The EU Mental State Report

EUROPEAN COUNCIL:THE STATE OF THE MENTAL HEALTH IN EUROPE

Mauro G. Carta Maria Carolina Hardoy

Vivianne Kovess

Paris 2004

-General description of well being-Source of hypothesis -Complementary data

against “ad hoc” surveys

MACRO INDICATORS SOURCES:WHO, OECD, EUROSTAT-CRONOS, IMS

Mental health Indicators

-Suicide-Alcohol consumption

-Alcohol related deaths-Drug related deaths

-Mental disorder mortality

AVAILABLE INDICATORS

Total suicide mortality rates across Europe, 1997.Standardised death rates, suicide and self-inflicted injury,

all ages per 100,000.

Source WHO Health for All database

Male deaths from suicide, events of undetermined intent and unknown and unspecified causes. 1999 by country

Female deaths from suicide, events of undetermined intent and unknown and unspecified causes. 1999 by country

Trends in male suicide by country.Standardised death rates, suicide and self inflicted injury,

males all ages per 100,000, 1980-1999.

Red linesindicate a decrease

Green lines

represent an

increase

Trends in female suicide by country.Standardised death rates, suicide and self inflicted injury,

females all ages per 100,000, 1980-1999

Green lines

represent an

increase

Red linesindicate a decrease

Trends of events of undetermined intent in EU in the 90thies MALE (EUROSTAT, COD 0.65)

**1995, °°1996, °1997, *1998, §1999, #2000 -20%0.4UK

-9.7%4.1SWE

=0.5SPA

+6%20.2POR

-20%0.4NOR

-8%0.5NED

-34%0.5LUX

+14.1%1.7ITA

+14.1%2.4IRE

+18%1.0GRE

-1.8%3.3GER

-8.0%4.5FRA

-28.9%3.8°°DNK

-21.3%2.9FNL

-1.2%2.7°BEL

-2.5%0.8AUS

=3.5EU 15

Trend/year, 1995/2000Rate/100,000; 1999 or lastCountry

Trends of events of undetermined intent in EU in the 90thies FEMALE (EUROSTAT, COD 0.65)

**1995, °°1996,°1997, *1998, §1999, #2000

=2.0UK

-2.6%2.3SWE

+7.1%1.7SPA

+5.2%5.9POR

-40.0%0.2NOR

=0.2NED

-13.3%0.6LUX

+13.4%0.6ITA

+14.3%0.7IRE

+20.0%0.4GRE

+4.0%1.5GER

+7.1%1.7FRA

-6.2%2.4DNK

-12.5%0.8FNL

-13.3%1°BEL

=0.5AUS

+1.4%1.4EU 15

Trend/year, 1995/2000Rate/100,000; 1999 or lastCountry

Suicide and old age in males across Europe. Standardised death rates for suicide and self-harm in males aged 0-64 years and males 65 years and over, 1997

Suicide and old age in females across Europe. Standardised death rates for suicide or intentional self harm for

females 0-64 years and females 65 years or older, 1997.

Suicides in young people across Europe. Standardised death rates suicide and self harm.

Males and females aged 15-24 years, 1997.

Mean income pro capita ($ US) trends 1980-2000

+3.2 -124232 (XII)UK

+3.0 -824232 (XII)SWE

+3.3 -120297 (IVX)SPA

+3.5 +117635 (XV)POR

+3.3 +130195 (II)NOR

+3.2 +327675 (V)NED

+3.7 046960 (I)LUX

+3.2 +12506 (IX)ITA

+3.7 +929066 (III)IRE

+3.3 -116950 (XVI)GRE

+3.0 -525936 (VIII)GER

+2.9 -724847 (XI)FRA

+3.2 +125078 (X)FNL

+3.3 +229050 (IV)DNK

+3.1 026049 (VII)BEL

+3,2 +III26864 (VI)AUS

Trend/year %, 1980/2000 (rank differnce)2000Country

Population at risk of poverty across Europe. Percentage of population below 60% of the median equivalised income after social transfers, 2001

1. Country rank of rate of suicide mortality vs country rank of north-south geographical situation

r=0.75 P<0.002 (Spearman correlation test)2. Country rank of rate of suicide mortality vs

country rank of mean income r=0.50 P<0.030 (Spearman correlation test)

1. Country rank of rate of suicide + undetermined intent eventsmortality vs country rank of north-south geographical situation

r=0.60 P<0.029 (Spearman correlation test)2. Country rank of rate of suicide mortality + undetermined intent

events mortality vs country rank of mean income r=0.23 P<0.39 (Spearman correlation test)

Male suicide risk in 15 European Union countries

Male suicide + undetermined intent events in 15 EuropeanUnion countries

Alcohol comsumption across Europe. Litres of pure alcohol per person aged 15 years or over per year, 2001

Relative risk of any mood disorder in the last 12 months

Sale of antidepressants (STAKES)Antidepressants as defined by the ATC

classification system by WHO (Class N06A includes SSRIs, tricyclic

and tetracyclic agents, triazolopyridines, aminoketons, MAO inhibitors, and

other new antidepressants like mirtazapine, reboxetine, venlafaxine,

nefazodone, etc.)

