The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010.

The global burden of drug use and mental disorders

BackgroundSystematic collection of mortality/morbidity data over time is crucial for monitoring trends in population health, developing health policies, assessing the impact of health programs. In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides data on the burden of over 300 diseases in 195 countries since 1990. We used the GBD database to undertake an assessment of disease burden in Poland, evaluate changes in population health between 1990–2017, and compare Poland with other Central European (CE) countries.MethodsThe results of GBD 2017 for 1990 and 2017 for Poland and CE were used to assess rates and trends in years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs). Data came from cause-of-death registration systems, population health surveys, disease registries, hospitalization databases, and the scientific literature. Analytical approaches have been used to adjust for missing data, errors in cause-of-death certification, and differences in data collection methodology. Main estimation strategies were ensemble modelling for mortality and Bayesian meta-regression for disability.ResultsBetween 1990–2017, age-standardized YLL rates for all causes declined in Poland by 46.0% (95% UI: 43.7–48.2), YLD rates declined by 4.0% (4.2–4.9), DALY rates by 31.7% (29.2–34.4). For both YLLs and YLDs, greater relative declines were observed for females. There was a large decrease in communicable, maternal, neonatal, and nutritional disease DALYs (48.2%; 46.3–50.4). DALYs due to non-communicable diseases (NCDs) decreased slightly (2.0%; 0.1–4.6). In 2017, Poland performed better than CE as a whole (ranked fourth for YLLs, sixth for YLDs, and fifth for DALYs) and achieved greater reductions in YLLs and DALYs than most CE countries. In 2017 and 1990, the leading cause of YLLs and DALYs in Poland and CE was ischaemic heart disease (IHD), and the leading cause of YLDs was low back pain. In 2017, the top 20 causes of YLLs and YLDs in Poland and CE were the same, although in different order. In Poland, age-standardized DALYs from neonatal causes, other cardiovascular and circulatory diseases, and road injuries declined substantially between 1990–2017, while alcohol use disorders and chronic liver diseases increased. The highest observed-to-expected ratios were seen for alcohol use disorders for YLLs, neonatal sepsis for YLDs, and falls for DALYs (3.21, 2.65, and 2.03, respectively).ConclusionsThere was relatively little geographical variation in premature death and disability in CE in 2017, although some between-country differences existed. Health in Poland has been improving since 1990; in 2017 Poland outperformed CE as a whole for YLLs, YLDs, and DALYs. While the health gap between Poland and Western Europe has diminished, it remains substantial. The shift to NCDs and chronic disability, together with marked between-gender health inequalities, poses a challenge for the Polish health-care system. IHD is still the leading cause of disease burden in Poland, but DALYs from IHD are declining. To further reduce disease burden, an integrated response focused on NCDs and population groups with disproportionally high burden is needed.

BackgroundMajor depressive disorder (MDD) has been previously recognized as a severely impacting disorder. Although effective intervention strategies exist, access to treatment remains low, particularly in low- to middle-income countries. The purpose of this thesis was to formulate a complete epidemiological profile for MDD. This involved investigating (1) the global distribution of MDD; (2) the global burden of MDD in terms of disability-adjusted life years (DALYs), years lived with disability (YLDs) and years lost to premature mortality (YLLs) for the Global Burden of Disease Study 2010 (GBD 2010); (3) the contribution of MDD as a risk factor to the distribution and burden of suicide and ischemic heart disease; and (4) the risk factors of MDD and related avenues for further research. Such an epidemiological profile assists in identifying the size of the population who may need intervention for MDD. It provides policy-makers with information that can, along with considerations of cost-effectiveness and equity, be used in resource allocation within the health sector. For researchers, it identifies where the gaps in the literature exist regarding the epidemiology of MDD which need to be addressed with future research.MethodsA systematic literature review was conducted to capture studies of the prevalence, incidence, duration, and excess-mortality associated with MDD. Data points were integrated into a statistical disease model using DisMod-MR, a Bayesian meta-regression tool. DisMod-MR predicts epidemiological data for parameters and parts of the world with no raw data and also accommodates known methodological and ecological determinants of MDD.To estimate burden, disability weights measuring the severity of health loss from MDD were obtained from population survey data. These were combined with DisMod-MR prevalence data to calculate YLDs for MDD by age, sex, year, and country. To calculate YLLs, comparative risk assessment methodology was used to explore MDD as a risk factor for both suicide and ischemic heart disease. Data from additional systematic literature reviews and meta-analyses were used to obtain the pooled relative-risk of (1) ischemic heart disease in those exposed to MDD, and (2) suicide in those exposed to select mental and substance use disorders including MDD. For each risk factor-outcome pairing, population attributable fractions were calculated from the pooled relativerisks and DisMod-MR prevalence data. These were then used to calculate the proportion of DALYs originally allocated to ischemic heart disease and suicide in GBD 2010 which could be re-assigned to MDD. Finally, an investigation into the risk factors for MDD was presented, with a workingexample of how two previously established risk factors, child sexual abuse (CSA) and intimate partner violence (IPV), can impact on the distribution of MDD.ResultsThe literature search for epidemiological data identified 116 prevalence, 4 incidence, 5 duration, and 11 excess-mortality studies. DisMod-MR estimated over 298 million point prevalence cases of MDD globally in 2010. The global point prevalence was very similar across time, although higher in low- to middle-income countries and females aged 25 to 34 years. The annual incidence of an episode of MDD followed a similar age and regional pattern to prevalence but was about one and a half times higher; consistent with an average duration of 37.7 weeks.When compared to the 290 other diseases and injuries in GBD 2010, MDD was ranked as the second leading cause of YLDs; accounting for 8.2% (5.9%–10.8%) of global YLDs in 2010. MDD was also a leading cause of DALYs, accounting for 2.5% (1.9%–3.2%) of global DALYs. Additionally, MDD explained 4 million ischemic heart disease DALYs and 16 million suicide YLLs. Out of 22.5 million (14.8-29.8 million) suicide YLLs attributable to all mental and substance use disorders identified as risk factors for suicide, MDD was responsible for the largest proportion (46.1%, 28.0%-60.8%).Data on the risk factors of MDD were sparse and incomplete however there was sufficient evidence to quantify the respective effect of conflict, CSA and IPV on MDD. CSA and IPV had the potential to explain up to 63·7% (46·2%-80·2%) of the sex difference in MDD however this finding was deemed preliminary given uncertainty and omissions in this data. Further research is required to investigate this further, particularly around how the observed effect of CSA and IPV on the sex difference of MDD interacts with other risk factors and changes across age, place and time.ConclusionMDD is a common and disabling disorder which imposes significant disease burden on the population. It also contributes substantially to the burden allocated to suicide and ischemic heart disease. These findings emphasize the importance of including MDD as a public-health priority and implementing cost-effectiveness interventions to reduce its burden. There was a paucity of data exploring the risk factors for MDD. However, data that were available underlined the importance of investigating how interventions to ameliorate the increased risk of MDD from abuse, war, and violence can be incorporated into prevention programs.

Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010

Updated trends in the global prevalence and burden of mental disorders, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.

Timely and accurate assessments of disease burden are essential for developing effective national health policies. We used the Global Burden of Disease Study 2015 to examine burden due to mental and substance use disorders in Australia. For each of the 20 mental and substance use disorders included in Global Burden of Disease Study 2015, systematic reviews of epidemiological data were conducted, and data modelled using a Bayesian meta-regression tool to produce prevalence estimates by age, sex, geography and year. Prevalence for each disorder was then combined with a disorder-specific disability weight to give years lived with disability, as a measure of non-fatal burden. Fatal burden was measured as years of life lost due to premature mortality which were calculated by combining the number of deaths due to a disorder with the life expectancy remaining at the time of death. Disability-adjusted life years were calculated by summing years lived with disability and years of life lost to give a measure of total burden. Uncertainty was calculated around all burden estimates. Mental and substance use disorders were the leading cause of non-fatal burden in Australia in 2015, explaining 24.3% of total years lived with disability, and were the second leading cause of total burden, accounting for 14.6% of total disability-adjusted life years. There was no significant change in the age-standardised disability-adjusted life year rates for mental and substance use disorders from 1990 to 2015. Global Burden of Disease Study 2015 found that mental and substance use disorders were leading contributors to disease burden in Australia. Despite several decades of national reform, the burden of mental and substance use disorders remained largely unchanged between 1990 and 2015. To reduce this burden, effective population-level preventions strategies are required in addition to effective interventions of sufficient duration and coverage.

Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

UK health performance: findings of the Global Burden of Disease Study 2010

SummaryBackgroundMental and substance use disorders are a major public health concern globally, with high rates of disability, morbidity, and mortality associated with these. In low- and middle-income countries, such as Kenya, mental health is often given low priority, and resources for the prevention and treatment of mental and substance use disorders are limited. Adolescence and young adulthood are critical periods for the development of mental and substance use disorders, with many disorders emerging during this time. In Kenya, the burden and risk factors of mental and substance use disorders among adolescents and young adults is not well understood.MethodsThe data used in this study were obtained from the Global Burden of Disease (GBD) Study 2019. We selected the data on the number of mental and substance use disorders among adolescents and young adults in Kenya from the GBD results tool. The data were extracted by mental health (MH) condition, by age group and by sex. We used descriptive statistical methods to summarise and present the data. Specifically, we calculated the disability-adjusted life-years (DALYs) rates, risk factors of mental and substance use disorders by age group and sex.FindingsIn 2019, among 10–24-year-olds in Kenya, mental disorders ranked as the second leading cause of disability, following unintentional injuries, and accounted for 248,936 [95% uncertainty interval 175,033; 341,680] DALYs or 9.4% of 2,656,546 total DALYs. Substance use disorders accounted 15,022 [9948; 20,710] DALYs. Depressive, anxiety, and conduct disorders accounted for the most DALYs of mental disorders accounting for 3.1%, 2.3% and 1.7% of the total DALYs, respectively. The main risk factors for incident DALYs in 10–24-year-olds were bullying and victimization (66.5%). Childhood sexual abuse accounted for 13.7% of the DALYs, lead exposure accounted for 8.5% of the DALYs, intimate partner violence accounted for 11.3% of the DALYs (2%) with all victims being females, and illicit drug use accounted for (52.7%) of DALYs.InterpretationImproved surveillance of mental health and substance use burden at national and county levels is needed. Focus on timely screening and intervention for idiopathic developmental intellectual disability, conduct disorder, and substance use disorder in young boys and depression, anxiety, and eating disorders in young girls and women is critically needed.FundingMK is funded by 10.13039/100000061FIC/10.13039/100000025NIMH K43 TW 010716 and R33MH124149-03. The publication was made possible by funding from the Gates Foundation.

Introductionnon-communicable diseases (NCDs) are the leading cause of mortality and disability worldwide especially in developing countries such as Tunisia. We aimed to describe the national burden of non-communicable diseases in 2017 and to analyze disability-adjusted life year trends from 1990 to 2017 in Tunisia by cause and gender.Methodswe used Joinpoint regression analysis to assess trends of the age standardized disability-adjusted life year rate from 1990 to 2017 and to determine average annual percentage change.Resultsnon-communicable diseases accounted for 87.7% of total disability-adjusted life year in Tunisia in 2017. The five leading causes of this rate in Tunisia in 2017 were cardiovascular diseases, musculoskeletal disorders, neoplasms, mental disorders and neurological disorders. The trend of disability-adjusted life year rate of non-communicable diseases decreased significantly from 23403.2 per 100.000 (95% CI: 20830.2-26285.8) in 1990 to 18454.6 (95% CI: 15611.3-21555.4) in 2017, with a change of -0.9%; p=0.00. The decrease of the age standardized disability-adjusted life year rate concerned mainly cardiovascular diseases and neoplasms secondly. This decrease was more important in female (change=-1.1, p=0.00) in comparison to males (change=-0.7, p=0.00). On the other hand, the increase of the standardized disability-adjusted life year rate was related to musculoskeletal disorders, diabetes, kidney disorders and substance use disorders with a significant annual percentage change of 0.1%, 0.2% and 1.3% (p=0.00) respectively. Conclusion: the implementation of the national strategy is the key solution to mitigate the impact of non-communicable diseases in Tunisia.

Neurological disorders in India: past, present, and next steps

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition

Global Disease Burden From Acute Glomerulonephritis 1990–2019

Mental and substance use disorders profoundly affect global population health, while there is a notable absence of systematic studies focusing on their burden in the Chinese population. We estimated the burden of Global Burden of Diseases (GBD) 2021 for 10 mental disorders and two types of substance use disorders in China from 1990 to 2021. We presented the numbers and rates of prevalence, disability-adjusted life years (DALYs), years of life lost (YLL) and years lived with disability (YLDs), from national and 33 province-level administrative units in China. In 2021, China contributed 174.4 million prevalent cases (95% uncertainty interval [UI] 162.4-188.4 million) of mental disorders and 27.0 million prevalent cases (23.8-30.7 million) of substance use disorders. The age-standardized DALY rate for mental and substance disorders in China was lower than that in countries with high Socio-demographic Index (SDI) and middle SDI, as well as lower than global level. Depressive disorder and anxiety disorder being the two leading causes, accounting for 61.1% of mental disorder YLDs, and were most prevalent among individuals aged 15 and over. Population growth was an important contributor to the 62.0% increases in DALYs for mental disorder. Regionally, the age-standardized prevalence rates for mental disorders were higher in Eastern China, while substance use disorders were more prevalent in Western regions. These findings showed the burden of mental disorders in China has increased mainly due to the population growth and population aging. The comprehensive prevention and early intervention strategies is urgent to mitigate the burden and the impact for the public.

Challenges to estimating the true global burden of mental disorders – Authors' reply