Mental health and related issues statistics
- Data extracted in January 2017. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: January 2018.
This article presents an overview of European Union (EU) statistics related to mental and behavioural disorders, Alzheimer’s disease (which is a disease of the nervous system) and intentional self-harm (which is an external cause of morbidity and mortality). It focuses on four aspects:
- deaths from mental and behavioural disorders, Alzheimer’s disease and intentional self-harm;
- the extent of depressive disorders;
- healthcare for mental and behavioural disorders and Alzheimer’s disease; and
- the availability of specialist healthcare resources (beds and personnel).
Mental and behavioural disorders include, for example, dementias (chronic or persistent mental disorders characterised by memory disorder, personality change and impaired reasoning), schizophrenia, and lifestyle influenced disorders (such as alcohol use or drug dependence).
Note that this article generally does not cover diseases of the nervous system, but because Alzheimer’s disease may be linked to mental disorders, in this article that particular disease is combined with the data for dementia in Tables 2 and 4 concerning causes of death and the average length of in-patients stays in hospital. Like dementia, Alzheimer’s disease is a brain disorder; it can be difficult to distinguish these two brain disorders as their symptoms may be similar. The aetio-pathological difference between vascular dementia (when dementia symptoms occur because of problems with the brain’s blood supply, for example through a stroke) and brain disorders caused by Alzheimer’s disease can be made post-mortem, through autopsy.
- 1 Main statistical findings
- 2 Data sources and availability
- 3 Context
- 4 See also
- 5 Further Eurostat information
- 6 External links
Main statistical findings
Deaths from mental and behavioural disorders, Alzheimer’s disease and intentional self-harm
In 2013, there were 177 thousand deaths in the EU-28 resulting from mental and behavioural disorders, equivalent to 3.6 % of all deaths. Table 1 shows that the proportion of deaths in the United Kingdom (7.5 %) and in the Netherlands, (7.4 %) from mental and behavioural disorders was more than double the EU average, while mental and behavioural disorders also accounted for at least 1 in 20 deaths in Sweden, Denmark and Luxembourg; some 7.8 % of all deaths in Switzerland were also attributed to mental and behavioural disorders. By contrast, less than 1.0 % of all deaths were from mental and behavioural disorders in six of the EU Member States, with this share falling to 0.1 % in Greece, Romania and Bulgaria.
A higher share of women (than men) in the EU-28 died from mental and behavioural disorders (4.5 % of women compared with 2.6 % of men). This pattern was repeated across most of the EU Member States and was most pronounced in the Netherlands and the United Kingdom where the difference between the sexes was around 4.5 percentage points. By contrast, a higher share of the deaths among men (rather than women) was attributed to mental and behavioural disorders in Slovenia, Estonia, Poland, Austria, Latvia and Romania. In Bulgaria the shares were similar for men and for women.
The EU-28’s standardised death rate for mental and behavioural disorders was 36.4 deaths per 100 000 inhabitants in 2013; the death rate for men was only slightly higher than that for women — see Table 1. In most EU Member States the standardised death rate for men was higher than that for women, most notably in Slovenia, Finland and Latvia where the difference was at least 10.0 deaths per 100 000 inhabitants. Standardised death rates for mental and behavioural disorders were higher for women than for men in Greece, Spain, Italy, Sweden, the Netherlands, Luxembourg, Ireland, the United Kingdom, and most notably in Malta where the difference in the rates was 15.4 deaths per 100 000 inhabitants.
Deaths in younger ages can be considered as premature. Indeed Table 1 also shows clearly that mental and behavioural disorders were a particularly common cause of death at advanced ages. The EU-28’s standardised death rate from mental and behavioural disorders for those aged 65 and over was 49 times as high as the standardised death rate for persons aged less than 65; this can be compared with the same ratio for all causes of death, where the death rate for those aged 65 and over was 20 times as high.
