ArticlesGlobal burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010
Introduction
Historically, mental and substance use disorders were not a global health priority, especially when compared with communicable diseases and non-communicable diseases such as cancer or cardiovascular disease. Services for mental and substance use disorders have typically been neglected, and in many countries were segregated from mainstream health care with resourcing not commensurate with the burden.1, 2 Since the 1993 World Development Report3 by the World Bank, global attention has been focused on the relative burden associated with disease morbidity, rather than mortality alone. The move to incorporate the effects of disease morbidity has been key in emphasising the importance of mental and substance use disorders. An international effort to improve the mental health of populations around the world is now underway.4
The first Global Burden of Disease study in 1990 (GBD 1990), showed that neuropsychiatric disorders—a grouping that included neurological disorders and dementia as well as mental and substance use disorders—accounted for more than a quarter of all non-fatal burden, measured in years lived with disability (YLD).5 Five of the top ten causes of disability were included in the neuropsychiatric disorder category. Depression was the most disabling disorder worldwide measured in YLDs, and the fourth leading cause of overall disease burden measured in disability-adjusted life years (DALYs), which combines premature mortality as years of life lost (YLLs) and disability as YLDs.6 Estimates for selected disorders were revised in the early 2000s with updated epidemiological evidence and, for some disorders, modified health states and disability weights.7, 8 These selected disorders were mood disorders (depression and bipolar disorder), anxiety disorders (panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder), and schizophrenia.9 Drug use disorders were shown as a combined estimate including harmful use and dependence of opioids and cocaine. A single estimate was also given for alcohol use disorders which encompassed alcohol-induced psychoses, alcohol dependence, and alcohol abuse.5 A notable limitation was the failure to capture some common disorders (eg, cannabis dependence, generalised anxiety disorder, eating disorders, and most childhood onset disorders).
In 2007, a new GBD study was launched10 and high level results for the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) were reported in December, 2012.11, 12, 13, 14, 15, 16, 17 GBD 2010 was a comprehensive reanalysis of burden for 291 causes, 20 age groups, both sexes, and 187 countries in 21 world regions for 1990 and 2010. The definition of world regions was based on geographical proximity and epidemiological similarity in terms of child and adult mortality.11 These regions were further grouped into seven super-regions (based on cause of death patterns) to permit imputation of data for regions where no information was available
The number of specific mental and substance use disorders was expanded in GBD 2010 to include 20 disorders, consisting of all anxiety disorders (compared with three in the original study), eating disorders (anorexia nervosa and bulimia nervosa), childhood behavioural disorders (attention-deficit/hyperactivity disorder and conduct disorder), pervasive developmental disorders (autism and Asperger's syndrome), and idiopathic intellectual disability, a residual category capturing intellectual disability not attributed to any of the other diseases and injuries. Existing disorder categories were also expanded; for example, bipolar disorder captured cyclothymic disorder in 2010 and unipolar depression was modelled as major depressive disorder and dysthymia. Substance use disorders were expanded to include burden for alcohol use disorders (alcohol dependence and fetal alcohol syndrome) and illicit drug use disorders (opioid dependence, cannabis dependence, cocaine dependence, and amphetamine dependence). Two residual categories capturing other mental and substance use disorders were also estimated. Harmful use or abuse of drugs and alcohol were not included in GBD 2010. The burden estimation techniques changed substantially in GBD 2010: notably, prevalent rather than incident based YLDs were estimated without age weighting and discounting. Because of changes in methodology, estimates for the years 1990 and 2010 were re-calculated for GBD 2010 to allow meaningful comparisons in burden across time.
In this report, we aimed to summarise fatal, non-fatal, and total burden for eleven classes of mental and substance use disorders for 2010 with reference to changes in burden since 1990.
