and noncommunicable diseases and that their disorders contribute to both intentional and unintentional injuries, the percentage may be even higher (Prince, Patel, et al., 2007).

Economic Resource Costs

Health problems associated with MEB disorders decrease productivity and significantly increase the utilization of services, thus reducing economic resources available to society for other purposes.


During childhood and adolescence, when most people do not participate in the labor market, the direct impacts of mental disorders and substance use on economic productivity are small but real. Young people with MEB disorders may diminish the productivity of others closely involved in their lives, particularly family members. For example, the stress and unpredictability of having a child with a serious MEB disorder can interfere with parents’ work lives (Busch and Barry, 2007), or a disruptive child in a classroom can interfere with other students’ learning. There may also be significant costs to the work or educational productivity of siblings (Fletcher and Wolfe, 2008).

The indirect and long-term consequences are also likely to be large. These conditions interfere with young people’s ability to invest in their own human capital via education. Many studies show that poor mental health and substance use among young people are negatively related to participation and performance in school (Diego, Field, and Sanders, 2003; Glied and Pine, 2002), as well as high school completion (Vander Stoep, Weiss, et al., 2003), important determinants of productivity in adulthood. These factors can increase risk for such behavioral problems as delinquent and antisocial behavior (Yoshikawa, 1994). Also, to the extent that MEB disorders in childhood carry over into adulthood, there will be further reductions in economic productivity. A large number of studies, many of which focus on depression, document that adults with mental illness and substance abuse disorders are less likely to be employed, and those who are employed work fewer hours and receive lower wages (see Ettner, Frank, and Kessler, 1997; Kessler, Heeringa, et al., 2008). Similarly, as adults, employees with mental


When aggregating the costs of mental disorders and substance abuse, it is important to keep in mind that productivity costs may already be reflected, at least to some extent, in measures of health burden, such as DALYs. Thus, one might be double-counting by claiming, for example, that a case of depression accounts for a certain number of DALYs in addition to productivity costs. This caveat, however, does not take away from the fact that in general productivity costs are large and important to consider in their own right.

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