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
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.