Health Economics: The Hidden Costs of Mental Illness

  • D. Richard MartiniEmail author
  • Tammer Attallah


Psychiatric illness is frequently complicated by challenges to adherence to the treatment plan. The care of patients suffering from mental disorders poses financial challenges for the individual, the family, and the community. However, focusing on direct costs alone is insufficient when considering the total financial burden of mental health disorders. These patients require accommodations in social support, education, housing, criminal justice, and social security systems. Chronic mental illness is frequently complicated by the presence of multiple diagnoses and the fact that these disorders progress and may become more disruptive. This is particularly true when the patient has comorbid physical illness, either as a preexisting condition or as a direct consequence of the psychiatric disorder. The size and scope of the economic impact of mental illness must be better understood in order to adequately allocate resources for patient treatment and support. In the course of treatment, the mental health professional should also consider the patient’s ability to function with autonomy and minimize the non-healthcare impact of the psychiatric disorder.


Financial cost of mental illness Nonadherence Health economics Adherence to psychiatric care 


  1. 1.
    Insel TR. Assessing the economic costs of serious mental illness. Am J Psychiatr. 2008;165(5):663–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Trautmann S, Rehm J, Wittchen H. The economics of mental disorders. EMBO Rep. 2016;17(9):1245–9.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Grupp H, Konig H, Konnopka. J Ment Health Policy Econ. 2014;17:3–8.PubMedGoogle Scholar
  4. 4.
    Bloom DE, Cafiero ET, Jane-Llopis E, et al. The global economic burden of non-communicable diseases. Geneva: World Economic Forum; 2011.Google Scholar
  5. 5.
    Suryavanshi MS, Yang Y. Clinical and economic burden of mental disorders among children with chronic physical conditions, United States, 2008–2013. Prev Chronic Dis. 2016;13:150535. Scholar
  6. 6.
    Oliveira C, Cheng J, Vigod S, Rehm J, Kurdyak P. Patients with high mental health costs incur over 30 percent more costs than other high-cost patients. Health Aff. 2016;35(1):36–43. Scholar
  7. 7.
    Carnethon MR, Kinder LS, Fair JM, et al. Symptoms of depression as a risk factor for incident diabetes: findings from the National Health and Nutrition Examination Epidemiologic Follow-up Study, 1971-1992. Am J Epidemiol. 2003;158:416–23. [PubMed: 12936896].PubMedCrossRefGoogle Scholar
  8. 8.
    Scherrer JD, Virgo KS, Zeringue A, et al. Depression increases risk of incident myocardial infarction among veterans administration patients with rheumatoid arthritis. Gen Hosp Psychiatry. 2009;31:353–9. [PubMed: 19555796].PubMedCrossRefGoogle Scholar
  9. 9.
    Egede LE. Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. Gen Hosp Psychiatry. 2007;29:409–16.PubMedCrossRefGoogle Scholar
  10. 10.
    Feldman RL, Dunner DL, Muller JS, et al. Medicare patient experience with vagus nerve stimulation for treatment-resistant depression. J Med Econ. 2013;16:62–74.PubMedCrossRefGoogle Scholar
  11. 11.
    Lepine BA, Moreno RA, Campos RN, et al. Treatment-resistant depression increases health costs and resource utilization. Rev Bras Psiquiatr. 2012;34:379–88.PubMedCrossRefGoogle Scholar
  12. 12.
    Ivanova JI, Bimbaum HG, Kidolezi Y, et al. Direct and indirect costs of employees with treatment-resistant and non-treatment-resistant major depressive disorder. Curr Med Res Opin. 2010;26:2475–84.PubMedCrossRefGoogle Scholar
  13. 13.
    Mrazek DA, Hornberger JC, Alter CA, Degtiar I. A review of the clinical, economic, and societal burden of treatment-resistant depression: 1996–2013. Psychiatr Serv. 2014;65:977–87.PubMedCrossRefGoogle Scholar
  14. 14.
