Skip to main content Accessibility help
×
Home

Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys

  • Daphna Levinson (a1), Matthew D. Lakoma (a2), Maria Petukhova (a2), Michael Schoenbaum (a3), Alan M. Zaslavsky (a2), Matthias Angermeyer (a4), Guilherme Borges (a5), Ronny Bruffaerts (a6), Giovanni de Girolamo (a7), Ron de Graaf (a8), Oye Gureje (a9), Josep Maria Haro (a10), Chiyi Hu (a11), Aimee N. Karam (a12), Norito Kawakami (a13), Sing Lee (a14), Jean-Pierre Lepine (a15), Mark Oakley Browne (a16), Michail Okoliyski (a17), José Posada-Villa (a18), Rajesh Sagar (a19), Maria Carmen Viana (a20), David R. Williams (a21) and Ronald C. Kessler (a2)...

Abstract

Background

Burden-of-illness data, which are often used in setting healthcare policy-spending priorities, are unavailable for mental disorders in most countries.

Aims

To examine one central aspect of illness burden, the association of serious mental illness with earnings, in the World Health Organization (WHO) World Mental Health (WMH) Surveys.

Method

The WMH Surveys were carried out in 10 high-income and 9 low- and middle-income countries. The associations of personal earnings with serious mental illness were estimated.

Results

Respondents with serious mental illness earned on average a third less than median earnings, with no significant between-country differences (χ2(9) = 5.5–8.1, P = 0.52–0.79). These losses are equivalent to 0.3–0.8% of total national earnings. Reduced earnings among those with earnings and the increased probability of not earning are both important components of these associations.

Conclusions

These results add to a growing body of evidence that mental disorders have high societal costs. Decisions about healthcare resource allocation should take these costs into consideration.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys
      Available formats
      ×

Copyright

Corresponding author

Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. Email: kessler@hcp.med.harvard.edu

Footnotes

Hide All

Declaration of interest

R.C.K. has been a consultant for GlaxoSmithKline, Kaiser Permanente, Pfizer, Sanofi-Aventis, Shire Pharmaceuticals and Wyeth-Ayerst; has served on advisory boards for Eli Lilly & Company and Wyeth-Ayerst; and has had research support for his epidemiological studies from Bristol-Myers Squibb, Eli Lilly & Company, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho-McNeil Pharmaceuticalsc, Pfizer and Sanofi-Aventis.

