problems are associated with psychological suffering (U.S. Public Health Service, 1999a) as well as increased risks of physical illnesses (Vreeland, 2007). These health consequences represent an enormous burden during childhood (Glied and Cuellar, 2003) and are also correlated with significantly increased risks to health and reduced productivity in adulthood (Kessler, Berglund, et al., 2005; Kessler, Ormel, et al., 2003).

A young person’s mental disorder or substance abuse may also lead to negative health consequences for other members of society. For example, mental disorders lead to lost productivity and functioning not only for the children, but also for the parents and caregivers of the children (Tolan and Dodge, 2005). Untreated mental illness may also have intergenerational effects. Having a depressed mother, or having two parents with poor mental health, is associated with mental, behavioral, and emotional problems in children (Kahn, Brandt, and Whitaker, 2004; see also Chapter 7).

Substance abuse, and to a lesser extent other MEB disorders, are also associated with more frequent risky behavior (such as driving under the influence) (Harwood, 2000), which often have substantial health repercussions for others. In addition, an individual’s health condition may affect his or her peers; in particular, substance abuse (Gaviria and Raphael, 2001) and suicidal behavior (Gould, Jamieson, and Romer, 2003) are thought to spread among peers via a contagion effect.

To quantify the total health burdens posed by various illnesses and disorders, researchers with the Global Burden of Disease project of the World Health Organization (WHO) and the World Bank calculated disability-adjusted life years (DALYs) lost due to each health condition. This measure accounts for both morbidity (mainly measured by functional impairments) and mortality. For the United States, depression and alcohol use and abuse were among the top five sources of premature death and disability (Michaud, McKenna, et al., 2006). According to the most recent estimates by age group for the United States, in 1996 mental disorders and substance abuse accounted for 30 percent of DALYs lost by people under age 25 (calculation by Eisenberg and Neighbors based on Supplementary Material, Additional File 4 to Michaud, McKenna, et al., 2006).4 This represents by far the highest burden of any disease category for this broad age range. By more specific age intervals, the proportions were 3 percent for ages 0-4, 18 percent for ages 5-14, and 48 percent for ages 15-24. Given evidence that people with mental disorders are at greater risk for both communicable

4

This percentage was calculated by including all conditions in the Global Burden of Disease project’s neuropsychiatric category except epilepsy and multiple sclerosis, which are not typically considered mental disorders. Updated estimates for the United States, for the year 2005, will be available within the next few years, according to Catherine Michaud, the first author of the report used to generate the estimates here.



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