Among the mental and behavioural disorders, dementia (including data for Alzheimer's disease) was the most important cause of death in the EU-28, although in some EU Member States deaths due to the use of alcohol were more common among men
A more detailed analysis of causes of death is presented in Table 2 for a selection of mental and behavioural disorders, including data for Alzheimer’s disease in the data for dementia. As can be seen, the leading causes of death from mental and behavioural disorders among both men and women were dementia and Alzheimer’s disease (International Statistical Classification of Diseases and Related Health Problems (ICD) codes F00–03 and G30). Nevertheless, the standardised death rate for mental and behavioural disorders due to the use of alcohol (code F10) was also relatively high in some EU Member States, notably among men in Denmark, Slovenia, Latvia, Luxembourg, Germany, Austria, Croatia and Estonia. In fact, among men, the standardised death rate for mental and behavioural disorders due to the use of alcohol was higher than for dementia and Alzheimer’s disease in Estonia and Slovenia (values for Slovenia only include Alzheimer's disease). Standardised death rates for other mental and behavioural disorders (codes F04–09, F17 and F20–99) were relatively low for men and women, with rates in most EU Member States below 5.0 per 100 000 inhabitants. The main exception to this pattern was Croatia where the rate for men reached 15.3 per 100 000 inhabitants and that for women stood at 13.2 per 100 000 inhabitants. Standardised death rates for drug dependence and toxicomania were even lower, with rates in most EU Member States below 1.0 per 100 000 inhabitants. The exceptions to this pattern were Germany and Luxembourg for men and Austria for men and women.
Men nearly four times as likely as women to die from intentional self-harm
In 2013, the standardised death rate for intentional self-harm (codes X60–84 and Y87.0) was 11.7 per 100 000 inhabitants for the EU-28, with the rate for men nearly four times as high as for women (see Table 3). It should be noted that the comparability of data on intentional self-harm is limited due to underreporting of suicides in certain EU Member States due to cultural stigma and other reasons.
The highest standardised death rate for intentional self-harm among the EU Member States was recorded for Lithuania (36.1 per 100 000 inhabitants), followed at some distance by Slovenia, Hungary and Latvia all with rates between 19.1 and 21.7 per 100 000 inhabitants. Rates between 8.1 and 17.3 per 100 000 inhabitants were recorded for most of the other EU Member States, with the United Kingdom (7.4 per 100 000 inhabitants), Italy (6.6 per 100 000 inhabitants), Cyprus (5.2 per 100 000 inhabitants), Malta (5.1 per 100 000 inhabitants) and Greece (4.8 per 100 000 inhabitants) below this range.
In all EU Member States, standardised death rates for intentional self-harm for men were higher than those for women, ranging from 1.9 times as high in Luxembourg to 8.5 times as high in Cyprus, with the largest relative difference in Malta where the rate for women was 0.4 per 100 000 inhabitants and the rate for men was 9.7 per 100 000 inhabitants.
The standardised death rate for intentional self-harm in the EU-28 was higher for persons aged 65 and over (17.4 per 100 000 inhabitants) than for younger people (10.3 per 100 000 inhabitants). This situation, a higher standardised death rate for older people, was observed for all EU Member States except for the United Kingdom, Ireland and Malta where the rates for younger people were higher than the rates for older people. For both of the age groups shown in Table 3, all Member States reported higher standardised death rates for intentional self-harm observed for men than for women.
Extent of depressive disorders
Women reported depressive disorders more often than men
Depressive disorders cover single depressive episodes and recurrent depressive disorders (codes F32–33). In typical depressive episodes: the patient suffers from lowering of mood, reduction of energy, and decrease in activity; the patient’s capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common; sleep is usually disturbed and appetite diminished; self-esteem and self-confidence are almost always reduced and, even in a mild form, some ideas of guilt or worthlessness are often present.
The second wave of the European Health Interview Survey (EHIS) was conducted between 2013 and 2015 and covers persons aged 15 and over. The survey included questions on self-assessment of an individual’s health and data on chronic diseases diagnosed by a medical doctor and which occurred during the previous 12 months. The second wave of EHIS is available for all EU Member States, Norway and Turkey. The next wave of the survey will be conducted in 2019 and it will be run at regular five-year intervals afterwards.
In 2014, at EU-28 level 7.1 % of the population reported having chronic depression. With 11.9 %, Portugal top ranked in the share of total population reporting that they had chronic depression. Overall (men and women combined) the share of people reporting depression was also over 9.0 % in Germany, Finland, Sweden, Luxembourg and Latvia, while it was lowest in Bulgaria and Romania (with shares below 3.5 %).
In all of the EU Member States, Norway and Turkey (see Figure 1), the proportion of people who had depressive disorders was higher for women than for men. The share of women reporting chronic depression peaked in Portugal at 17.2 %, this Member State presented also by far the largest gender difference (11.3 percentage points – pp). The gender gap was at least 5.0 pp also in Spain, Latvia and Sweden, as well as in Turkey.
