New calculations of mental health expectancy from EPReMeD

Carol Jagger

Funded by the EUROPA Public Health Programme 2003-2008

EPReMeD

European Policy Information Research on Mental Disorders (EPREMED) aims to:• qualitatively and quantitatively improve mental

health policy practices and potential in Europe • using recently completed ESEMeD/MHEDEA

survey and other related European studies and through

• analyses• data synthesis including mental health expectancy• effective dissemination to relevant stakeholders• provision of training and mobility

ESEMeD/MHEDEA survey design

• Cross-sectional, stratified, multistage, clustered area, probability sample design

• 21 425 adults aged 18+ from Belgium, France, Germany, Italy, the Netherlands and Spain between Jan 2001 and Aug 2003

• Sample frame generally a register of residents or postal registries (France - a commercial list of telephone numbers)

• Non-institutionalised individuals speaking language of their national survey was delivered

• The Composite International Diagnostic Interview (WMH-CIDI) was administered by home interviews using Computer Assisted Personal Interview (CAPI) technology

• Response rate varied from 78.6% (Spain) to 45.9% (France)

Methods for Mental HE

• Sullivan’s method

• Life tables from the EHEMU Information System for the 6 countries • Belgium, France, Germany, Italy, Netherlands, Spain

• Age and sex specific 12 month prevalence of 4 mental disorders (ICD10)• anxiety disorder • major depression episode • dysthymia• mood disorder

• Data weighted to adjust for sampling probabilities, differences between the age and gender characteristics of the national samples and the census distributions of their general populations, and for differences in population size of the countries involved

Results

• Context• LE at birth in 6 countries

• Cross-national comparison of LE with each of 4 mental disorders• LE with and without anxiety at age 25

• Cross-national comparison of proportion of remaining life with each of 4 mental disorders• Proportion of remaining life at age 25 with anxiety

• Relative burden of disorders at age 25• radar plots of proportion of remaining life at age 25 by

gender

Context: LE at birth for 6 countries 1995-2004

LE at birth

72

74

76

78

80

82

84

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Exp

ecte

d y

ears

of

life

Belgium F France F Germany F Italy F Netherlands F Spain F

Belgium M France M Germany M Italy M Netherlands M Spain M

WOMEN

MEN

LE with and without anxiety at age 25

0

5

10

15

20

25

30

35

40

45

50

55

60

M F M F M F M F M F M F

Exp

ecte

d y

ears

of

life

AnxFLE AnxLE

BELGIUM FRANCE GERMANY ITALY NETHERLANDS

SPAIN

Proportion of LE with anxiety at age 25

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

M F M F M F M F M F M F

Pro

po

rtio

n o

f re

mai

nin

g l

ife

AnxFLE AnxLE

BELGIUM FRANCE GERMANY ITALY NETHERLANDS

SPAIN

Relative burden of disorders at age 25Women

0.0

5.0

10.0

15.0

20.0

25.0Anxiety

Major depression

Dysthymia

Mood disorder

Belgium

France

Germany

Italy

Netherlands

Spain

Relative burden of disorders at age 25Men

0.0

1.0

2.03.0

4.0

5.0

6.0

7.0

8.0

9.0Anxiety

Major depression

Dysthymia

Mood disorder

Belgium

France

Germany

Italy

Netherlands

Spain

Dissemination

• Scientific papers

• Focus groups with policy makers

• Country report

Design of country report

Four A4 pages on folded A3• Front

• HE background

What is HE

Mental HE

Calculating HE

Data sources

Index of report

European Policy I nformation Research on Mental Disorders

Country Reports December 2006

MENTAL HEALTH EXPECTANCY I N BELGI UM

What is health expectancy?

Health expectancies were first developed to address whether or not longer life is being accompanied by an increase in the time lived in good health (the compression of morbidity scenario) or in bad health (expansion of morbidity). So health expectancies divide life expectancy into life spent in different states of health, from say good to bad health. In this way they add a dimension of quality to the quantity of life lived.

How is the effect of longer life measured?