    Olfson M, Gameroff MJ. Generalized anxiety disorder, somatic pain and health care costs. Gen Hosp Psychiatry. 2007;29:310–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Zhu B, Zhao Z, Ye W, Marciniak MD, Swindle R. The cost of comorbid depression and pain for individuals diagnosed with generalized anxiety disorder. J Nerv Ment Dis. 2009;197:136–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Papakostas GI, Petersen TJ, Farabaugh AH, et al. Psychiatric comorbidity as a predictor of clinical response to nortriptyline in treatment-resistant major depressive disorder. J Clin Psychiatry. 2003;64:1357–61.PubMedCrossRefGoogle Scholar
  17. 17.
    DiazGranados N, Ibrahim LA, Brutshce NE, et al. Rapid resolution of suicidal ideation after a single infusion of N-methyl-D=aspartate agonist in patient with treatment resistant major depressive disorder. J Clin Psychiatry. 2011;71:1605–11.CrossRefGoogle Scholar
  18. 18.
    Wulsin LR, Singal BM. Do depressive symptoms increase the risk for the onset of coronary disease? Systematic quantitative review. Psychosom Med. 2003;65(2):201–10.PubMedCrossRefGoogle Scholar
  19. 19.
    Penninx BW, Beekman AT, Honia A, et al. Depression and cardiac mortality: results from a community-based longitudinal study. Arch Gen Psychiatry. 2001;58(3):221–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Carney RM, Rich MW, Freeland KE, et al. Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosom Med. 1988;50(6):627–33.PubMedCrossRefGoogle Scholar
  21. 21.
    Whooley MA, de Jonge P, Vittinghoff E, Otte C, Moos R, Carney RM, et al. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. J Am Med Assoc. 2008;300(2):2379–88.CrossRefGoogle Scholar
  22. 22.
    Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol. 2010;56(1):38–46.PubMedCrossRefGoogle Scholar
  23. 23.
    Dickerson F, Brown CH, Fang L, Goldbert RW, Kreyenbuhl J, et al. Quality of life in individuals which serious mental illness and type 2 diabetes. Psychosomatics. 2008;49(2):109–14. Scholar
  24. 24.
    Egede LE, Ellis C. Diabetes and depression: global perspectives. Diabetes Res Clin Pract. 2010;87(3):302–12.PubMedCrossRefGoogle Scholar
  25. 25.
    Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002;25(3):464–70.PubMedCrossRefGoogle Scholar
  26. 26.
    Kalsekar ID, Madhavan SM, Amonkar MM, Scott V, Douglas SM, et al. The effect of depression on health care utilization and costs in patients with type 2 diabetes. Manag Care Interface. 2006;I9(3):39–46.Google Scholar
  27. 27.
    Dickerson F, Brown CH, Fang L, Goldbert RW, Kreyenbuhl J, et al. Quality of life in individuals which serious mental illness and type 2 diabetes. Psychosomatics. 2008;49(2):109–14. Scholar
  28. 28.
    Burton C, McGorm K, Richardson G, Weller D, Sharpe M. J Psychosom Res. 2012;72:242–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. 1990;99:409–15.PubMedCrossRefGoogle Scholar
  30. 30.
    Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders, prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38:1569–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Drossman DA, Camilleri M, Mayer EA, et al. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:2108–31.PubMedCrossRefGoogle Scholar
  32. 32.
    Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500–11.PubMedCrossRefGoogle Scholar
  33. 33.
    Lydiard RB, Fossey MD, Marsh W, et al. Prevalence of psychiatric disorders in patients with irritable bowel syndrome. Psychosomatics. 1993;34:229–34.PubMedCrossRefGoogle Scholar
  34. 34.
    Drossman DA, Creed FH, Olden KW, et al. Psychosocial aspects of the functional gastrointestinal disorders. Gut. 1999;45(suppl 2):25–30.Google Scholar
  35. 35.
    Kleine-Budde K, Muller R, Kawohl W, Bramesfeld A, Moock J, Rossler W. The cost of depression – a cost analysis from a large database. J Affect Disord. 2013;147:137–43.PubMedCrossRefGoogle Scholar
  36. 36.
    Robinson RL, Grabner M, Palli SR, Faries D, Stephenson JJ. Covariates of depression and high utilizers of healthcare: impact on resource use and costs. J Affect Disord. 2016;85:35–43.Google Scholar
  37. 37.
    Corey-Lisle PK, Birnbaum HG, Greenberg PE. Identification of a claims data “signature” and economic consequence for treatment-resistant depression. J Clin Psychiatry. 2002;63:717–26.PubMedCrossRefGoogle Scholar
  38. 38.
