Depression: Europe’s biggest challenge

In 2017, more than 40 million Europeans suffered from depression¹. The OECD estimated the total cost of mental ill-health to EU GDP at more than 4 percent in 2015, equivalent to over €600 billion per year². During the pandemic, the prevalence of depression doubled or even tripled in many countries compared with the previous year³, while access to talking therapy and innovative treatment remains uneven⁴.

Beyond statistics, however, untreated depression can adversely affect the lives of individuals² and informal caregivers, for example family members, whose careers and aspirations can be limited by their responsibilities². Problems compound over time, leading to complex webs of additional health care issues², social isolation⁵ and premature deaths². For many sufferers, the stigma of acknowledging depression is so great that they hide it completely and therefore never show up in official figures².

The societal cost 

When OECD economists for the 2018 Health at Glance Report reviewed the impact of mental health on 2015 GDP for the EU, they identified three key areas of focus. The first was spending on health care provision. The second was greater social spending on welfare support for patients and carers. The third and largest impact stemmed from the reduced economic activity of mental health sufferers, as they withdrew from the labor force or became less productive².

This shows that depression is fundamentally a social affair. It may be just one person who suffers directly, but the impact ripples out across their family, community and, ultimately, society at large. Local businesses make less money as depression sufferers retreat from daily life, fewer jobs are created and, at a national level, tax receipts fall due to reduced economic activity.

These widespread social repercussions give governments multiple reasons to address depression. And research suggests there is a wider economic benefit too: a WHO-led study in The Lancet Psychiatry in 2016 suggested that spending on treatments for depression and anxiety had a four-fold return, thanks to the increased health and economic activity of patients¹⁴.

Historically, however, investment in depression has lagged behind other medical areas. As a result of extreme underinvestment, universal mental health coverage remains far out of reach. According to the WHO, in high-income countries only 23 percent of depression sufferers receive minimally adequate treatment⁸. Clinical innovation in depression treatments has also been slow considering the significant burden of the disease¹⁵.

The way forward

There are signs, though, that EU states are finally waking up to the challenge and, as different countries pursue their own strategies, there are ample opportunities for governments to learn from each other.

In 1978, Italy became the first country to institute a community care-based approach to mental health, rather than treating patients punitively by isolating them in asylums, and it has continued to show institutional leadership within Europe ever since¹⁶. In 2019 the Ministry of Health established a Working Group to define guidelines for treatments and work with local mental health departments¹⁶. The government is mandating both rigorous data collection and the sharing of data in common formats so that comparisons can be made more easily¹⁶.

The Covid-19 pandemic increased the spotlight on depression issues in Italy, leading to a mobilization of groups across civil society. Scientific groups have called for additional resources to manage depression, while patient associations are demanding better access to services¹⁷. At a primary care level, pilots have been set up for psychiatrists to oversee and mentor general practitioners in the treatment of depression¹⁸.

French citizens can self-refer to a longstanding network of 1,700 centres médico-psychologiques, which provide a one-stop shop for mental health services. These services range from primary care such as psychiatrists, psychologists and mental health nurses, to secondary support services, including social workers¹⁹.

The French government’s National Court of Auditors has concluded that public psychiatry suffers from chronic underfunding, while a survey last year (commissioned by Janssen France and conducted by polling firm CSA with support from the Pierre Deniker Foundation for mental health research and patient group Unafam) found that only a third of current and past sufferers of depression have received any form of follow-up from a health care professional²⁰.

In Germany social security provides universal access to a range of therapeutic options from Cognitive Behavioral Therapy (CBT) to psychotherapy. Depression sufferers are empowered to make their own decisions on how to use the coverage from social security and they often choose to compensate family carers for their support. This gives patients a sense of control, while also providing a channel for state funds to reach family carers that bear the brunt of supporting depression sufferers²¹.

Germany’s health and social care systems also seek to tailor mental health support to individual patients through joint consultations between the triad of patient, family or carer, and health care professional²¹.

But governments cannot do the work alone. This social problem will require collaboration with communities, health care professionals and pharmaceutical companies to reduce stigma around depression and, crucially, to share data in order to develop modern, predictive techniques for diagnosing and intervening in depression.

Reference List

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2. OECD. (2018). “Health at a Glance: Europe 2018 State if Health in the EU Cycle”. Available at:  https://health.ec.europa.eu/system/files/2020-02/2018_healthatglance_rep_en_0.pdf
3. The Economist Group (2022). “Depression in Europe. Building resilience through awareness, improved access, integrated care, and parity of esteem”. Available at: https://impact.economist.com/projects/depression-in-europe/
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CP-347413 September 2022