Calculation is based on the volume of sales to pharmacies and hospitals by

wholesalers.

Number of 'defined daily doses' (DDD = assumed average dose

per day for each drug) per 1,000 inhabitants per 365 days.

*1999, °Packages

…22.0 (V) UK

+2.8 48.8 (I)SWE

+1.1° 19.4° (VI)SPA°

…----POR

+2.1 41.4 (II)NOR

…----NED

…---LUX

…9.7 (IX)ITA*

…10.4 (VIII)IRE

…---GRE

+0.7 12.6 (VII)GER

…49,3(I)?FRA

+2.4 35.5 (III)FNL

+0.2 30.3 (IV)DNK

…---BEL

…6.2 (X)AUS

Trend/YearAntidepressantsCountry

Sale of anxiolytics and hypnotics (STAKES)Anxiolytics as defined by the ATC

classification system by WHO (Class N05B includes benzodiazepines, barbiturates and

others like buspirone, hydroxyzinehydrochloride etc.).

Hypnotics as defined by the ATC classification system by WHO (Class N05C

includes benzodiazepines -short acting-, zopiclone, zaleplone, zolpidem etc.).

Calculation is based on the volume of sales to pharmacies and hospitals by wholesalers.

Number of 'defined daily doses' (DDD = assumed average dose

per day for each drug) per 1,000 inhabitants per 365 days.

*1999

…31.8 (V)UK

+0.3 62.6 (II)SWE

-------SPA°

+1.3° ---POR

…50.8(IV)NOR

+1.2 ---NED

…---LUX

…0.3 (IX)ITA*

…13.5 (VI)IRE

…---GRE

+0.4 5.5 (VII)GER

…121 (I?)FRA

+2.481.7 (I)FNL

-2.3 53,1 (III)DNK

…----BEL

…4.8 (VIII)AUS

Trend/YearAnxiolytics and hypnoticsCountry

Sale of antipsychotics (STAKES)

Antipsychotics as defined by the ATC classification system by WHO

(Class N05A includes phenothiazines, thioxanthenes, dibenzoxazepines, dihydroindoles, butyrophenones,

diphenylbutylpiperidines, benzamines and atypical neuroleptics like clozapine,

risperidone, olanzapine etc.).

Calculation is based on the volume of sales to pharmacies and hospitals by wholesalers.

Number of 'defined daily doses' (DDD = assumed average dose

per day for each drug)per 1,000 inhabitants per 365 days.

*1999, °Packages

…4.2 (IX) UK

-0.1 8.6 (VI)SWE

-0.04° 11.7 (III)SPA°

…---POR

+0.1 9.0 (IV)NOR

…----NED

…---LUX

…3.5 (X)ITA*

…19.3 (I)IRE

…---GRE

-0.6 4.6 (VIII)GER

…---FRA

+0.02 15.3 (II)FNL

+0.3 8.0 (VII)DNK

+0.28.9 (V)BEL

…3.1 (XI)AUS

Trend/YearAntipsychoticsCountry

Sale of Antidepressants (IMS)

Antidepressants as defined by the ATC classification system by WHO

(Class N06A includes SSRIs, tricyclic and tetracyclic agents, triazolopyridines,

aminoketons, MAO inhibitors, and other new antidepressants like mirtazapine,

reboxetine, venlafaxine, nefazodone, etc.)

Calculation is based on the volume of sales to pharmacies and hospitals by wholesalers.

Euro per number of inhabitants

+5.6% 6, 77 (IV)UK

+10.1% 10, 70 (I)SWE

+17.8% 6,33 (V)SPA

+16.6% 5, 48 (VII)POR

……NOR

+12.5%5,33 (VIII)NED

……LUX

+28.2%3,55 (IX)ITA

+15.5%9,04 (II)IRE

……GRE

+12.6% 3,32 (X)GER

+7.8 % 6,02 (VI)FRA

……FNL

……DNK

+8.7%7,90 (III)BEL

……AUS

Trend/Year2002 AntidepressantsCountry

Sale of Antipsychotics (IMS).

Antipsychotics as defined by the ATC classification system by WHO

(Class N05A includes phenothiazines, thioxanthenes, dibenzoxazepines, dihydroindoles, butyrophenones,

diphenylbutylpiperidines, benzamines and atypical neuroleptics like clozapine,

risperidone, olanzapine etc.).

