Mental Disorders

Excerpt

This chapter focuses on the attributable and avoidable burden of four leading contributors to mental ill health globally: schizophrenia and related nonaffective psychoses, bipolar affective disorder (manic-depressive illness), major depressive disorder, and panic disorder. The choice of these disorders is determined not only by their contribution to disease burden, but also by the availability of data for the cost-effectiveness analyses. Even where such data are available, they are often from industrial countries and extrapolation has been necessary. The exclusion of other mental disorders, such as childhood disorders, from analysis is not because the authors consider these disorders unimportant but because of the paucity of data. Also, this chapter does not specifically deal with the important issue of suicide. A background paper on suicide in developing countries has been developed as part of the Disease Control Priorities Project (DCPP) and is available (Vijayakumar, Nagaraj, and John 2004). The economic analysis presented in this chapter uses the cost-effectiveness analysis methodology specifically developed for the DCPP. The authors recognize that mental disorders impose costs and burdens on families as well as individuals that are not captured by the DALY. Treatment will alleviate some of this burden in addition to alleviating symptoms and disability.

A description of the major clinical features, natural course, epidemiology, burden, and treatment effectiveness for each group of disorders is given in the next section. For diagnostic criteria, readers are referred to The ICD-10 Classification of Mental and Behavioral Disorders (ICD-10) (WHO 1992) or Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR) (American Psychiatric Association 2000). A discussion follows of population-level costs and cost-effectiveness of interventions capable of reducing the current burden associated with four disorders in different developing regions of the world (tables 31.2–31.6), before moving to a discussion of key issues and implications for mental health policy and improvement of services in developing regions of the world.