Abstract
BackgroundThe Global Burden of Disease Study 2010 (GBD 2010) identified mental and substance use disorders as the 5th leading contributor of burden in 2010, measured by disability adjusted life years (DALYs). This estimate was incomplete as it excluded burden resulting from the increased risk of suicide captured elsewhere in GBD 2010's mutually exclusive list of diseases and injuries. Here, we estimate suicide DALYs attributable to mental and substance use disorders.MethodsRelative-risk estimates of suicide due to mental and substance use disorders and the global prevalence of each disorder were used to estimate population attributable fractions. These were adjusted for global differences in the proportion of suicide due to mental and substance use disorders compared to other causes then multiplied by suicide DALYs reported in GBD 2010 to estimate attributable DALYs (with 95% uncertainty).ResultsMental and substance use disorders were responsible for 22.5 million (14.8–29.8 million) of the 36.2 million (26.5–44.3 million) DALYs allocated to suicide in 2010. Depression was responsible for the largest proportion of suicide DALYs (46.1% (28.0%–60.8%)) and anorexia nervosa the lowest (0.2% (0.02%–0.5%)). DALYs occurred throughout the lifespan, with the largest proportion found in Eastern Europe and Asia, and males aged 20–30 years. The inclusion of attributable suicide DALYs would have increased the overall burden of mental and substance use disorders (assigned to them in GBD 2010 as a direct cause) from 7.4% (6.2%–8.6%) to 8.3% (7.1%–9.6%) of global DALYs, and would have changed the global ranking from 5th to 3rd leading cause of burden.ConclusionsCapturing the suicide burden attributable to mental and substance use disorders allows for more accurate estimates of burden. More consideration needs to be given to interventions targeted to populations with, or at risk for, mental and substance use disorders as an effective strategy for suicide prevention.
Highlights
There has been growing recognition of the importance of mental and substance use disorders as contributors to health loss in all countries
The Global Burden of Disease Study 2010 (GBD 2010) is the largest and most recent effort to quantify this by systematically integrating years of life lost (YLLs) and years of life with disability (YLDs) into disability adjusted life years (DALYs) for diseases, injuries and risk factors [1,2,3,4,5,6,7]
A statistically significant sex difference was only observed for alcohol dependence (Table S2 in File S1 summarizes sex-specific pooled RRs) the overall pooled proportions for both sexes combined were used in Population attributable fractions (PAFs) calculations
Summary
There has been growing recognition of the importance of mental and substance use disorders as contributors to health loss in all countries. Mental and substance use disorders explained 7.4% (95% uncertainty interval: 6.2–8.6%) of total DALYs in 2010, confirming them as the leading disease category of YLDs, and the 5th leading category of DALYs globally [10,11,12] This estimate reflects ‘direct burden’ where mental and substance use disorders are the direct cause of health loss, but excludes the excess (attributable) burden resulting from the increased risk of mortality and disability due to subsequent health outcomes captured elsewhere in the mutually exclusive disease and injury categories in GBD 2010. The Global Burden of Disease Study 2010 (GBD 2010) identified mental and substance use disorders as the 5th leading contributor of burden in 2010, measured by disability adjusted life years (DALYs) This estimate was incomplete as it excluded burden resulting from the increased risk of suicide captured elsewhere in GBD 2010’s mutually exclusive list of diseases and injuries. We estimate suicide DALYs attributable to mental and substance use disorders
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