Looking across the age groups from youngest to oldest, the share of people reporting depression in general increased. The exception was the age class ‘65-74’ which had lower shares than both the ‘55-64’ and ‘75 and over’. In 16 Member States self-perceived chronic depression peaked in the ‘75 and over’ age group and in another 6 Member States it was the highest in the ’55–64’ age group. In Portugal one in every five people between the age class ‘65–74’ reported having chronic depression. On the contrary, in the remaining Member States the highest shares were among the younger age classes: Sweden in the age class ‘25–34’ (13.1 %); Denmark in the ‘35–44’ age class (9.8 %); and Luxembourg (12.4 %), the Netherlands (10.0 %) and Estonia (7.3 %) in the ‘45–54’ age class.
There were around 3.5 million in-patients with mental and behavioural disorders discharged in 2014 from hospitals in the EU (2013 data for Belgium and 2012 for the Netherlands and no data available for Greece). In-patient discharges of those treated for mental and behavioural disorders accounted for 7.4 % of the total number of in-patient hospital discharges in Sweden, 7.5 % in Luxembourg and 7.7 % in Latvia, while these diseases accounted for 1.0 % or less of all in-patient discharges in the Netherlands (2012 data) and just 0.9 % in Ireland.
Relative to population size, Germany, Austria, Romania and Finland recorded the highest number of in-patient discharges for those treated for mental and behavioural disorders, around 1.3 – 1.7 thousand per 100 000 inhabitants, more than 10 times as high as the equivalent ratios for Ireland and the Netherlands (2012 data), while in Cyprus the ratio was as low as 98 per 100 000 inhabitants: note that Ireland and the Netherlands do not provide data on psychiatric/mental health hospitals as is also the case for Belgium, Spain and France.
Particularly long average length of stay for in-patients with mental and behavioural disorders
Across the EU (2014 data except: 2013 data for Belgium, 2012 for the Netherlands and no data for Greece), in-patients with mental and behavioural disorders (ICD codes F00–F99) spent a total of 82.0 million days in hospital.
Table 4 presents an analysis of the average length of hospital stays for in-patients treated for mental and behavioural disorders in 2009 and 2014 (earlier data for some Member States). In 2014, this ranged from 5.7 days in France and 9.9 days in Ireland (excluding psychiatric hospitals or mental health care institutions in both these Member States) up to 38.9 days in the United Kingdom, 40.0 days in the Czech Republic and 44.5 days in Malta. For the majority of EU Member States these were the longest average lengths of stay of all the categories in theInternational Shortlist for Hospital Morbidity Tabulation, the few exceptions being in Cyprus, France and Ireland. It should be noted that the data presented in Table 4 exclude in-patients in some or all psychiatric hospitals or mental health care institutions in several Member States — Belgium, Ireland, Spain, France, Cyprus and the Netherlands.
Among those EU Member States for which data are available (see Table 4 for availability), the average length of a hospital stay for people treated for mental and behavioural disorders generally fell between 2009 and 2014. There were 9 Member States that recorded an increase in the average time spent in hospital for these diseases: Germany, Estonia, Croatia, Latvia, Luxembourg, Hungary, Austria and Romania recorded increases of less than 4.0 days, while Malta reported a very large increase from 27.0 days to 44.5 days.
The remainder of Table 4 provides a more detailed analysis of the average length of hospital stays for in-patients diagnosed with six different types of mental and behavioural disorders; data for in-patients treated for Alzheimer’s disease are again included in the data for dementia. Generally, in-patients with schizophrenia, schizotypal and delusional disorders (codes F20–29) and with dementia and Alzheimer’s disease (codes F00–03 and G30) spent the highest average number of days in hospital, whereas those with disorders related to the use of alcohol (code F10) or psychoactive substances (codes F11–19) generally spent the lowest average number of days in hospital.
Healthcare beds and personnel
Falling numbers of psychiatric beds in hospitals but increasing numbers of psychiatrists
In 2014, there were 370 thousand psychiatric care beds in hospitals in the EU-28, equivalent to 14.0 % of all hospital beds. This share exceeded one quarter in Belgium (27.9 %) and Malta (28.6 %), as well as in Norway (30.2 %), while it was below one tenth in Poland (9.8 %), Bulgaria (9.4 %), Austria (8.1 %) and Cyprus (6.4 %), Italy (2.9 % in 2013) as well as in Turkey (2.1 %).
