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Open Access Highly Accessed Research article

Is it worth investing in mental health promotion and prevention of mental illness? A systematic review of the evidence from economic evaluations

Ingrid Zechmeister1, Reinhold Kilian2*, David McDaid3 and the MHEEN group

Author Affiliations

1 Post-doc researcher at the Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090 Vienna, Austria

2 Senior lecturer at the University of Ulm, Department of Psychiatry II, BKH Guenzburg, Ludwig-Heilmeyer-Str. 2, D-89312 Guenzburg, Germany

3 Research fellow at the LSE Health and Social Care and European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK

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BMC Public Health 2008, 8:20  doi:10.1186/1471-2458-8-20

Published: 22 January 2008



While evidence on the cost of mental illness is growing, little is known about the cost-effectiveness of programmes in the areas of mental health promotion (MHP) and mental disorder prevention (MDP). The paper aims at identifying and assessing economic evaluations in both these areas to support evidence based prioritisation of resource allocation.


A systematic review of health and non health related bibliographic databases, complemented by a hand search of key journals and analysis of grey literature has been carried out. Study characteristics and results were qualitatively summarised. Economic evaluations of programmes that address mental health outcome parameters directly, those that address relevant risk factors of mental illness, as well as suicide prevention interventions were included, while evaluations of drug therapies were excluded.


14 studies fulfilled the inclusion criteria. They varied in terms of topic addressed, intervention used and study quality. Robust evidence on cost-effectiveness is still limited to a very small number of interventions with restricted scope for generalisability and transferability. The most favourable results are related to early childhood development programmes.


Prioritisation between MHP and MDP interventions requires more country and population-specific economic evaluations. There is also scope to retrospectively add economic analyses to existing effectiveness studies. The nature of promotion and prevention suggests that innovative approaches to economic evaluation that augment this with information on the challenges of implementation and uptake of interventions need further development.