of schizophrenia. People are most commonly diagnosed between the ages of 16 and 30 (when symptoms usually develop), and rarely after 45. Men and women are equally susceptible1.

Consequence: People suffering from schizophrenia exhibit three types of symptoms: positive, negative and cognitive. Positive symptoms are behaviors that are not seen in healthy people, and include hallucinations, delusions, and thought and movement disorders. Negative symptoms are more subtle and may be mistaken for depression. They include disruptions to normal emotions and behaviors, such as a flat affect and a lack of pleasure in everyday life. Cognitive symptoms such as poor “working memory” (the ability to use information right after learning it), are even more difficult to identify, and are usually only detected by psychological testing1.

Cure: The treatment of schizophrenia addresses its symptoms (as its causes are not well understood), and relies on antipsychotic medications, which suppress hallucinations and other psychotic symptoms, and psychosocial approaches. Psychosocial treatments include an array of methods, ranging from cognitive and behavioral therapy to social and vocational training1.

References

1. Schizophrenia. National Institute of Mental Health. Web. 1 April 2014.

2. Somaiya, M, S Grover, A Avasthi, & S Chakrabarti. (2014). Changes in cost of treating schizophrenia: Comparison of two studies done a decade apart. Psychiatry Research, 215:547-553.

3. Wu, EG, HG Birnbaum, L Shi, DE Ball, RC Kessler, M Moulis, and J Aggarwal. (2005). The economic burden of schizophrenia in the United States in 2002. Journal of Clinical Psychiatry, 66(9):1122-1129.

4. Zhai, J, X Guo, Min Chen, J Zhao, & Z Su. (2013). An investigation of economic costs of schizophrenia in two areas of China. International Journal of Mental Health Systems, 7:26

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