Mental health and related issues statistics
Data extracted in September 2017.
Figures 1, 2, 6 and Table 4 containing EHIS data: updated in May 2018.
Planned article update: January 2019.
In 2015, 14 % of all hospital beds in the EU were psychiatric care beds.
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, that particular disease is combined with the data for dementia in Tables 2 and 5 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 disorders as their symptoms are often quite 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 an autopsy.
This article is one of a set of statistical articles concerning health status in the EU which forms part of an online publication on health statistics.
Deaths from mental and behavioural disorders, Alzheimer’s disease and intentional self-harm
In 2014, there were 183 thousand deaths in the EU-28 resulting from mental and behavioural disorders, equivalent to 3.7 % of all deaths. Table 1 shows that the proportion of deaths in the United Kingdom (8.2 %) and in the Netherlands, (7.4 %) from mental and behavioural disorders was at least twice as high as the EU-28 average, while mental and behavioural disorders also accounted for at least 1 in 20 deaths in Sweden, Denmark and Luxembourg; some 7.7 % 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 Romania and Bulgaria.
A higher share of women (than men) in the EU-28 died from mental and behavioural disorders (4.7 % of women compared with 2.8 % 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 more than 4.0 percentage points. By contrast, a higher share of the total number of deaths among men (rather than women) was attributed to mental and behavioural disorders in Slovenia, Estonia, Poland and Austria. In Bulgaria, Latvia and Romania the shares were similar for men and for women.
The EU-28’s standardised death rate for mental and behavioural disorders was 38.3 deaths per 100 000 inhabitants in 2014; the death rate for men was only slightly higher than that for women — see Table 1. This pattern was repeated in most EU Member States, most notably in Luxembourg and Slovenia, where the difference was at least 15.0 deaths per 100 000 inhabitants. Standardised death rates for mental and behavioural disorders were higher for women (than men) in Italy, Spain, Greece, Ireland, the Netherlands, Sweden, Malta, the United Kingdom, and most notably in Cyprus where the difference in the rates was 10.2 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 55 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 Latvia and Slovenia 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, Croatia, Germany and Austria. 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 Latvia 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 below 5.0 per 100 000 inhabitants in all but one of the EU Member States. The exception to this pattern was Croatia, where the rate for men stood at 10.9 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 only exceptions to this pattern were recorded in Austria and Germany for men and Luxembourg for women.
Men nearly four times as likely as women to die from intentional self-harm
In 2014, the standardised death rate for intentional self-harm (codes X60-84 and Y87.0) was 11.3 per 100 000 inhabitants for the EU-28, with the rate for men was nearly four times as high as that for women (see Table 3). It should be noted that the comparability of data on intentional self-harm is thought to be limited due to an under reporting of suicides in certain EU Member States (possibly 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 (31.5 per 100 000 inhabitants), followed at some distance by Hungary, Latvia, Slovenia and Estonia, each with rates within the range of 18.3-19.4 per 100 000 inhabitants. Rates between 8.2 and 17.3 per 100 000 inhabitants were recorded for most of the other EU Member States, with the United Kingdom (7.1 per 100 000 inhabitants), Italy (6.3 per 100 000 inhabitants), Greece (5.0 per 100 000 inhabitants) and Cyprus (4.5 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 2.2 times as high in Sweden to 6.9 times as high in Poland, with the largest absolute difference in Lithuania where the rate for women was 9.4 per 100 000 inhabitants and the rate for men was 59.0 per 100 000 inhabitants.
The standardised death rate for intentional self-harm in the EU-28 was higher for persons aged 65 and over (16.8 per 100 000 inhabitants) than for younger people (9.9 per 100 000 inhabitants). This situation, a higher standardised death rate for older people, was observed for all EU Member States except for Poland, the United Kingdom and Ireland where the rates for younger people were higher than those for older people. For both of the age groups shown in Table 3, all of the Member States reported higher standardised death rates for intentional self-harm for men (compared with women); the smallest differences between the sexes for both age groups were recorded in Cyprus.
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. These data are available for all EU Member States, Iceland, 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, 7.1 % of the EU-28 population reported having chronic depression. With 12.1 %, Ireland topped the ranking for the share of its population reporting chronic depression, while double-digit shares were also recorded in Portugal, Germany and Finland. The proportion of people reporting depression was less than 4.0 % in the Czech Republic, Cyprus, Bulgaria and Romania.
