invested in prevention. Not all MEB disorders are preventable, given current knowledge, and some may never be preventable. On one hand, from this perspective, the estimate of $247 billion overstates the potential value of prevention. On the other hand, this estimate includes only costs avoided from preventing disorders that would meet full clinical criteria and does not include costs that would be avoided from reducing problem behaviors and symptoms in the range in which symptoms are not severe enough to meet diagnostic criteria. These costs are generally not included in cost-of-illness studies, but they may be very large. From this perspective, the estimate of $247 billion understates the aggregate costs of MEB disorders among young people. As well, the estimate does not fully capture the quality of life of the children and their families.

Quantifying the costs of MEB disorders among young people is useful as a way to approximate the potential value of prevention and to compare the burden of these disorders11 among young people with other disease burdens, but very few studies have addressed this topic. In general, as Hu (2006) describes, methodologies in cost-of-illness studies vary and often depend on several assumptions that require further study. In the context of MEB disorders among young people, one important next step for this research literature is to conduct a comprehensive cost-of-illness study for the United States that builds on previous studies, such as Harwood, Ameen, and colleagues (2000) and Ringel and Sturm (2001), and the estimates created for this report by Eisenberg and Neighbors (2007) and accounts for the substantial use of services outside medical settings shown by Costello, Copeland, and colleagues (2007). After the initial work is completed to refine the methodology and identify data sources, periodic updates will be much easier to produce. In addition, further research is needed to improve the ability to project lifetime consequences of mental disorders in childhood. In particular, researchers face the challenge of disentangling confounding factors from true causal relationships in observed relationships between mental disorders in childhood and later outcomes.

Miller (in Biglan, Brennan, et al., 2004) provides a much higher estimate of $435.4 billion in 1998 ($557.3 in 2007 dollars) for the costs of problem behaviors among youth, defined as underage drinking, heroin or cocaine abuse, high-risk sex, youth violence, youth smoking, high school dropout, and youth suicide acts. More than half was attributable to suffering and quality of life, with the balance consisting of work losses, medical spending, and other resource costs. Averaged across all youth, this would be an average cost of $12,300 per youth ages 12-20 ($15,744 in 2007 dollars).

11

 The discussion that follows refers specifically to emotional and behavioral disorders rather than problems, as it is referring to costs associated with actual disorders.



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