Open Access Research article

The rise of mortality from mental and neurological diseases in Europe, 1979–2009: observational study

Johan P Mackenbach1*, Marina Karanikolos2 and Caspar WN Looman1

Author Affiliations

1 Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, Netherlands

2 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK

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BMC Public Health 2014, 14:840  doi:10.1186/1471-2458-14-840

Published: 13 August 2014



We studied recent trends in mortality from seven mental and neurological conditions and their determinants in 41 European countries.


Age-standardized mortality rates were analysed using standard methods of descriptive epidemiology, and were related to cultural, economic and health care indicators using regression analysis.


Rising mortality from mental and neurological conditions is seen in most European countries, and is mainly due to rising mortality from dementias. Mortality from psychoactive substance use and Parkinson’s disease has also risen in several countries. Mortality from dementias has risen particularly strongly in Finland, Iceland, Malta, Netherlands, Spain, Sweden and the United Kingdom, and is positively associated with self-expression values, average income, health care expenditure and life expectancy, but only the first has an independent effect.


Although trends in mortality from dementias have probably been affected by changes in cause-of-death classification, the high level of mortality from these conditions in a number of vanguard countries suggests that it is now among the most frequent causes of death in high-income countries. Recognition of dementias as a cause of death, and/or refraining from life-saving treatment for patients with dementia, appear to be strongly dependent on cultural values.

Mortality; Mental and behavioural disorders; Diseases of the nervous system; Dementias; Psychoactive substance use; Meningitis; Parkinson’s disease; Alzheimer’s disease; Multiple sclerosis; Epilepsy; World Value Survey; Europe