title: Scaling-up treatment of depression and anxiety: a global return on investment analysis.
abstract: BACKGROUND
  Depression and anxiety disorders are highly prevalent and disabling disorders, which result not only in an enormous amount of human misery and lost health, but also lost economic output. Here we propose a global investment case for a scaled-up response to the public health and economic burden of depression and anxiety disorders.
  
  
  METHODS
  In this global return on investment analysis, we used the mental health module of the OneHealth tool to calculate treatment costs and health outcomes in 36 countries between 2016 and 2030. We assumed a linear increase in treatment coverage. We factored in a modest improvement of 5% in both the ability to work and productivity at work as a result of treatment, subsequently mapped to the prevailing rates of labour participation and gross domestic product (GDP) per worker in each country.
  
  
  RESULTS
  The net present value of investment needed over the period 2016-30 to substantially scale up effective treatment coverage for depression and anxiety disorders is estimated to be US$147 billion. The expected returns to this investment are also substantial. In terms of health impact, scaled-up treatment leads to 43 million extra years of healthy life over the scale-up period. Placing an economic value on these healthy life-years produces a net present value of $310 billion. As well as these intrinsic benefits associated with improved health, scaled-up treatment of common mental disorders also leads to large economic productivity gains (a net present value of $230 billion for scaled-up depression treatment and $169 billion for anxiety disorders). Across country income groups, resulting benefit to cost ratios amount to 2·3-3·0 to 1 when economic benefits only are considered, and 3·3-5·7 to 1 when the value of health returns is also included.
  
  
  CONCLUSIONS
  Return on investment analysis of the kind reported here can contribute strongly to a balanced investment case for enhanced action to address the large and growing burden of common mental disorders worldwide.
  
  
  BACKGROUND
  Grand Challenges Canada.
authors.affiliation: Department of Mental Health and Substance Abuse, WHO, Geneva, Switzerland. Electronic address: ChisholmD@WHO.int.
authors.forename: Dan
authors.initials: D
authors.lastname: Chisholm
authors.affiliation: Victoria Institute of Strategic Economic Studies, Melbourne, VIC, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Sweeny
authors.affiliation: Victoria Institute of Strategic Economic Studies, Melbourne, VIC, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Sheehan
authors.affiliation: Victoria Institute of Strategic Economic Studies, Melbourne, VIC, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Rasmussen
authors.affiliation: Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands; Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Netherlands.
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
authors.affiliation: Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Department of Mental Health and Substance Abuse, WHO, Geneva, Switzerland.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Saxena
mesh_terms: D001007:Anxiety / Q000191:economics / Q000628:therapy*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003863:Depression / Q000191:economics / Q000628:therapy*; D014943:Global Health; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008605:Mental Health Services / Q000191:economics* / Q000458:organization & administration