    Olchanzki N, McInnis Myers M, Halseth M, et al. The economic burden of treatment-resistant depression. Clin Ther. 2013;35:512–22.CrossRefGoogle Scholar
  39. 39.
    Ormel J, Petukhova M, Chatterji S, et al. Disability and treatment of specific mental and physical disorders across the world. Br J Psychiatry. 2008;192:368–75. [PubMed: 18450663].PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Moussavi S, Chatterji S, Verdes E, et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007;370:851–8. [PubMed: 17826170].PubMedCrossRefGoogle Scholar
  41. 41.
    Alonzo J, Velagat G, Chattergi S, et al. Including information about comorbidity estimates of disease burden: results from the World Health Information World Mental Health Surveys. Psychol Med. 2011;41:876–86.Google Scholar
  42. 42.
    Revici DA, Travers K, Wyrwich KW, et al. Humanistic and economic burden of generalized anxiety disorder in North America and Europe. J Affect Disord. 2012;140:103–12.CrossRefGoogle Scholar
  43. 43.
    Ruscio AM, Chiu WT, Roy-Byrne P, Stang PE, Stein DJ, Wittchen HU, Kessler RC. Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication. J Anxiety Disord. 2007;21:662–76.PubMedCrossRefGoogle Scholar
  44. 44.
    Revicki DA, Brandenburg N, Matza L, Hornbrook MD, Feeny D. Health-related quality of life and utilities in primary-care patients with generalized anxiety disorder. Qual Life Res. 2008;17:1285–94.PubMedCrossRefGoogle Scholar
  45. 45.
    Wetherell JL, Thorp SR, Patterson TL, Golshan SK, Jeste DV, Gatz M. Quality of life in geriatric generalized anxiety disorder: a preliminary investigation. J Psychiatr Res. 2004;38:305–12.PubMedCrossRefGoogle Scholar
  46. 46.
    Marciniak MD, Lage MJ, Dunayevic E, Russell JM, Bowman I, Landbloom RP, Levine LR. The cost of treating anxiety: the medical and demographic correlates that impact total medical costs. Depress Anxiety. 2005;21:178–84.PubMedCrossRefGoogle Scholar
  47. 47.
    Wittchen HU. Generalized anxiety disorder; prevalence, burden, and cost to society. Depress Anxiety. 2002;16:162–71.PubMedCrossRefGoogle Scholar
  48. 48.
    Alonso J, Angermeyer MC, Bernert S, ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMed) Project, et al. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand. Supplementum. 2004;420:21–7.Google Scholar
  49. 49.
    Leucht S, Burkard T, Henderson J, Maj M, Sartorius N. Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand Nov. 2010;116(5):371–33.Google Scholar
  50. 50.
    Bushe CJ, Taylor M, Haukka J. Mortality in schizophrenia: a measurable clinical endpoint. J Psychopharmacol. 2010;24(Suppl):17–25.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Webb R, Abel K, Pickles A, Appleby L. Mortality in offspring of parents with psychotic disorders: a critical review and meta-analysis. AM J Psychiatry. 2005;162(6):1045–56.PubMedCrossRefGoogle Scholar
  52. 52.
    Riggs DS, Caulfield MB, Street AE. Risk for domestic violence: factors associated with perpetration and victimization. J Clin Psychol. 2000;56:1289–316. [PubMed: 11051060].PubMedCrossRefGoogle Scholar
  53. 53.
    Lehrer JA, Buka S, Gortmaker S, et al. Depressive symptomatology as a predictor of exposure to intimate partner violence among US female adolescents and young adults. Arch Pediatr Adolesc Med. 2006;160:270–6. [PubMed: 16520446].PubMedCrossRefGoogle Scholar
  54. 54.
    Kessler RC. The costs of depression. Psychiatr Clin N Am. 2012;35(1):1–14.CrossRefGoogle Scholar
  55. 55.
