This is an edited version of presentations and discussion at the roundtable. For a full transcript, go to www. Source: IFS Insurance Broking (figures based on real industry funds) Professor Gordon Parker: There was a famous document that the World Bank, World Health Organisation and Harvard produced where they actually quantified burden and disability for all disorders. And within the top 10, four were psychiatric disorders.

Most people misinterpret the figures, saying that in 1990 depression was the second most disabling, expected to rise to number one in 2020. But, in fact, the disability data showed depression to be number one already by then… Schizophrenia was also in there. Bi-polar was number six. But the (estimated) prevalence of bipolar in those calculations was almost certainly way way down. So, the total morbidity in the general population, which might be over a lifetime, is in the order of 20 per cent.

One in five people over their lifetime will have a meaningful severe disabling mental condition. We can break that down to probably 1 per cent of the general community again having schizophrenia. And about 10 per cent having a mood disorder. And then the residual would be made up of a whole residue category comprising anxiety disorders and so on and so forth. So, depression and bi-polar disorder are the key conditions in terms of disability. They are the most disabling because they tend to come on at a young age. They are recurrent. And the episodes are lengthy and that’s why they top the pops in terms of disability.

Depression is highly correlated with suicide data. Of those who killed themselves, 90 per cent were depressed. So the correlation is immensely strong. With bi-polar, in the old days we talked about ‘manic depressive’ disorder. ‘Psychosis’ we now call ‘bi-polar 1’. That probably has a lifetime rate of 0.5 to 1 per cent in the general community. ‘Bi-polar 2’ disorder is often regarded as a milder version. Stephen Fry, the BBC comedian who has it, described it as bi-polar lite. In fact it is not a trivial condition. And it is increasing for reasons we may care to go into.

But it is at least 10 times more common, up to 20 times more common than bi-polar 1. There’s a lot of it around. It is not bipolar lite in the sense that good studies have shown that the suicide rate is at least as high as bi-polar 1, and in some studies slightly higher. Basically, what you have with bipolar 1 is people having episodes lasting months, getting better, and then another episode. Bi-polar 2 people are oscillating most of the time. So, if you look at a hare-and-tortoise sort-of analogy, every time someone on a high goes into a low, they go back into that black space again – that suicidal, terrible world.

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