The general model of health transitions (WHO, 1984) shows the differences between life spent in different states: total survival, disability-free survival and survival without disabling chronic disease. This leads naturally to life expectancy (the area under the 'mortality' curve), disability-free life expectancy (the area under the 'disability' curve) and life expectancy without chronic disease (the area under the 'morbidity' curve).

The general model of health transition (WHO, 1984): observed mortality and hypothetical morbidity and disability survival curves for females, USA, 1980.

There are in fact as many health expectancies as concepts of health. The commonest health expectancies are based on subjective health and physical functioning. There have been a few mental health expectancies in single countries previously calculated based on

dementia or cognitive impairment

depression.

How do we compare health expectancies?

Health expectancies are independent of the size of populations and of their age structure and so they allow direct comparison of different population sub-groups: e.g.

sexes, socio-professional categories, as well as countries within Europe.

Health expectancies are most often calculated by the Sullivan method (Sullivan, 1971). However to make valid comparisons, the underlying health measure should be truly comparable. The ESEMeD/MHEDEA project (Alonso et al., 2002), funded by the EU, was conducted between 2001 and 2003. This survey was designed to produce comparable data on prevalence, risk factors, burden, and service use of individuals with mental disorders in six European countries (Belgium, France, Germany, Italy, the Netherlands, Spain) representing about 213 million adult and elderly Europeans aged 18 years and over.

What is in this report?

This report is produced by the European Policy Information Research for Mental Disorders (EPReMeD) project as part of its aim to maximise the production of policy relevant information of ESEMeD to the individual countries. In the report we present:

a description of the main purpose of health expectancies

country specific health expectancies based on anxiety, major depression, dysthymia and mood disorder at ages 25, 35 45 and 55

comparison of the proportion of remaining life at ages 25 and 55 spent with each of the disorders in each of the six countries.

References

World Health Organization. The uses of epidemiology in the study of the elderly: Report of a WHO Scientific Group on the Epidemiology of Aging. Geneva: WHO, 1984 (Technical Report Series 706).

Sullivan DF (1971) A single index of mortality and morbidity. HSMHA Health Reports 86:347-354.

Alonso J, Ferrer M, Romera B, et al. The European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000) Project: rationale and methods. International Journal of Methods in Psychiatric Research 2002;11(2): 55-67.

Further details on the calculation and interpretation of health expectancies can be found on www.ehemu.eu and in Robine JM, Jagger C, Mathers CD, Crimmins EM Suzman RM, Eds. Determining health expectancies. Chichester UK: Wiley, 2003.

Format

Four A4 pages on folded A3• Front

• HE background

• Back• Comparison of relative burden (proportion of LE) of all

disordersOR• Bar charts of years spent in good mental health (free of

any disorder) by country

Relative burden age

25

Contact details

Relative burden age

55

Further inf ormation on EPREMED can be f ound on www.epremed.org or contact ????????. Further inf ormation on health expectancies in Europe can be f ound on the European Health Expectancy Monitoring Unit – EHEMU – website: http:/ / www.ehemu.eu

Cross-national comparison of the proportion of life with and without 12 month anxiety disorder, major depression, dysthymia and mood disorder at ages 25 and 55 (Source: ESEMeD/MHEDEA 2001-2)

The radar plots1 below show the proportion of life expectancy at each of the ages 25 and 55 spent with each of the mental disorders by each of the six countries and separately for males and females. The key points are:

Life expectancies in 2001-2 in the six countries ranged from 47.5 years (Belgium) to 49.2 years (Italy) in men and 56.5 years (Netherlands) to 58.7 (France) in women at age 25.

There appeared to be more variation between countries in the proportion of life spent with disorders in men than women.

The proportion of life spent with dysthymia showed the least variation between countries. France had the greatest proportion of life spent with most disorders, particularly anxiety, in women.