Footnotes

References

Hide All
1 Murray, CJL, Lopez, AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Harvard University Press, 1996.
2 Gabriel, P, Liimatainen, MR. Mental Health in the Workplace. International Labour Office, 2000.
3 Zhang, X, Zhao, X, Harris, A. Chronic diseases and labour force participation in Australia. J Health Econ 2009, 28: 91108.
4 Chatterji, P, Alegria, M, Lu, M, Takeuchi, D. Psychiatric disorders and labor market outcomes: evidence from the National Latino and Asian American Study. Health Econ 2007; 16: 1069–90.
5 Kessler, RC, Heeringa, S, Lakoma, MD, Petukhova, M, Rupp, AE, Schoenbaum, M, et al. Individual and societal effects of mental disorders on earnings in the United States: results from the national comorbidity survey replication. Am J Psychiatry 2008; 165: 703–11.
6 Kessler, RC, Frank, RG. The impact of psychiatric disorders on work loss days. Psychol Med 1997; 27: 861–73.
7 Kessler, RC, Barber, C, Birnbaum, HG, Frank, RG, Greenberg, PE, Rose, RM, et al. Depression in the workplace: effects on short-term disability. Health Aff (Millwood) 1999; 18: 163–71.
8 Berndt, ER, Finkelstein, SN, Greenberg, PE, Howland, RH, Keith, A, Rush, AJ, et al. Workplace performance effects from chronic depression and its treatment. J Health Econ 1998; 17: 511–35.
9 Tarricone, R. Cost-of-illness analysis. What room in health economics? Health Policy 2006; 77: 5163.
10 Kessler, RC, Aguilar-Gaxiola, S, Alonso, J, Angermeyer, MC, Anthony, JC, Brugha, TS, et al. Prevalence and severity of mental disorders in the world mental health survey initiative. In The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders (eds Kessler, RC, Üstün, TB): 534–40. Cambridge University Press, 2008.
11 Shiels, C, Gabbay, MB, Ford, FM. Patient factors associated with duration of certified sickness absence and transition to long-term incapacity. Br J Gen Pract 2004; 54: 8691.
12 World Bank. Data & Statistics, Country Groups by Income. World Bank, 2009 (http://data.worldbank.org/about/country-classifications/country-and-lending-groups).
13 Heeringa, SG, Wells, EJ, Hubbard, F, Mneimneh, ZN, Chiu, WT, Sampson, NA, et al. Sample designs and sampling procedures. In The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders (eds Kessler, RC, Üstün, TB): 1432. Cambridge University Press, 2008.
14 Pennell, B-E, Mneimneh, Z, Bowers, A, Chardoul, S, Wells, JE, Viana, MC, et al. Implementation of the World Mental Health Surveys. In The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders (eds Kessler, RC, Üstün, TB): 3357. Cambridge University Press, 2008.
15 Kessler, RC, Üstün, TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004; 13: 93121.
16 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). APA, 1994.
17 World Health Organization. The ICD–10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
18 First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP). Biometrics Research, New York State Psychiatric Institute, 2002.
19 Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291: 2581–90.
20 Leon, AC, Olfson, M, Portera, L, Farber, L, Sheehan, DV. Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med 1997; 27: 93105.
21 Rice, DP, Miller, LS. Health economics and cost implications of anxiety and other mental disorders in the United States. Br J Psychiatry 1998: 173 (suppl 34): 49.
22 Duan, N, Manning, W, Morris, C, Newhouse, J. Choosing between the sample-selection model and the multi-part model. J Bus Econ Stat 1984; 2: 283–9.
23 Manning, WG. The logged dependent variable, heteroscedasticity, and the retransformation problem. J Health Econ 1998; 17: 283–95.
24 Manning, WG, Mullahy, J. Estimating log models: to transform or not to transform? J Health Econ 2001; 20: 461–94.
25 McCullagh, P, Nelder, J. Generalized Linear Models. Chapman and Hall, 1989.
26 Buntin, MB, Zaslavsky, AM. Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. J Health Econ 2004; 23: 525–42.
27 Schempf, A, Becker, S. On the application of decomposition methods. Am J Public Health 2006; 96: 1899.
28 Wolter, KM. Introduction to Variance Estimation. Springer-Verlag, 1985.
29 Engle, RF. Wald, likelihood ratio, and Lagrange multiplier tests in econometrics. In Handbook of Econometrics, Volume I (eds Griliches, Z, Intriligator, MD): 796801. Elsevier, 1983.
30 Harwood, H, Ameen, A, Denmead, G, Englert, E, Fountain, D, Livermore, G. The Economic Cost of Mental Illness, 1992. National Institute of Mental Health, 2000.
31 Rice, DP, Kelman, S, Miller, LS, Dunmeyer, S. The Economic Costs of Alcohol and Drug Abuse and Mental Illness: 1985. US Department of Health and Human Services, 1990.
32 Ormel, J, Petukhova, M, Chatterji, S, Aguilar-Gaxiola, S, Alonso, J, Angermeyer, MC, et al. Disability and treatment of specific mental and physical disorders across the world. Br J Psychiatry 2008; 192: 368–75.
33 Crowther, RE, Marshall, M, Bond, GR, Huxley, P. Helping people with severe mental illness to obtain work: systematic review. BMJ 2001; 322: 204–8.
34 Latimer, E. Economic considerations associated with assertive community treatment and supported employment for people with severe mental illness. J Psychiatry Neurosci 2005; 30: 355–9.
35 Kessler, RC, Berglund, PA, Zhao, S, Leaf, PJ, Kouzis, AC, Bruce, ML, et al. The 12-month prevalence and correlates of Serious Mental Illness (SMI). In Mental Health, United States, 1996 (eds Manderscheid, RW, Sonnenschein, MA): 5970. US Government Printing Office, 1996.
36 Rost, K, Smith, JL, Dickinson, M. The effect of improving primary care depression management on employee absenteeism and productivity. A randomized trial. Med Care 2004; 42: 1202–10.
37 Wang, PS, Simon, GE, Avorn, J, Azocar, F, Ludman, EJ, McCulloch, J, et al. Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. JAMA 2007; 298: 1401–11.
38 Standing, G. Economic insecurity and global casualisation: threat or promise? Soc Indic Res 2008; 88: 1530.
39 Charles, KK, Decicca, P. Local labor market fluctuations and health: is there a connection and for whom? J Health Econ 2008; 27: 1532–50.
40 Whooley, MA, Kiefe, CI, Chesney, MA, Markovitz, JH, Matthews, K, Hulley, SB. Depressive symptoms, unemployment, and loss of income. The CARDIA Study. Arch Intern Med 2002; 162: 2614–20.
41 Angrist, JD, Imbens, GW, Rubin, DB. Identification of causal effects using instrumental variables. J Am Stat Assoc 1996; 91: 444–55.
42 Rosenbaum, PR. Observational Studies. Springer, 2002.
Type Description Title
PDF
Supplementary materials

Levinson et al. supplementary material
Supplementary Table S1

 PDF (43 KB)
43 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys

  • Daphna Levinson (a1), Matthew D. Lakoma (a2), Maria Petukhova (a2), Michael Schoenbaum (a3), Alan M. Zaslavsky (a2), Matthias Angermeyer (a4), Guilherme Borges (a5), Ronny Bruffaerts (a6), Giovanni de Girolamo (a7), Ron de Graaf (a8), Oye Gureje (a9), Josep Maria Haro (a10), Chiyi Hu (a11), Aimee N. Karam (a12), Norito Kawakami (a13), Sing Lee (a14), Jean-Pierre Lepine (a15), Mark Oakley Browne (a16), Michail Okoliyski (a17), José Posada-Villa (a18), Rajesh Sagar (a19), Maria Carmen Viana (a20), David R. Williams (a21) and Ronald C. Kessler (a2)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *