The depression challenge

Brussels Declaration

Helping people with depression in Europe

Recommendations by the Expert Platform on Mental Health – Focus on Depression in support of the European Pact for Mental Health and Well-being

The burden of depression in Europe

Depression is a major public health problem in the Member States of the European Union (EU). It is highly prevalent and has severe consequences in terms of premature mortality and disability.

Depression affects 6% to 8% of EU citizens in any one year, a figure that is valid for all EU Member States. This corresponds to more than 20 million women and men of working age in the EU suffering each year from depression. Furthermore, the burden of depression is likely to grow in the coming years. Whilst a report of the World Bank reveals that mental illness is today the third cause of disability in the world, the WHO predicts that by 2020 depression will rank second in terms of its impact on disability adjusted life years (DALYs). The high prevalence of depression and its disabling impact create a substantial – and potentially growing – economic loss for society. In 2011, the cost of depression in Europe (including the EU 27 Member States, Iceland, Norway and Switzerland) was estimated at €113.4 billion.1

Although governments across the EU have made increasing efforts to devise and establish effective prevention and intervention strategies to deal with depression, only a proportion of people living with the disease receive adequate care. Those who are not recognized as having depression as well as those who are recognized but do not receive adequate treatment, suffer unnecessarily and cannot make their full contribution to society. Depression is also one of the main risk factors for suicide, substance use and physical illness.

The complexity of depression is not fully understood, which contributes to misdiagnosis and inadequate care for people living with this disease. The situation is aggravated by the stigmatisation by the disease which makes many reluctant to seek help. Stigma also reduces the willingness of health care workers to provide care, and readiness of decision makers to allocate sufficient financial measures for the services that would help people with depression.

The burden of depression in the EU has been addressed by the European Pact on Mental Health and Well-being initiated by the European Commission. The Pact provides a framework for exchange and cooperation on mental health across all EU Member States. Furthermore, by including the “Prevention of Depression and Suicide” as one of the five priority themes of the Pact, the European Commission has recognized the importance of specifically addressing unmet needs in depression. Finally, the European Parliament has been vocal on mental health, resulting in Parliament Resolutions on this issue (including the European Parliament Resolution of 19 February 2009 on Mental Health) as well as the setting up of the European Parliament Interest Group on Mental Health, Well-being and Brain Disorders.

Following the European Parliament’s call for the set-up of an EU Platform on Mental Health and Well-being to implement the European Pact, consisting of all the key stakeholders involved in the debate2, the Expert Platform on Mental Health – Focus on Depression was established in September 2009 to support this objective. It is a multi-stakeholder initiative bringing together major organizations concerned with mental health in Europe, as well as mental health experts and representatives of the European institutions. The mission of the Platform is to support the implementation of the EU Mental Health Pact and to contribute to the solution of problems related to depression by addressing issues that were not covered by the Pact.

The Expert Platform and its member organizations fully endorse the important recommendations that have come out of the five EU thematic conferences convened under the EU Mental Health Pact, including the need to fight the stigmatization of depression, to support the prevention of mental disorders, to promote mental health and well-being and to raise awareness of depression as an issue which affects all segments of society and hence calls for a coordinated societal response. These issues have been addressed in detail by a number of the Platform’s member organizations in relevant publications.

Having reviewed the evidence about depression and carried out a survey of services aiming to help people with depression, the Expert Platform has identified three major challenges facing European countries that have to cope with problems related to depression.

It has also formulated a series of recommendations that could help the EU and its Member States to deal with these challenges.

The Challenges

Depressive disorders are often not recognised and do not receive adequate and timely care, which can have severe consequences for individuals suffering from depression, for their family and society.

Approximately half the people who present themselves in primary care with a depression receive a correct and timely diagnosis. Out of those nearly one half do not receive appropriate and timely healthcare for their condition. As a result, these people experience the debilitating effects of their disease, reducing their ability to interact with friends and family, to function at work and to contribute to society.

Even among those who receive adequate treatment and whose condition improves, there are some who experience residual symptoms of the disease, in particular an impairment of cognitive functions (ability to process information, attention, learning and memory), which impacts their functioning in their social roles and their ability to work.

In Europe, countries differ with regard to the availability of psychiatrists, psychiatric nurses, psychotherapists and GPs, reimbursement provisions for treatment interventions, access to innovative disease management approaches and self-help and psycho-education for patients and carers. Such health inequalities in the depression field also exist within Member States.

People living with depression as well as health professionals in the EU frequently do not have sufficient information about mental health services available in their country and often have difficulties when trying to understand what services they can use.

Despite the fact that depression has a huge impact on the person living with the disease as well as on their family and other carers, neither the patients nor their carers are involved in planning and evaluating services that are there to help them.

Depression imposes a huge burden on individuals and their family. Family members are affected by depression to a much greater extent than is recognised, not only in economic terms due to days lost at work while caring for a depressed relative, but also in terms of the impact on their own mental and physical health. As the first contact point for people living with depression, families and carers are frequently at the frontline of the management of depression, yet without specific training and knowledge on what constitutes effective care. In many Member States there are no provisions that would ensure adequate support to family and other carers.

People with depression as well as their families have vast experience and their contribution to the planning of care and to its evaluation would be very useful; yet they are only rarely involved in the decisions about care and its implementation.

National data on the costs of depression is scarce and hardly impacts health policies

Depression is associated with huge direct and indirect costs. In 2011 the cost of depression in Europe (including the EU 27 Member States, Iceland, Norway and Switzerland) has been estimated at €113.4 billion.3 These estimates have to be considered cautiously. Data on the costs associated with depression in individual European countries is often incomplete or inconsistent. There are still many countries in Europe where the cost of depression is under-researched and underestimated, and where the economic impact of depression is not adequately recognised by decision-makers and in the society at large.