Calculation is based on the volume of sales to pharmacies and hospitals by wholesalers.

Euro per inhabitants.

+36.0% 4, 38 (III)UK

……SWE

+27.1% 3,75 (IV)SPA

…----POR

…----NOR

+15.6%2, 39 (IX)NED

…----LUX

+21.8%2, 11 (X)ITA

+23.7%4,50 (II)IRE

+27.2%3, 22 (V)GRE

+21.1% 3, 15 (VI)GER

+10.6% 2,90 (VIII)FRA

+21.0% 5, 21 (I)FNL

…----DNK

+20.4% 3,02 (VII)BEL

…----AUS

Trend/Year2002 AntipsychoticsCountry

Sale of Anxiolytics (IMS).

Anxiolytics as defined by the ATC classification system by WHO (Class

N05B includes benzodiazepines, barbiturates and others like buspirone,

hydroxyzinehydrochloride etc.).

Calculation is based on the volume of sales to pharmacies and hospitals by

wholesalers.

Euro per inhabitants.

+6.0% 0,30 (X)UK

…-----SWE

+1.0% 1,26 (VI)SPA

+1.8% 2,84 (II)POR

…----NOR

+0.2%0,56 (VIII)NED

…----LUX

+3.2%2,87 (I)ITA

+11.0%2.45 (III)IRE

+7.2%0,75 (VII)GRE

-7.4% 0,41 (IX)GER

-0.4% 1,70 (V)FRA

…-----FNL

…----DNK

-4.0% 2,24 (iV)BEL

…----AUS

Trend/Year2002 AnxiolyticsCountry

PRESCRIPTIONS of Antidepressants (IMS)

Antidepressants as defined by the ATC classification system by WHO

(Class N06A includes SSRIs, tricyclic and tetracyclic agents, triazolopyridines,

aminoketons, MAO inhibitors, and other new antidepressants like mirtazapine,

reboxetine, venlafaxine, nefazodone, etc.)

Calculation is based on the volume of sales to pharmacies and hospitals by wholesalers.

Prescriptions by physicians per number of inhabitants per year

+9.2% 0.50 (II)UK

--------------SWE

+4.2% 0.41 (IV)SPA

+10.6% 0.42 (III)POR

……NOR

+2.1%0.30 (VI)NED

……LUX

+8.8%0.24 (VII)ITA

……IRE

……GRE

+1.8% 0.24 (VII)GER

+8.6 % 0.35 (V)FRA

……FNL

……DNK

+4.72%0.501 (I)BEL

……AUS

Trend/Year2000-2002

2002 AntidepressantsCountry

PRESCRIPTIONS of Antipsychotics (IMS)

Antipsychotics as defined by the ATC classification system by WHO

(Class N05A includes phenothiazines, thioxanthenes, dibenzoxazepines, dihydroindoles, butyrophenones,

diphenylbutylpiperidines, benzamines and atypical neuroleptics like clozapine,

risperidone, olanzapine etc.).

Calculation is based on the volume of sales to pharmacies and hospitals by wholesalers.

Prescriptions by physicians per number of inhabitants per year

-0.7% 0.09 (III)UK

……SWE

+2.4% 0.19 (I)SPA

…----POR

…----NOR

-3.1%%0.07 (V)NED

…----LUX

-0.5%0.09 (III)ITA

…----IRE

-----------GRE

+3.1% 0.16 (II)GER

+1.6% 0.08 (IV)FRA

----------FNL

…----DNK

-3.1%% 0.19 (I)BEL

…----AUS

Trend/Year2002 AntipsychoticsCountry

Prescriptions of Anxiolytics (IMS)

Anxiolytics as defined by the ATC classification system by WHO (Class

N05B includes benzodiazepines, barbiturates and others like buspirone,

hydroxyzinehydrochloride etc.).

Calculation is based on the volume of sales to pharmacies and hospitals by

wholesalers.

Prescriptions by physicians per number of inhabitants per

year +2.1% 0,10 (VIII)UK

…-----SWE

+0.6% 0.51 (III)SPA

+1.0% 0.61 (I)POR

…----NOR

-1.2%0,27 (V)NED

…----LUX

-6.2%0.20 (VI)ITA

…----IRE

-----------GRE

-3.7% 0,16 (VII)GER

+3.4% 0.38 (IV)FRA

…-----FNL

…----DNK

-5.5% 0.53 (II)BEL

…----AUS

Trend/Year2002 AnxiolyticsCountry

CONCLUSIONS

Suicide, Sale of Psychotropic drugs

Useful macro-indicators but not sufficient and reliable data for monitoring in E.U.

Needs for improvement in the quality of data

This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.