People said they would pay more to avoid some serious medical conditions than they would to avoid severe mental illnesses, such as schizophrenia and depression, according to the results of a national survey.

Respondents recognized that the two mental conditions had a health burden comparable to or higher than diabetes, below-the-knee amputation or partial blindness, according to Dylan Smith, PhD, of Stony Brook University in Stony Brook, NY, and colleagues.

For a comparable benefit in terms of quality of life, participants in the study were willing to pay about 40% less to avoid the psychiatric illnesses, Smith and colleagues reported in the April issue of Psychiatric Services.

The findings suggest that treatments for mental illnesses are “devalued by the public,” but not because of a belief that physical illness is more severe or burdensome than general medical illness, the researchers argued. For this study, Smith and colleagues reported findings from a national, Internet-based survey of U.S. adults. The goal of the survey was to elicit “perception of the burdensomeness of a series of mental and general medical illnesses and their willingness to pay to cure themselves of the illnesses,” the authors explained. In June and July 2006, 1,000 random participants in the panel were asked to complete a survey, in which they were asked how much they’d pay to avoid 1 of the 5 conditions:   Diabetes   Below-the-knee amputation   Partial blindness   Depression   Schizophrenia In each case, the participant was asked to imagine that the condition was imminent within a month, unless he or she took a pill that would prevent it completely. How much, participants were asked, would they pay out of their own pockets for such a pill on a monthly basis? They were also asked to rate how burdensome they felt each condition would be. Among the 710 respondents, the researchers found a perception that the two mental illnesses had a high burden of quality of life, but not a willingness to pay more to avoid them. Specifically, on a scale of 0 to 100, participants rated schizophrenia as having the highest burden, at 63.26, followed by partial blindness at 52.75, and depression at 51.05. The burden of amputation came in at 41.26 and diabetes at 37.15. Respondents said they were willing, on average, to pay only $76.90 to avoid depression, which was significantly lower than the amount they would have paid to avoid all the other conditions (at P=0.001 for all comparisons). They said they were willing to pay $100.91 to avoid schizophrenia, but $109.13 to avoid partial blindness, a difference that was significant at P=0.001. Although the perceived burden of amputation was significantly less than that of schizophrenia, participants on average were willing to pay almost as much to avoid it - $98.96, which was not significantly different. Finally, respondents reported that they would have paid $92.27 to avoid diabetes. The difference from schizophrenia was significant at P=0.001. The researchers also looked at the ratio of willingness to pay to perceived burden and found that, on average, participants were willing to pay about 40% less to avoid the mental conditions compared with the physical conditions. Put another way, participants said they were willing to pay $2.76 for each unit of increased quality of life they would get by avoiding the physical conditions, but only $1.70 per unit for the mental illnesses. The difference was significant at P<0.001. Smith and colleagues cautioned that the questions were asked about "a hypothetical valuation of an idealized treatment" so that the answers "may not always accurately reflect actual behavior." As well, they noted, participants were asked to put a monetary value on things they do not usually pay for, which might have biased the results.