Figure 3 shows the number of psychiatric care beds in hospitals relative to the size of population and this shows a similar list of countries with particularly high or low values. Between 2009 and 2014 the number of psychiatric care beds in hospitals relative to the size of population fell in most EU Member States with the notable exceptions of Germany, Lithuania, Romania and Croatia where it increased by more than 4 beds per 100 000 inhabitants.
Psychiatrists are medical doctors who specialise in the prevention, diagnosis and treatment of mental illness. They have post-graduate training in psychiatry and may also have additional training in a psychiatric specialty, such as neuropsychiatry or child psychiatry. In 2014, there were around 88 thousand psychiatrists in the 27 EU Member States for which data are available (2013 data for the Czech Republic, Denmark and Sweden, 2010 data for Hungary; no data for Slovakia). There were between 7.9 and 27.4 psychiatrists per 100 000 inhabitants across those EU Member States for which data are available. The highest number of psychiatrists relative to the size of population was in Finland (27.4 per 100 000 inhabitants), although this was surpassed in Switzerland (49.9 per 100 000 inhabitants).
Psychologists study the mind and its functions, in particular in relation to individual and social behaviour. The EHIS conducted between 2006 and 2010 included questions asking respondents about their medical consultations with various specialists, including psychologists; the survey’s coverage was persons aged 15 and over. In most of the participating EU Member States (see Figure 5) the proportion of people who had consulted a psychologist in the previous 12 months was higher for women than for men: in Bulgaria and Romania the proportions were about the same. The largest gender difference was in the Czech Republic where the share of women having consulted a psychologist was more than double the share for men. Overall (men and women combined), the proportion of the population aged 15 and over that consulted a psychologist in the previous 12 months was generally between 1.9 % and 2.7 % among those Member States for which data are available, with the shares in Spain, France, Hungary and Belgium above this range and the shares in Bulgaria and Romania below it.
Data sources and availability
An in-patient is a patient who is formally admitted (or ‘hospitalised’) to an institution for treatment and/or care and stays for a minimum of one night or more than 24 hours in the hospital or other institution providing in-patient care. An in-patient or day care patient is discharged from hospital when formally released after a procedure or course of treatment (episode of care). A discharge may occur because of the finalisation of treatment, signing out against medical advice, transfer to another healthcare institution, or because of death.
The number of deaths from a particular cause of death can be expressed relative to the size of the population. A standardised (rather than crude) death rate can be compiled which is independent of the age and sex structure of a population: this is done as most causes of death vary significantly by age and according to sex and the standardisation facilitates comparisons of rates over time and between countries.
Healthcare resources and activities
Statistics on healthcare resources (such as beds and personnel) and healthcare activities (such as information on hospital discharges) are documented in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.
For hospital discharges and the length of stay in hospitals, the International Shortlist for Hospital Morbidity Tabulation (ISHMT) is used to classify data from 2000 onwards; Chapter V covers mental and behavioural disorders and Chapter VI covers diseases of the nervous system (which includes Alzheimer’s disease):
- Dementia (0501);
- Mental and behavioural disorders due to alcohol (0502);
- Mental and behavioural disorders due to use of other psychoactive substances (0503);
- Mood [affective] disorders (0504);
- Schizophrenia, schizotypal and delusional disorders (0505);
- Other mental and behavioural disorders (0506);
- Alzheimer's disease (0601).
For country specific notes on this data collection, please refer to this background information document.
Self-reported statistics covering the health status of the population for a range of chronic diseases is provided by the European health interview survey (EHIS). This source is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions. The data presented in this article refer to the share of the population aged 15 and over reporting to have been diagnosed by a medical doctor with depression which occurred during the 12 months prior to the survey.
Causes of death
Statistics on causes of death provide information on mortality patterns, supplying information on developments over time in the underlying causes of death. This source is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.