    Breslau I, Miller E, Jin R, et al. A multinational study of mental disorders, marriage, and divorce. Acta Psychiatr Scand. 2011;124:474–86.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Alonso J, Petukhova M, Vilagut G, et al. Days out of role due to common physical and mental conditions: results from the WHO World Mental Health surveys. Mol Psychiatry. 2010;16(12):1234–46. (e-publication ahead of print).PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Jungbauer J, Stelling K, Dietrich S, Angermeyer MC. Schizophrenia: problems of separation in families. J Adv Nurs. 2004;47(6):605–13.PubMedCrossRefGoogle Scholar
  58. 58.
    NAMI. 2008. Schizophrenia, Public attitudes, personal needs.Google Scholar
  59. 59.
    Tronick E, Reck C. Infants of depressed mothers. Harv Rev Psychiatry. 2009;17:147–56. [PubMed: 19373622].PubMedCrossRefGoogle Scholar
  60. 60.
    Breslau J, Lane M, Sampson N, et al. Mental disorders and subsequent educational attainment in a US national sample. J Psychiatr Res. 2008;42:708–16. [PubMed: 183317411].PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Lee S, Tsang A, Breslau J, et al. Mental disorders and termination of education in high-income and low-and middle-income countries: epidemiological study. Br J Psychiatry. 2009;194:411–7. [Pub Med: 19407270].PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    McLeod JD, Kaiser K. Childhood emotional and behavioral problems and educational attainment. Am Sociol Rev. 2004;69:636–58.CrossRefGoogle Scholar
  63. 63.
    Porche MV, Fortuna LR, Lin J, et al. Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young adults. Child Dev. 2011;82:982–98. [PubMed: 21410919].PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Vaughn MG, Wexler J, Beaver KM, et al. Psychiatric correlates of behavioral indicators of school disengagement in the United States. Psychiatry Q. 2011;82:191–206. [PubMed: 20957435].CrossRefGoogle Scholar
  65. 65.
    Tiihonen J, Isohanni M, Rasanen P, Koiranen M, Moring J. Specific major mental disorders and criminality: a 26-year prospective study of the 1966 northern Finland birth cohort. AM J Psychiatry. 1997;154(6):840–5.PubMedCrossRefGoogle Scholar
  66. 66.
    Hodgins S. Violent behavior among people with schizophrenia: a framework for investigations of causes, and effective treatment, and prevention. Philos Trans R Soc Lond Ser B Biol Sci. 2008;363(1503):2505–18.CrossRefGoogle Scholar
  67. 67.
    O’Campo P, Sterigipoulous V, Nir P, et al. How did a housing first intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomized trial. BMJOpen. 2016;6(9):e010581. Scholar
  68. 68.
    Eno Louden J, Skeem JL. Parolees with mental disorder: toward evidence-based practice. 2011. Accessed 15 Nov 2018.
  69. 69.
    Luthra S. Community paramedics work to link patients with mental health care. November 14, 2016: 2016. Accessed 15 Nov 2018.
  70. 70.
    Robertson AG, Swanson JW, Van Dorn RA, Swartz MS. Treatment participation and medication adherence: effects on criminal justice costs of persons with mental illness. Psychiatr Serv. 2014;65:1189–91. Scholar
  71. 71.
    Swanson JW, Frisman LK, Robertson AG, et al. Costs of criminal justice involvement among persons with serious mental illness in Connecticut. Psychiatr Serv. 2013;64:630–7. Scholar
  72. 72.
    Brent DA, Emslie GJ, Clarke GN, et al. Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORIDA) study. Am J Psychiatr. 2009;166:418–26.PubMedCrossRefGoogle Scholar
  73. 73.
    Alegria M, Chatterju P, Wells K, et al. Disparity in depression treatment among racial and ethnic minority population sin the United States. Psychiatr Serv. 2009;59:1264–72.CrossRefGoogle Scholar
  74. 74.
    Berry JG, Bloom S, Foley S, et al. Health inequity in children and youth with chronic health conditions. Pediatrics. 2010;126(suppl 3):S111–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Roehrig C. Mental disorders top the list of the most costly conditions in the United States: $201 billion. Health Aff. 2016;35(6):1130–5. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Pediatric Psychiatry and Behavioral Health, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA
  2. 2.Department of Psychiatry and Behavioral HealthPrimary Children’s HospitalSalt Lake CityUSA
  3. 3.Primary Children’s HospitalSalt Lake CityUSA

Personalised recommendations