The proportion of people who had depressive disorders was higher for women than for men in each of the EU Member States; this pattern was also repeated in Iceland, Norway and Turkey. The share of women reporting chronic depression peaked in Portugal at 17.2 %, which contributed towards Portugal recording the largest gender gap (as the share of Portuguese women reporting chronic depression was 11.3 percentage points higher than the corresponding share for Portuguese men). Gaps of at least 5.0 percentage points were also recorded in Spain, Latvia and Sweden; this was also the case in Turkey.
1 in 10 Europeans aged 75 and over reported chronic depression
Looking across the age groups from youngest to oldest in Table 4, the share of people reporting depression generally increased with age; that said, there was a relatively low prevalence of chronic depression among the young (compared with most other diseases). The only exception was for the class covering those aged 65-74 years, where the prevalence of depression was lower than for people aged 45-54 and 55-64 years.
In 15 of the EU Member States self-perceived chronic depression peaked within the age group covering those aged 75 or over and in another seven of the Member States it was the highest among people aged 55-64. In Portugal, more than one in every five people between the ages of ’65 and 74 years reported having chronic depression. By contrast, the highest shares of people reporting chronic depression in Sweden was among those aged 25-34 (13.1 %), while in Denmark it was among those aged 35-44 (9.8 %). The pattern in Iceland was almost the reverse of the general developments witnessed for the whole of the EU-28 insofar as the highest proportion of the population reporting chronic depression was recorded among those aged 15-24 years (21.7 %), a share that fell with age to 7.9 % among those aged 65-74, before climbing to 10.0 % for those aged 75 or more.
Europeans living in cities were most likely to report chronic depression disorders
Except for the demographic factors analysed so far, the prevalence of chronic depression is also affected by the degree of urbanisation. Figure 2 reveals that the population living in cities was more likely to suffer from chronic depression. In 2014, 7.8 % of the persons living in cities reported depression. This rate was higher than that for those living in towns and suburbs (7.1 %) and rural areas (6.2 %).
Concerning the effects of urbanisation, the majority of countries can be classified into two distinct groups following opposite patterns: those in which the chronic depression rate was higher among those living in cities and those in which rural areas accounted for the highest depression rates. In the first group, the highest proportions were recorded in Ireland (13.2 %), Portugal (13 %), Germany (11.7 %) and Finland (11.3 %). Among the eight countries composing the second group, Sweden (10.2 %) and Spain (8.6 %) recorded the highest rates. Only in Luxembourg, Latvia, Lithuania, as well as Iceland, were the rates for chronic depression higher for those in towns and suburbs. They ranged from 17.4 % in Iceland to 5.5 % in Lithuania.
In 2015, there were 3.5 million in-patients with mental and behavioural disorders who were discharged from hospitals in the EU (2014 data for Belgium, Denmark and Estonia; no recent data for Greece or the Netherlands). In-patient discharges of those treated for mental and behavioural disorders accounted for 7.6 % of the total number of in-patient hospital discharges in Sweden, 7.5 % in Latvia and Luxembourg and 7.2 % in Finland, while these diseases accounted for less than 1.0 % of all in-patient discharges in Ireland (2014 data).
Relative to population size, Germany, Austria, Romania, Lithuania and Finland recorded the highest number of in-patient discharges for those treated for mental and behavioural disorders, some 1.2–1.7 thousand per 100 000 inhabitants, more than 10 times as high as the equivalent ratios for Ireland and Cyprus, where the lowest ratios were recorded.
Particularly long average length of stay for in-patients with mental and behavioural disorders
Across the EU (2015 data except: 2014 data for Belgium and Hungary; no recent data for Greece or the Netherlands), in-patients with mental and behavioural disorders (ICD codes F00-F99) spent a total of 83.1 million days in hospital.
Table 5 presents an analysis of the average length of hospital stays for in-patients treated for mental and behavioural disorders in 2010 and 2015. In 2015, this ranged from 5.8 days in France and 9.5 days in Belgium (2014 data) up to more than 40.0 days in the Czech Republic and in Malta. For the majority of EU Member States these were the longest average lengths of stay of all the categories in the International Shortlist for Hospital Morbidity Tabulation, the few exceptions being in Cyprus, France and Ireland.