Causes of death are classified according to the European shortlist (86 causes), which is based on the International Statistical Classification of Diseases and Related Health Problems (ICD). Chapter V of the ICD covers mental and behavioural disorders, Chapter VI covers diseases of the nervous system (including Alzheimer's disease) and Chapter XX covers external causes of mortality (including intentional self-harm):
- F00–F09 Organic, including symptomatic, mental disorders;
- F10–F19 Mental and behavioural disorders due to psychoactive substance use;
- F20–F29 Schizophrenia, schizotypal and delusional disorders;
- F30–F39 Mood [affective] disorders;
- F40–F48 Neurotic, stress-related and somatoform disorders;
- F50–F59 Behavioural syndromes associated with physiological disturbances and physical factors;
- F60–F69 Disorders of adult personality and behaviour;
- F70–F79 Mental retardation;
- F80–F89 Disorders of psychological development;
- F90–F98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence;
- F99 Unspecified mental disorder;
- G30 Alzheimer's disease;
- X60–X84 and Y87.0 Intentional self-harm.
For country specific notes on this data collection, please refer to this background information document.
Note on tables: the symbol ‘:’ is used to show where data are not available.
Mental and behavioural disorders make up one of the largest categories of diseases. The number of in-patient bed days in the EU in 2014 (2013 data for Belgium, 2012 for the Netherlands and no data for Greece ) for mental and behavioural disorders was more than 82 million (about one in eight of the total), more than for any other category, except diseases of the circulatory system; a further 2 million in-patient bed days were recorded for patients diagnosed with Alzheimer’s disease. Nevertheless, it is believed that many mild to moderate mental disorders are under-diagnosed and consequently untreated and not reported.
As well as being important for individuals, good mental health is important for society. It impacts on economic performance through productivity losses and increased work-disability costs and may also create a burden for educational and justice systems.
In November 2005, the European Commission published a Green paper ‘Improving the mental health of the population — towards a strategy on mental health for the European Union’. Subsequently, the European pact for mental health and well-being was launched, identifying five priority areas:
- prevention of depression and suicide;
- mental health in youth and education;
- mental health in workplace settings;
- mental health of older people;
- combating stigma and social exclusion.
Between 2009 and 2011 the pact was implemented by way of five conferences, one for each priority; two further conferences were held on ‘Mental health: challenges and possibilities’ (October 2013) and ‘Youth mental health’ (December 2014).
In 2013, a Joint action — mental health and wellbeing was launched. This action builds on previous work developed under the European pact and was carried out until January 2016. Its objective was to contribute to the promotion of mental health and well-being, the prevention of mental disorders, and the improvement of care and social inclusion of people with mental disorders in Europe. The joint action addresses issues related to five areas:
- promotion of mental health at the workplace;
- promotion of mental health in schools;
- promoting action against depression and suicide and implementation of e-health approaches;
- developing community-based and socially inclusive mental health care for people with severe mental disorders; and
- promoting the integration of mental health in all policies.
Causes of death
General health statistics articles
Further Eurostat information
- Health status (health_state)
- Self-reported chronic morbidity (hlth_srcm)
- People reporting a chronic disease, by disease, sex, age and educational attainment level (%) (hlth_ehis_st1)
- Self-reported chronic morbidity (hlth_srcm)
- Health care (hlth_care)
- Health care resources (hlth_res)
- Health care staff (hlth_staff)
- Health care facilities (hlth_facil)
- Health care activities (hlth_act)
- Hospital discharges and length of stay for inpatient and curative care (hlth_co_dischls)
- Hospital discharges - National data (hlth_hosd)
- Length of stay in hospital (hlth_hostay)
- Consultations (hlth_consult)
- Self-reported consultation of a psychologist or physiotherapist by sex, age and educational attainment level (%) (hlth_ehis_hc6)
- Health care resources (hlth_res)
- Causes of death (t_hlth_cdeath)
- General mortality (hlth_cd_gmor)
- Causes of death - Deaths by country of residence and occurrence (hlth_cd_aro)
- Causes of death - Standardised death rate by residence (hlth_cd_asdr2)
- General mortality (hlth_cd_gmor)
Methodology / Metadata
- Causes of death statistics (ESMS metadata file — hlth_cdeath_esms)
- European health interview survey (ESMS metadata file — hlth_det_esms)
- Healthcare activities (ESMS metadata file — hlth_act)
- Healthcare resources (ESMS metadata file — hlth_res)
Source data for tables and figures (MS Excel)
- European Commission — Directorate-General for Health and Food Safety — Autistic Spectrum Disorders (ASD)
- European Commission — Directorate-General for Health and Food Safety — Dementia
- European Commission — Directorate-General for Health and Food Safety — European core health indicators (ECHI)
- European Commission — Directorate-General for Health and Food Safety — Mental health
- European Commission — Directorate-General for Health and Food Safety — Neurodegenerative disorders