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Quantifying the cost to society of panic and anxiety.

Posted Sep 01 2010 8:27pm

What's the price of panic? What economic costs does it impose on individuals, businesses, and society?

We can probably make a fair assessment of treatment costs directly attributable to panic disorder. Beyond that, the short answer is, It's hard to say. Certainly there are lots of folks receiving treatment for physical ailments -- acid reflux, for instance, or heart palpitations -- that are not directly attributable to but are unquestionably contributed to by panic.

And then there are the costs of un- and underemployment.

Consider my story. More than once in my life, I've been unemployable, or damn close to it, thanks to panic. These were the times when agoraphobia took over, pulling the geographical boundaries of my life closer and closer, shrinking the world to the point that I couldn't even make it to the corner store without being overwhelmed by inexplicable but searing terror.

The prospect of making it through the day in a cold, claustrophobic cubicle farm can become unbearable during these times. I've panicked a number of times in office settings, and spent more than a few hours staring at the clock and counting off the minutes until 4:45 or 4:50 p.m. would finally roll around and I might sneak away from my desk before the official 5 p.m. quitting time without putting my job in too much jeopardy. When panic and agoraphobia have entered the picture, work for me has been a challenge to endure, even when I've had jobs that were both interesting and high-paying.

The prospect of commuting to and from work makes periods of agoraphobia even worse. My first panic attack took place on a highway (I-95 in Connecticut; see here ), and over the years I've developed a mighty fear of scenarios common to commuters everywhere. The derailed commuter train, stuck in the tunnel between stations. The sweltering subway car, AC disabled; the press of sticky bodies as the train rounds a bend; the end-of-day summertime commuter-train stink. The rush-hour highway traffic jam, where it takes a full hour to get to the next exit. The line of cars in the left-turn lane, only one or two making it through before each green light turns red. When it comes to causing dread at various categories of rush-hour transportation, my agoraphobia does not discriminate.

When the agoraphobia gets bad enough, un- or underemployment is sure to follow. Investment analyst, book editor, web writer, legal-document proofreader, short-order cook . . . I've left or been let go from a number of jobs because agoraphobia had rendered me unable to drive on rush-hour highways and bridges, or ride a rush-hour subway, or take a rush-hour bus. Sometimes, I've been able to manage my fear to the point that I could work part-time; other times, I've worked during off hours (on the overnight shift at Kinko's, for example) so I didn't have to brave the crowds during regular commuting hours, or restricted myself to temp jobs because I didn't trust my ability to commit to a position for the long term.

Knock on wood, things have been better for me in recent years, so I no longer experience the prospect of attending a business meeting in an office downtown as an existential challenge. But things have been worse in the past, and I there's always the threat that agoraphobia will make them worse again in the future. I've been around long enough to know that, and accept it. And there's no escaping the fact that the career I've built for myself, as a marketing consultant and copywriter, allows me to spend most of my time in my home, always the safest, easiest, most comfortable place for a would-be agoraphobic to be.

Obviously, I'm not the only person whose career path has been sidetracked by periods of shaky mental health. There are millions of us out there, most of us silent about what we've endured, whether out of shame or fear of being found out by employers. Mental illness has imposed that cost on us, in addition to what we pay as individuals and as a society for treatment.

But how much is that, exactly? According to one study published in the American Journal of Psychiatry , lost earnings related to serious mental illness approach $200 billion per year. On average, those with serious mental illness have an annual income that's 42% lower than the average income for the rest of us ( $22,545, versus $38,851 ).

As the study makes clear, this is just part of the total economic cost imposed by mental illness is important to recognize that the NCS-R yields a conservative sample for estimating economic impact. As a door-to-door survey, NCS-R did not assess individuals hospitalized in institutions, incarcerated in prisons or jails, or who are homeless. Indeed, NCS-R had so few subjects with schizophrenia or autism that these diagnoses were not part of the original epidemiological analysis, even though both are associated with chronic disability and lifelong loss of income on a far greater per capita basis than mood or anxiety disorders. 
Accepting this conservative estimate of a loss of $193.2 billion in earnings each year from serious mental illness, can we estimate the total economic impact of serious mental illness? In Table 1 we begin to answer this question, adding the new estimates of income loss to data from 2002 on the direct costs of health care and disability benefits, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) cash assistance, food stamps, and public housing financed by federal and state revenues. Missing are the costs of health care for comorbid conditions. Missing are estimates for the loss of productivity due to premature death and the loss of productivity of those with serious mental illness who are institutionalized, incarcerated, or homeless. Missing is the cost of incarceration, although as many as 22% of individuals in jails and prisons have been diagnosed with mental illness.... Missing is the cost of homelessness, although approximately one third of adult homelessness is associated with serious mental illness.... And, of course, missing from any such tabulation is the cost to family members who bear much of the emotional and financial burden of these illnesses. The $317 billion estimated economic burden of serious mental illness in Table 1 excludes costs associated with comorbid conditions, incarceration, homelessness, and early mortality.
This study focuses on the costs of serious mental illness in general; the cost of panic will be a fraction of this cost. The exact amount? Again, it's hard to say. But rest assured that it's in the tens of billions of dollars. Per year. If another study , this one from the Netherlands, is any indication at all, the cost is great indeed; there, the annual per capita economic cost of panic is estimated to exceed $20,000.

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