Among 16 of the 26 EU Member States for which data are available (no comparison available for Greece or the Netherlands), the average length of a hospital stay for people treated for mental and behavioural disorders fell between 2010 and 2015; the largest reductions were recorded in Cyprus, Finland, the United Kingdom and the Czech Republic (where the average stay fell by 12.5 days). Of the 10 Member States that recorded an increase in the average time spent in hospital for these diseases, increases were consistently less than 4.0 days except in Malta where the average length of stay rose from 34.4 days to 47.3 days (up by 12.9 days).
The remainder of Table 5 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 less time in hospital.
Healthcare beds and personnel
Falling numbers of psychiatric beds in hospitals but increasing numbers of psychiatrists
In 2015, there were 367 thousand psychiatric care beds in hospitals in the EU-28, equivalent to 14.0 % of all hospital beds. This share exceeded one quarter in the Netherlands (30.3 %; 2013 data), Belgium (28.1 %) and Malta (27.9 %), while it was below one tenth in Poland (9.8 %), Bulgaria (9.5 %), Austria (8.1 %), Cyprus (6.4 %) and Italy (2.9 %).
Figure 4 shows the number of psychiatric care beds in hospitals relative to the size of population and this shows a similar list of EU Member States with particularly high or low values. Between 2010 and 2015 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 and Romania (where there was relatively fast growth), as well as Bulgaria, Poland, Latvia, Estonia and Slovenia (where the rate of change was more subdued).
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 speciality, such as neuropsychiatry or child psychiatry. In 2015, there were around 87 thousand psychiatrists in the 26 EU Member States for which data are available (2014 data for Denmark and Sweden, 2013 data for the Czech Republic; no recent data for Hungary or Slovakia). There were between 7.6 and 23.6 psychiatrists per 100 000 inhabitants across those EU Member States for which data are available (see Figure 5), with the highest number of psychiatrists relative to the size of population in Finland and the lowest in Bulgaria.
Psychologists study the mind and its functions, in particular in relation to individual and social behaviour. The second wave of the EHIS included questions asking respondents about their medical consultations with various specialists, including psychologists, psychotherapists or psychiatrists; the survey’s coverage was persons aged 15 and over.
On average, the percentage of persons who reported having consulted a psychologist, psychotherapist, or psychiatrist in the previous 12 months was higher among women (6.3 %) than men (4.2 %). This pattern was evident across almost all EU Member States (see Figure 6) with the exception of Croatia and Malta, where the respective proportion was higher for men than women. In Romania, the proportions for the two sexes were about the same. The largest gender differences were in Sweden, Denmark as well as Iceland (differences of 6 percentage points or more), where the share of women having consulted a psychologist or psychiatrist was about two times higher than the share for men.
Overall (men and women combined), the proportion of the population aged 15 or over that consulted a psychologist or psychiatrist in the previous 12 months was generally between 2 % and 8 %, with the shares in Luxembourg, Sweden, the Netherlands, Germany and Denmark as well as Iceland above this range and the shares in Bulgaria, Cyprus and Romania below it.
Source data for tables and graphs
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 in the EU. The number of in-patient bed days for mental and behavioural disorders in the EU was more than 83 million in 2015 (2014 data for Belgium, Ireland and Hungary; no recent data for Greece or the Netherlands), which was second only to diseases of the circulatory system; an additional 1.9 million in-patient bed days were recorded for EU patients diagnosed with Alzheimer’s disease (2014 data for Belgium and Hungary; no recent data for Estonia, Greece or the Netherlands). Nevertheless, it is believed that many mild to moderate mental disorders are under-diagnosed and consequently untreated and not reported within these official statistics.
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 in 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
- Health status (health_state)
- Self-reported chronic morbidity (hlth_srcm)
- People reporting a chronic disease, by disease (hlth_ehis_cd1)
- 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 mental healthcare or rehabilitative care professionals (hlth_ehis_am6)
- 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)
- 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)
- European Health Interview Survey (EHIS wave 2) — Methodological manual — 2013 edition