A recent study led by Judit Simon from the Department of Health Economics, Center for Public Health, at the Medical University of Vienna shows for the first time comprehensively the extent to which people with mental disorders suffer from physical illnesses – and the resulting hospital costs. The analysis of data from 32 European countries, published in the journal The Lancet Psychiatry, shows that the inpatient and emergency treatment of physical comorbidities in alcohol use disorders, depression, bipolar disorders and schizophrenia accounted for a total of around 30.5 billion euros in additional annual hospital costs in Europe in 2019.

These costs are not caused by psychiatric care itself, but by physical illnesses that occur at above-average rates in people with mental illness and often require inpatient or emergency treatment. Particularly common are injuries, for example as a result of falls, substance use or suicide attempts, as well as diseases of the digestive tract such as liver disease or chronic inflammation, which play a major role in alcohol use disorders in particular. Diseases of the nervous system, respiratory system, musculoskeletal system and the cardiovascular system are also significantly more common in people with mental illness. This often results in longer and more intensive hospital treatment, which entails considerable additional costs for the healthcare system. As the study shows, although the largest share of these costs is attributable to alcohol use disorders and depression due to their high rate of occurrence, the proportion of above-average costs is the highest for alcohol use disorders and bipolar disorders.

First estimates of potential savings
In addition to these new insights into costs, the study for the first time also provides estimates of the potential economic savings: a reduction of just one per cent in the physical burden of illness among people with mental illness would lead to annual savings of over 190 million euros in the hospital sector across Europe. "The figures we have calculated underscore the importance of integrated prevention and care approaches that do not treat physical and mental health separately," emphasises study leader Judit Simon, Professor of Health Economics at the Center for Public Health at MedUni Vienna. "Better integration of psychiatric and somatic care can not only improve the quality of life of people with mental illness, but also contribute to the sustainability of healthcare systems."

Mental illness is associated with a significantly increased risk of physical illness. These so-called comorbidities are often the result of a combination of biological, social and care-related factors. “For example, limited access to preventive care, unhealthy living conditions or side effects of medication all play a role,” adds Dennis Wienand, who worked on the study as part of his public health doctoral studies at the Department of Health Economics. For 2019, the latest study in the 27 EU Member States plus Iceland, Liechtenstein, Norway, Switzerland and the United Kingdom found 21.2 million cases of alcohol use disorders associated with 84 million physical co-morbidities. Furthermore, 7.4 million cases of bipolar disorder with 66.8 million comorbidities, 32 million cases of depression with 66.2 million additional physical problems, and three million cases of schizophrenia with 4.9 million physical illnesses were identified. The modelling study is based on data from the European Statistical Agency, the Global Burden of Disease study, country-specific health statistics and a comprehensive synthesis of existing research findings, and takes into account the working-age population (20 to 64 years).