title: Association between annual earnings and mental disorders in Spain: individual and societal-level estimates.
abstract: OBJECTIVE
  Indirect costs of mental disorders are considerable and include loss of work productivity. We aimed to study the association between personal annual earnings and common mental disorders in Spain.
  
  
  METHODS
  A cross-sectional population study of a representative sample of noninstitutionalized adults from Spain was performed (ESEMeD-Spain). CIDI 3.0 was administered to assess DSM IV mental disorders, and the Sheehan Disability Scales were used for severity appraisal. Four categories of mental disorders were defined: 12-month serious, 12-month moderate, 12-month mild, and lifetime. Personal annual earnings were assessed. Three models were fitted to estimate differences in annual earnings associated with mental disorders, controlling for sociodemographic variables.
  
  
  RESULTS
  Prevalence rates of 12-month mental disorders were: mild 4.6%, moderate 3.8%, and serious 1.6%. Respondents with 12-month serious mental disorder (SMD) were less likely to report any earnings compared to those with no mental disorders (OR = 0.16; 95% CI = 0.07-0.34, p < 0.001). The earnings gap associated with SMD at the individual level was <euro> 3,935, about 55% less than individuals with no mental disorders. Taking prevalence into account, the societal impact of SMD in Spain was estimated at <euro> 1.40 million annually.
  
  
  CONCLUSIONS
  This is the first study in Spain that describes the earnings gap between individuals with and without mental disorders. Despite the low prevalence of SMD, they represent considerable societal-level productivity loss. Prevention and treatment of SMD should improve work productivity.
authors.affiliation: Health Services Research Unit, IMIM, Institut de Recerca Hospital del Mar, 88, Carrer del Doctor Aiguader, E-80003 Barcelona, Spain.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Barbaglia
authors.forename: Gemma
authors.initials: G
authors.lastname: Vilagut
authors.forename: Lucía
authors.initials: L
authors.lastname: Artazcoz
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.forename: Montserrat
authors.initials: M
authors.lastname: Ferrer
authors.forename: Carlos García
authors.initials: CG
authors.lastname: Forero
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007182:Income; D007406:Interview, Psychological; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D017678:Sex Distribution; D012737:Sex Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult