The evidence is in. Countries like Australia, the United States, New Zealand, and Canada are crazy. Or at least a lot crazier than many countries around the world. Especially compared to countries in South and East Asia. So, if you live in Delhi or Shanghai, or Manila, are you a crazy fool for thinking of immigrating to somewhere like Sydney? Seattle? Or Toronto?

Let’s see what the Top 25 countries are in terms of share of health burden due to mental health and substance abuse disorders. The data comes from ourwoldindata.org’s study which was released through the Institute for Health Metrics and Evaluation and through the Global Burden of Disease study. Consider the following table:

Rank

Country

Health Burden Share due to Mental Health & Substance Abuse

1

Australia

21.627%

2

United States

21.565%

3

New Zealand

21.276%

4

Iran

19.932%

5

Chile

19.086%

6

Canada

18.969%

7

Finland

18.847%

8

Ireland

18.613%

9

Argentina

18.624%

10

France

18.467%

11

Spain

18.348%

12

Netherlands

18.274%

13

Norway

18.259%

14

Brazil

18.001%

15

Morocco/Uruguay

17.958%

17

Portugal

17.932%

18

Belgium

17.782%

19

Germany

17.661%

20

Lesotho

17.660%

21

Afghanistan

17.632%

22

Palestine

17.625%

23

United Kingdom

17.592%

24

Lebanon

17.468%

25

Greece

17.438%

26

Russia

17.433%

The first thing we notice is that as a country’s mental health costs – as a share of its overall healthcare costs – rise, as we seem to find some of the most prosperous countries in the world on this list. Exactly the ones that are sought after by immigrants from around the globe. Can this be? Is it true that the more prosperous and developed a country is, the worse its mental health outcomes? Remember, this measure also includes substance abuse, so things like alcoholism and unprescribed and/or illegal drug use are also factored in to the survey’s results. This makes sense, seeing that drug abuse is a serious problem in many developed countries, one which exacts an increasing toll on the healthcare and law enforcement systems of the countries in question.

As the table show, there are no countries from East Asia; Southeast Asia, or South Asia in the top 25. Here’s a list of the top countries from Asia:

Country

Health Burden Share due to Mental Health & Substance Abuse

South Korea

15.875%

Mongolia

15.638%

Bhutan

15.364%

Nepal

15.266%

Bangladesh

14.999%

India

14.961%

China

14.715%

North Korea

14.434%

Singapore

14,365%

Japan

14.123%

So, why do East, South, and Southeast Asian countries have noticeably lower rates of mental health and substance abuse disorders?

According to the study, there are 3 basic levels under which factors that contribute to good mental health or towards poor mental health can be grouped: individual factors, social factors, environmental factors.

Looking at factors that cause negative mental health outcomes we have:

Factors causing negative mental health incomes

While looking at factors that lead to good mental health outcomes we see the following:

Factors Causing Positive Mental Health Outcomes

This way of grouping factors which may be crucial in determining mental health outcomes gives rise to some puzzling questions:

  • How do we square the results of the data where developed countries with high incomes and good social services are at the top of the list of countries with mental health and substance abuse disorders? Australia, the United States, and New Zealand are among the top destinations – along with Canada – for immigrants yet they rank as the world’s worst countries in terms of mental health. Canada comes in at 6th spot, just behind Iran and Chile.
  • Does economic progress necessarily mean poorer mental health outcomes? Or is there more at play?
  • Is mental health also influenced by culture? Does a respondent’s answers to surveys about their mental health also depend on their country’s culture?
  • Is mental health more carefully recorded in countries with more advanced economies? Or in countries with more mental health professionals?
  • How is technological disruption influencing mental health outcomes, especially as it relates to workplace stress?

 

Technological Disruption

How does technology affect a country’s mental health? One simple metric we can use is internet usage and smartphone ownership by adults. Generally, the higher this metric, the more technologically advanced a country, although the relationship is not a perfect one, there seems to be good correlation here. Consider the following graph:

Cell Phone and internet usage vs mental health

These are very interesting results. They are based on a similar set of countries to those we used for mental health outcomes, but with a broader geographic range in order to include countries from all continents. Notice that we have a sort of curve where mental health outcomes improve (the number on the x-axis decreases) with an increase of cellphone and internet penetration up to about 50% of the adult population. At that point additional cellphone and internet usage begins to worsen mental health outcomes, until we reach examples like Australia with very high internet and cellphone usage but poor mental health outcomes.

However, it is also important to note that countries with very different rates of cellphone and internet usage have similar mental health outcomes, proving that other factors, perhaps cultural ones relating to work and society, also play a vital role.

 

Emotional Intelligence

Are Australians and Americans just plain lousy at resolving problems? This seems very unlikely. Countries like Australia, the United States, Canada, and others have proven to be some of the most innovative societies ever, constantly thinking about and seeking new ways to solve society’s problems. A study by Hossein Reza Nikoui found no clear link between nationality and emotional intelligence, although it was limited to business leaders from the United States, Canada, Mexico, Turkey and Slovakia. This is an area that needs more research, but it seems that culture rather than nationality is a better predictor of emotional intelligence. And the link between emotional intelligence and mental health needs to be carefully studied to ensure that better emotional health in general leads to less mental health problems.

So, what is it about Asian (as well as African and also Central and Tropical Latin American) culture that results in better mental health outcomes? Is it about the differences in how individuals and groups of people are viewed?

 

Social Capital

Social capital is a fairly new way of thinking about societies and in a study by Ronald Lattin and Stephen Young, they construct a social capital index composed of 13 variables which are then averaged out into an overall measure of a country’s social capital. These 13 variables can be grouped into 3 categories:

  • Economic variables: GDP per capita; Sovereign Credit Ratings
  • Social and Cultural variables: Measures of Corruption; Economic & Political Freedom; Human Development
  • Legal and political institutions: Rule of law; Best practices at Financial Institutions; Indicators of Good Governance

These 3 groups of variables interact between themselves in either virtuous or vicious cycles. For example, a transparent political and legal system encourages investment and savings and rewards honest behavior leading to better institutions and more growth leading to better cultural values, and on and on.

Or the reverse can be true as well. Corrupt institutions cause short term economic behavior often with inflation and this degrades values which degrades institutions which causes more economic distortions and/or stagnation.

Here’s how it looks in a diagram:

The Social Capital Cycle

  • Germany in the 1920s.
  • Zimbabwe starting in the 1990s
  • Venezuela starting in the early 2000s
  • Kampuchea/Cambodia over the latter years of the 20th century.

Surely social capital would be a good contrarian indicator when it comes to mental health?

Not necessarily.

Lattin and Young’s model reveals that high social capital does not necessarily mean good mental health outcomes. In the graph below, we compare social capital (a higher number means a higher level of social capital for the country) with our results for mental health outcomes:

Mental Health vs. Social Capital

Once again, we observe a similar relationship to what we saw when we compared cell phone and internet usage to mental health outcomes. It appears that initially more social capital can help lower the percentage of mental health problems a country observes, but as social capital increases further, mental health outcomes begin to deteriorate again.

So oddly enough, high levels of social capital are no guarantee of good mental health outcomes. Again, remember that as the number on the x-axis increases, the mental health outcome is worse.

 

Work Stress

Is it all about your workplace environment? Is an open and cutthroat competitive economy one that some people have a hard time dealing with? An OECD study on Work-Life balance across the OECD countries seems to be our last best hope of trying to find out why mental health outcomes are so poor in some of the world’s most highly regarded countries. It looks at factors like:

  • hours worked,
  • gender inequality,
  • leisure time, and
  • wage increases.

Here’s a graph with a comparison of Work-life balance against Mental Health outcomes. The number on the y-axis measures the ranking of each OECD country in terms of the work-life balance in that country. The higher the number the better the balance. The x-axis measures the share of healthcare devoted to mental health and substance abuse, so a larger number means a worse outcome.

Work-Life Balance vs Mental Health

Do we finally have the evidence we have been looking for? While the sample is merely OECD countries and thus excludes a majority of the world’s countries, does it display a positive correlation between work-life balance and good mental health outcomes?

No. Not really.

In fact, it could be argued that it shows a mildly positive link between better work-life balance and poorer mental health. What to make of this?

 

Conclusion

If Australia, the United States, New Zealand, and Canada are such unhappy places, why is the world so eager to move to these countries and start a new life there? Are immigrants that badly informed? Or crazy? This would hardly seem to be the case, seeing that with our connected world, it’s never been easier to research the country you are planning to immigrate to.

So, until we have studies that show exactly why mental health outcomes are so bad in some of the world’s most developed countries – perhaps alienation and loneliness are key here – we’ll just have to admit that life is not so bad in Sydney or Seattle or Auckland, or Vancouver. In fact, it’s pretty darn good, most people would tell you.

Does it mean you shouldn’t think of immigrating from India – which has a much lower rate of mental health spending? Or China? Or the Philippines? Hardly. But it does mean you should realize that you will be moving to a new culture and that there will be a period of culture shock. And yes, you’ll find some find more than a few pretty stressed-out people. Just like in Shanghai or Delhi or Manila. And some depressed people. Especially around January in Toronto. But be of good cheer and come to Canada. Your attitudes and energy and determination are part of what helps countries like Canada or Australia, or the United States, renew themselves. Even if we are a little crazy.


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