Association between annual earnings and mental disorders in Spain: individual and societal-level estimates

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.

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.

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 € 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 € 1.40 million annually.

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.