The economic burden of mental disorders in children and adolescents in China: a cross-sectional study

Abstract Background Mental disorders of children and adolescents, as a major contributor to disease burden in both developed and developing countries, have gained much attention from researchers and policy makers. This study aimed to estimate the economic burden of mental disorders in children and adolescents in China. Methods We obtained data from electronic medical records of 107 hospitals in 2017, which we selected from Shandong province using multi-stage stratified random sampling methods. We included 3378 inpatient and 47859 outpatient records of patients aged 18 years or younger who were diagnosed with mental disorders (classified under the tenth revision of the International Classification of Diseases, codes F00–F99). Prevalence, population, and gross domestic product per capita were derived from Health Statistical Yearbook of China while disability weight and productivity weight were derived from previous research. We used a prevalence-based bottom-up approach and an estimation model to estimate the total economic burden. The total burden contains the direct burden, indicating direct medical costs to patients and their families, and indirect burden, including the economic loss to patients' families represented by the wage loss of patients' caregivers, and economic burden to society due to the loss of quality of life and productivity for the patients, also termed social costs. Findings The total economic burden of mental disorders in children and adolescents in 2017 was US$1·191 billion. The direct burden was $565 million (comprising $351 million from inpatients and $213 million from outpatients), and would have increased to $49 billion if all patients had sought professional therapy. The indirect costs were $1653 for each family and $47 billion in the whole country because of the working time loss of caregivers. We estimated 1287 disability-adjusted life-years per 1000 people, and the indirect cost to society was $1181 billion. Additionally, the direct medical costs of female patients, $342 million, was higher than those of male patients ($226 million. By contrast, the estimate of indirect burden on society of male patients ($627 billion) was larger than that of female patients ($554 billion). Interpretation Mental disorders in children and adolescents have led to a considerable economic burden for both individuals and society. More effective prevention measures and more preferential policies should be adopted to cut down economic burdens caused by mental disorders in children and adolescents. Funding National Natural Science Foundation of China (71373146).