Throughout much of history in the Western world, health was understood simply as the opposite of sickness, and sickness as the opposite of health. Limiting the consideration of these concepts in this manner constrains the ability of the medical community and society to appreciate the more subtle complexities of health and disorder. A more comprehensive understanding is gaining popularity in the West as more is learned about wellness and correlates of disease such as disability and dysfunction.1,2
A concept called health-related quality of life (HRQOL) is one product of the changing understanding of health and disorder. HRQOL measurements reflect perceived health and life satisfaction over a period of time.3
Different than other methods of evaluation, HRQOL measurement focuses on the individual's own observations of impairment and health, and thus provides a glimpse into the effects of this diagnosis and is, arguably, the best indication of the impact of disease on an individual's life.
One metric of HRQOL, created by the Centers for Disease Control and Prevention (CDC), the Healthy Days Measures, allows for dramatically different diseases to be compared using the same measurement. Generally, it is difficult to compare the burdens of different disorders because their effects are often dissimilar and unrelated; however, the Healthy Days Measures are able to translate the unique effects of different diseases into a common language, called “unhealthy days,” for easy and effective comparison.
Just as our understanding of health is evolving, so is the nature of health issues confronting humanity. The past century saw a categorical transition in the developed world in the leading causes of death from infectious diseases to chronic conditions.4
Today, 70% of the U.S. population dies from diseases in this class, which absorbs more than $700 billion a year—more than 70% of health-care expenditures in the nation.4,5
This study specifically compared HRQOL of people in the U.S. with chronic medical conditions (diabetes, back/neck problem, and hypertension) with the HRQOL of those with a mental health condition (depression, anxiety, or emotional problem). This assessment offers valuable insight into the differences in perceived health and quality of life for these populations, as there is still much that is unknown about the disability and impairment associated with mental health conditions, which contributes to stigma and discrimination.
Formulating an association with medical disorders, whose effects we are more familiar with, might construct a frame of reference as we examine the societal and individual impacts of mental health conditions. The medical conditions selected were chosen for comparison because of their high prevalence, professional and public familiarity, and because they are symptomatic (depression, back and neck pain, diabetes) and nonsymptomatic (hypertension).
A recent study by Gerberding showed that diabetes poses a serious, and growing, health threat to the country.6
This preventable disease directly cost $92 billion in the U.S. in 2002, and an additional $40 billion in indirect costs. As of 2005, 14.6 million Americans have been diagnosed with diabetes—a number more than twice that of 15 years ago. Furthermore, an additional 6.2 million Americans have undiagnosed cases. For those people born in the U.S. in the year 2000, one in three are projected to develop the disease.
The next condition, back/neck problem, encompasses disorders that range from back or neck injury to disk disorders and other related conditions.7
Approximately $9 million in Workers' Compensation costs and 100 million days of work are lost yearly because of back pain alone.8,9
In 2004, more than 45 million visits were made to physicians and more than 1.5 million hospitalizations occurred because of back or neck problems.7
The last of the medical conditions examined, hypertension, affects almost one in every three American adults, and caused or contributed to 277,000 deaths in the U.S. in 2003.10,11
For the year 2006, hypertension costs reached approximately $63.5 billion.11
Because of its prevalence and severity, hypertension rounds out the three medical conditions examined by this survey.
In America, in a given year, more than 25% of adults have a clinically diagnosable mental health condition, which translates to approximately 75 million individuals in 2006.12,13
Not including research costs, the U.S. spends $150 billion on mental health disorders each year.14
Mental health disorders can be pervasively disabling, limiting functioning, impairing quality of life, contributing to emotional distress, and causing discrimination and alienation.15
Not only can mental health disorders be debilitating, they can also contribute to death. Of those who commit suicide, which claimed 32,439 lives in the U.S. in 2004, 90% are estimated to have a mental health disorder.16,17
In a groundbreaking study by Murray and Lopez, projections show that depression will eclipse other disorders and rank second in terms of burden of disease by the year 2020.18
As part of their study, Murray and Lopez had health-care professionals around the world rank disorders in terms of the severity of disability associated with each. Surpassing Down's syndrome and below-knee amputation, depression was ranked in the same category as paraplegia and blindness. Our study differs in that Murray and Lopez utilized the opinions of health-care professionals, and while there is great value to this information, the Healthy Days Measurements give more insight into the actual perceived burden of disorder from those who experience it firsthand, because of their basis in self-report. Also, the data used in this study are more current, filling a void left since the 1990 data used by Murray and Lopez garnered important information about the burdens of disease.