Elsevier

Biological Psychiatry

Volume 72, Issue 3, 1 August 2012, Pages 228-237
Biological Psychiatry

Archival Report
Early-Life Mental Disorders and Adult Household Income in the World Mental Health Surveys

https://doi.org/10.1016/j.biopsych.2012.03.009Get rights and content

Background

Better information on the human capital costs of early-onset mental disorders could increase sensitivity of policy makers to the value of expanding initiatives for early detection and treatment. Data are presented on one important aspect of these costs: the associations of early-onset mental disorders with adult household income.

Methods

Data come from the World Health Organization (WHO) World Mental Health Surveys in 11 high-income, five upper-middle income, and six low/lower-middle income countries. Information about 15 lifetime DSM-IV mental disorders as of age of completing education, retrospectively assessed with the WHO Composite International Diagnostic Interview, was used to predict current household income among respondents aged 18 to 64 (n = 37,741) controlling for level of education. Gross associations were decomposed to evaluate mediating effects through major components of household income.

Results

Early-onset mental disorders are associated with significantly reduced household income in high and upper-middle income countries but not low/lower-middle income countries, with associations consistently stronger among women than men. Total associations are largely due to low personal earnings (increased unemployment, decreased earnings among the employed) and spouse earnings (decreased probabilities of marriage and, if married, spouse employment and low earnings of employed spouses). Individual-level effect sizes are equivalent to 16% to 33% of median within-country household income, and population-level effect sizes are in the range 1.0% to 1.4% of gross household income.

Conclusions

Early mental disorders are associated with substantial decrements in income net of education at both individual and societal levels. Policy makers should take these associations into consideration in making health care research and treatment resource allocation decisions.

Section snippets

Samples

The 22 countries include 6 classified by the World Bank as low/lower-middle (Colombia, India, Iraq, Nigeria, Peoples' Republic of China [PRC], and Ukraine), 5 upper-middle (Brazil, Bulgaria, Lebanon, Mexico, and Romania), and 11 higher (Belgium, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Northern Ireland, Portugal, Spain, and the United States) income countries (24). All surveys were based on probability samples of the adult household population either nationally representative

Prevalence of Early-Onset Mental Disorders

Previous WMH reports presented DSM-IV/CIDI disorder lifetime prevalence estimates (17, 36). As in those earlier reports, preliminary analyses found that lifetime prevalence of any early-onset DSM-IV/CIDI disorder is highest in high-income countries (21.5%), lowest in low/lower-middle income countries (11.7%), and intermediate in upper-middle income countries (17.1%). Disorder-specific prevalence estimates generally follow this same cross-national pattern. (Detailed prevalence estimates of

Discussion

Our results show that common early-onset mental disorders are strongly associated with low current household income after adjusting education but that this association is considerably stronger in high-income than upper-middle income countries and not significant at all in low/lower-middle income countries. It considering these differences, it is important to remember that “early onset” is defined as onset before completing education. Given that level of educational attainment varies with

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