Excess physical disease burden associated with selected mental health disorders in Europe

Abstract Introduction People with mental health disorders (MHDs) have worse physical health compared to the general population. To date, no comprehensive epidemiological overview exists and the extent of the excess public health burden is unknown. Our aim was to estimate the prevalence of excess PHC diagnoses associated with MHDs in the European working-age population. Methods We estimated excess PHC diagnoses associated with depressive disorders (DD), bipolar disorder (BD), schizophrenia (SZ), and alcohol use disorders (AUD) for year 2019. Levels of excess risks for PHCs were identified by a structured literature review and synthesised per MHD and categories of PHCs using random-effects meta-analyses. Estimated relative risks (RRs) were combined with country-level disease prevalence and population data to calculate population attributable fractions (PAFs). Based on obtained PAFs we calculated excess PHC diagnoses due to underlying MHDs for all EU-27 member states, Iceland, Liechtenstein, Norway, Switzerland, and the United Kingdom. Results We identified 72 studies for estimating excess levels of risk for PHCs, focused on DD (n = 29, 40%), SZ (n = 26, 36%), BD (n = 9, 13%), AUD (n = 4, 6%), or multiple MHDs (n = 4, 6%). Estimated RRs ranged from 1.3 to 1.8 (DD), from 1.8 to 15.8 (BD), from 1.5 to 4.0 (SZ), and from 1.9 to 3.3 (AUD). Corresponding excess PHC diagnoses in the total European working-age population (312.5 million) were 24.6 million (AUD), 12.6 million (DD), 6.6 million (BD), and 0.9 million (SZ). Discussion This is the first comprehensive estimation of the public health burden of excess PHCs associated with DD, BD, SZ, and AUD in the European working-age population. Our results unequivocally demonstrate broader population health benefits of investments into integrated mental and physical healthcare. Targeted policies should consider prevention strategies as sustainable and equitable approaches to alleviate substantial physical health disparities in people with MHDs. Key messages • Working-age individuals with mental health disorders in Europe suffer from substantial physical health disparities in nearly all physical health areas. • Integrated mental and physical healthcare, and prevention strategies are equitable and sustainable approaches to reduce these physical health disparities.