Section snippets
Definitions of mental and substance use disorders
To be included, specific mental and substance use disorders had to meet the threshold for a case according to criteria described in the Diagnostic and Statistical Manual of Mental Disorders (DSM)18 or the International Classification of Diseases (ICD).19 To obtain the most comprehensive dataset possible, we included all clinically relevant case definitions that would map to DSM or ICD diagnostic criteria. We tested for differential case-finding properties of different diagnostic criteria in a
Results
Worldwide, mental and substance use disorders accounted for 183·9 million DALYs (95% UI 153·5 million–216·7 million), or 7·4% (6·2–8·6) of total disease burden in 2010 (table). Overall, mental and substance use disorders were the fifth leading disorder category of global DALYs (table).
Within the mental and substance use disorders group, depressive disorders accounted for most DALYs, followed by anxiety disorders, drug use disorders, and alcohol use disorders (figure 1). Eating disorders,
Discussion
Mental and substance use disorders are notable contributors to the global burden of disease, directly accounting for about 7·4% of disease burden worldwide (panel). These disorders were responsible for more of the global burden than were HIV/AIDS and tuberculosis, diabetes, or transport injuries. GBD 2010 provides a comprehensive picture of burden compared with previous estimates in view of the wide range of disorders included, improved definitions, data, and methods used. The inclusion of
References (77)
- et al.
The Lancet's series on global mental health: 1 year on
Lancet
(2008) - et al.
Global burden of disease 2005: call for collaborators
Lancet
(2007) - et al.
Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010
Lancet
(2012) - et al.
Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
Systematic review of prospective studies investigating “remission” from amphetamine, cannabis, cocaine or opioid dependence
Addict Behav
(2010)
What data are available on the extent of illicit drug use and dependence globally? Results of four systematic reviews
Drug Alcohol Depend
Mortality among cocaine users: a systematic review of cohort studies
Drug Alcohol Depend
A systematic review of the global distribution and availability of prevalence data for bipolar disorder
J Affect Disord
What difference does dependent comorbidity make in burden of disease studies? A survey analysis and simulation. Global Health Metrics and Evaluation. Seattle, USA
Lancet
HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage
Lancet
Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys
Lancet
Modeling the impact of alcohol dependence on mortality burden and the effect of available treatment interventions in the European Union
Eur Neuropsychopharmacol
Resources for mental health: scarcity, inequity, and inefficiency
Lancet
Global mental health: a failure of humanity
Lancet
Treatment and prevention of mental disorders in low-income and middle-income countries
Lancet
Mental health and psychosocial support in humanitarian settings: linking practice and research
Lancet
Barriers to improvement of mental health services in low-income and middle-income countries
Lancet
Scale up of services for mental health in low-income and middle-income countries
Lancet
Depression, chronic diseases, and decrements in health: results from the World Health Surveys
Lancet
Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: a systematic review
Soc Sci Med
Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: a systematic review
Soc Sci Med
Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001-05: an epidemiological survey
Lancet
Cross-national difference in the prevalence of depression caused by the diagnostic threshold
J Affect Disord
Estimating the burden of disease attributable to illicit drug use and mental disorders: what is ‘Global Burden of Disease 2005’ and why does it matter?
Addiction
The global burden of mental disorders
Am J Public Health
World Development Report 1993. Investing in health: world development indicators
Quantifying disability: data, methods and results
Bull World Health Organ
The global burden of disease, 1990–2020
Nat Med
Global Burden of Disease 2000: version 2 methods and results
The global burden of disease: 2004 update
Diagnostic and statistical manual of mental disorders (DSM-IV-TR)
The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research
Cited by (4363)
Resting-state fMRI is associated with trauma experiences, mood and psychosis in Afro-descendants with bipolar disorder and schizophrenia
2024, Psychiatry Research - NeuroimagingPredicting the outcome of psilocybin treatment for depression from baseline fMRI functional connectivity
2024, Journal of Affective DisordersSex-specific associations between sex hormones and clinical symptoms in late-life schizophrenia
2024, Schizophrenia ResearchTraffic-related pollution and symptoms of depression and anxiety among Chinese adults: A population-based study
2024, Journal of Affective DisordersCharacterization of “microbiome-metabolome-immunity” in depressed rats with divergent responses to Paroxetine
2024, Journal of Affective Disorders