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Objective: To provide an overview of the importance of the data generated by the European Study of the Epidemiology of Mental Disorders (ESEMeD), which found that prevalence and burden of mood and anxiety disorders were high and that care of individuals with mental disorders was suboptimal. Thus, ESEMeD data, based on 21,425 noninstitutionalized adults from Belgium, France, Germany, Italy, the Netherlands, and Spain who underwent computer-assisted personal interviews, confirmed previous findings from epidemiologic studies performed in other locations. In addition, how this large and unique dataset may be utilized for maximum benefit to patients is outlined., Participants: The co-chairmen David J. Nutt, M.D., Ph.D., and Ronald C. Kessler, Ph.D., invited 6 faculty members to participate: Jordi Alonso, M.D., Ph.D.; Alastair Benbow, M.B., M.R.C.P.I.; Yves Lecrubier, M.D.; Jean-Pierre Lépine, M.D.; David Mechanic, Ph.D.; and André Tylee, M.D., Evidence: The consensus statement is based on the 6 review articles published in this supplement, which include ESEMeD data and data from pertinent scientific literature., Consensus Process: The faculty met over a 2-day period: day 1 included discussion of the review articles, during which the chairmen identified issues for further debate; day 2 included discussion of key issues to arrive at a consensus view. The consensus view was drafted by the chairmen and approved by all attendees., Conclusions: ESEMeD provides a very important opportunity to improve knowledge on the epidemiology of mood and anxiety disorders. Despite a decade of educational initiatives, the diagnosis and treatment of mood and anxiety disorders remain suboptimal. Lack of awareness and stigma surrounding mental illness, variations in physicians' ability to diagnose and treat psychiatric conditions, and physician time pressures all contribute to the problem. Future education initiatives should include patients, primary care physicians, employers, and health policy influencers. Patients with mood and anxiety disorders may benefit from targeted antidepressant treatment, which should optimize the chance of patients' receiving appropriate therapy. In addition, depending on the patients' circumstances, psychotherapy, counseling, or social support may also be initiated.

The European Study of the Epidemiology of Mental Disorders (ESEMeD) is the first large-scale survey to collect data comprehensively on the prevalence, risk factors, disability, and use of health care services associated with mood, anxiety, and alcohol-related disorders throughout Europe. Findings from the ESEMeD study are updated using a modified version of the Composite International Diagnostic Interview 3.0 in order to achieve the maximum diagnostic accuracy. The study is based on a sample of 21,425 noninstitutionalized adults, representative of an overall population of more than 212 million from Belgium, France, Germany, Italy, the Netherlands, and Spain. In total, 25.9% of participants reported a lifetime presence of any mental disorder, and 11.5% had experienced a mental disorder during the past 12 months. Females, younger participants, the unmarried, and the unemployed were more at risk, and comorbidity was prevalent. Associated levels of disability and reductions in quality of life exceeded levels seen in patients with chronic physical conditions. Nevertheless, only 36.8% of participants with a mood disorder and 20.6% with an anxiety disorder sought help from health care services; of these, 20.7% received no treatment. ESEMeD data provide an epidemiologic basis for reform of mental health policy within Europe.

Over the past 20 years, hypnotic drug use has diminished in France, while consumption of anxiolytics and neuroleptics has remained stable and antidepressant use has risen. Data from the ESEMeD survey (European Study of Epidemiology of Mental Disorders) conducted in 2002 in Germany, Belgium, Spain, France, Netherlands and Italy showed that use of anxiolytics during the previous year (including recurrent use) was less frequent in Germany than elsewhere. Belgium and France had a higher prevalence of antidepressant consumption. Among depressed patients, fewer than one-third reported antidepressant use (no difference among the countries), while one-third said they used anxiolytics (higher rate in France). One-quarter of patients with anxiety stated they used a benzodiazepine (lower rate in Germany). Age, psychiatric disorders and neurological disorders were strongly associated with benzodiazepine use. Factors strongly associated with antidepressant use were age (bell-shaped curve), female sex, and psychiatric disorders.

Anxiety disorders are the most prevalent of psychiatric disorders, yet less than 30% of individuals who suffer from anxiety disorders seek treatment. Prevalence of anxiety disorders is difficult to pinpoint since even small changes in diagnostic criteria, interview tools, or study methodology affect results. Analyses of the largest prevalence studies of psychiatric illnesses in the United States find that anxiety disorders afflict 15.7 million people in the United States each year, and 30 million people in the United States at some point in their lives. Currently, the European Study of Epidemiology of Mental Disorders and the World Health Organization World Mental Health 2000 studies are underway. These studies, which share a similar methodology, will facilitate future worldwide comparisons of the prevalence of anxiety disorders. Anxiety disorders impose high individual and social burden, tend to be chronic, and can be as disabling as somatic disorders. Compared with those who have other psychiatric disorders, people with anxiety disorders are high care utilizers who present to general practitioners more frequently than to psychiatric professionals, placing a strain upon the health care system. The economic costs of anxiety disorders include psychiatric, nonpsychiatric, and emergency care; hospitalization; prescription drugs; reduced productivity; absenteeism from work; and suicide.