Abstract
The eastern Mediterranean region (EMR) is witnessing an increase in mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the global burden of disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost–YLLs) and nonfatal outcomes (years lived with disability–YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of total disease burden in EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years. The highest proportion of DALYs occurred in the 25–49 age group. The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Depressive disorders accounted for most DALYs, followed by anxiety disorders. Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to global level. Our findings call for EMR health ministries to increase provision of mental health services and to address stigma of mental illness. Our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability.
Highlights
Mental disorders are a major public health concern
In Global Burden of Disease study (GBD) 2013, YLLs were computed by multiplying numbers of deaths from each cause in each age group by the reference life expectancy at the average age of death for those who die in the age group following the standard GBD 2010 methods [31,32,33]
In 2013, mental disorders in the Eastern Mediterranean Region (EMR) contributed to 11Á9 million DALYs (95% Uncertainty Interval (UI): 7Á6 million– 17Á2 million) equivalent to 1894 DALYS/100,000 population
Summary
The global lifetime prevalence of mental disorders in adults is estimated to be between 12Á2%-48Á6% and the 12-month prevalence between 4Á3% and 26Á4% [1, 2]. According to the 2001 World Health Report, 10–20% of children and adolescents globally suffer from a mental disorder and 50% of mental disorders start before 14 years of age [3]. About 90% of suicides are due to underlying mental illness [5] with the World Health Organization (WHO) estimating an incidence of 800,000 suicides per year in 2005, with 86% being in low and middleincome countries [6]. Mental and substance use disorders were responsible for 22Á5 million of the 36Á2 million DALYs allocated to suicide in 2010 with depression contributing the most (46Á1%) to suicide DALYS [7]
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