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Abstract

Royalty-Free/Corbis

Mental disorders exact a heavy economic and social toll in industrial and developing countries alike. Despite advances in the development of treatments, there remains a considerable lag between the state of knowledge and its application. Mental disorders substantially interfere with the ability of children to learn and the ability of adults to function in their families, at work, and in the broader society. The combination of high prevalence, early onset, persistence, and impairment makes mental disorders a major contributor to total disease burden.

In many countries and many cultures, the stigma associated with mental illness constitutes a barrier to help–seeking behavior, diagnosis, and treatment. Four leading contributors to mental ill health globally?schizophrenia, bipolar affective disorder, major depressive disorder, and panic disorder?impose costs and burdens on individuals and families not fully captured by the concept of disability–adjusted life years. For example, among the consequences of mental illness is family burden, as productive time and household resources are given up in the care of the sick family member. The situation of major depressive disorder is especially disturbing in developing countries, where individuals in less than a quarter of cases receive a correct diagnosis and typically are treated with medicines of doubtful efficacy.

Moreover, in developing countries, much of the cost burden of mental illness falls on individuals who purchase modern treatments but only if they can afford to do so. Because of the catastrophic costs associated with mental disorders, governments in developing countries need to be involved in this aspect of health care delivery. Cost–effective interventions include outpatient treatment with first–generation antipsychotic or mood–stabilizing drugs as well as psychosocial counseling for schizophrenia and bipolar disorder and treatment with selective serotonin reuptake inhibitors for depression and panic disorder. These interventions can be implemented as the first steps to overcoming cultural, financial, and structural barriers that prevent people from seeking and receiving treatment.