Men age 25 Women age 25

0.01.02.03.04.05.06.07.08.0

9.0Anxiety

Major depression

Dysthymia

Mood disorder

BelgiumFranceGermanyItalyNetherlandsSpain

0.0

5.0

10.0

15.0

20.0

25.0Anxiety

Major depression

Dysthymia

Mood disorder

Belgium

France

Germany

Italy

Netherlands

Spain

Men age 55 Women age 55

0.0

1.0

2.0

3.0

4.0

5.0

6.0Anxiety

Major depression

Dysthymia

Mood disorder

BelgiumFranceGermanyItalyNetherlandsSpain

0.0

4.0

8.0

12.0

16.0Anxiety

Major depression

Dysthymia

Mood disorder

BelgiumFranceGermanyItalyNetherlandsSpain

1 Radar plots are a useful way to illustrate the different patterns of mental disorders in the six countries. Plotting the proportion of life

expectancy with each of the disorders takes into account the different life expectancies in the six countries. If the patterns are the same

for all countries then the six quadrilaterals should be the same shape. If the same proportion of remaining life is spent with each of the

disorders then the resulting shape will be a square.

About EPReMeD The European Policy Information Research for Mental Disordersw (EPReMeD) is funded by the European Public Health Programme (2004-2007). It aims to qualitatively and quantitatively improve mental health policy practices and potential in Europe through implementing effective dissemination strategies to different key audiences: the scientific community, the policy-makers, the civil and society, and the mass media. The project includes an active plan of training and mobility together with a formal evaluation of dissemination activities will be performed.

Format

Four A4 pages on folded A3• Front

• HE background

• Back• Comparison of relative burden (proportion of LE) of all

disorders

• Middle• Left – LE with and without each disorder by gender age

25 and definition of disorders• Right – LE with and without each disorder by gender age

55 and references to other country specific mental HE and HE

MHE at age 55 by

gender and

disorder

Key results

Other HE references

Life expectancy with and without 12 month anxiety disorder, major depression, dysthymia and mood disorder at age 55 for Belgium (Source: ESEMeD/MHEDEA 2001-2)

Age 55

19.4

26.3

19.1

27.0

19.5

28.1

18.8

26.6

0.4

2.1

0.7

1.5

0.4

0.4

1.0

1.8

0

5

10

15

20

25

30

Men Women Men Women Men Women Men WomenE

xpec

ted

yea

rs o

f li

fe

LE free of disorder LE with disorder

Anxiety DysthymiaDepression Mood disorder

Published results of health expectancies for Belgium

Bossuyt N, Gadeyne S, Deboosere P, Van Oyen H. Socio-economic inequalities in health expectancy in Belgium. Public Health 2004; 118(1):3-10.

Van Oyen H, Bossuyt N, Deboosere P, Gadeyne S, Tafforeau J. Differences in health expectancy indicators in Belgium by region. Archives of Public Health 2002; 60:341-362.

Key points: In 2002, LE at age 65 in Belgium was 19.7 years for women and 15.9 years for men. Based on the Eurobarometer 58, at age 65, women spent 7.9 years in good health, 9.3 years in fair

health and 2.5 years in bad health (see above for definition of good health). Men of the same age spent 8.3 years in good health compared to 5.7 and 1.8 years in fair or bad

health respectively. Although total years lived by men were less than those for women, the years spent in good health

according to the generic indicator were greater for men than women. These results should be interpreted cautiously given the small sample size (in Belgium 127 women and 88 men aged 65+ years) and the lack of the institutional population. However they serve as an example of future yearly calculations of the “Years of Healthy Life” and other health expectancy indicators which will be possible once the SILC-survey data become routinely available.

Key points: Life expectancy at age 55 in 2001 was 19.8 years for men and 28.4 years for women. The remaining years with mental disorders at age 55 ranged in men from 0.4 years with dysthymia to

1.0 years with mood disorders and in women from 0.4 years with dysthymia to 2.1 years with anxiety.

As at earlier ages, women spend more years and a greater proportion of remaining life than men with anxiety, depression and mood disorders at age 55.

Men at age 55 spend 2.1% of their remaining life at age 55 with anxiety, 3.6% with depression, 1.9% with dysthymia and 5.2% with mood disorders.

Women at age 55 spend 7.44% of their remaining life at age 55 with anxiety, 5.2% with depression, 1.4% with dysthymia and 6.5% with mood disorders.