BackgroundThe global burden of mental disorders and substance abuse has increased 38% in absolute terms (5·8% per capita) between 1990 and 2010, from 5·3% to 7·4% of total disability-adjusted life-years (DALYs). Given the increasing importance of mental disorders worldwide, particularly for young adults, how can we make meaningful comparisons to determine which countries' policies have been effective in reducing their burden? This research will demonstrate new methods for comparative analysis highlighting the burden of mental disorders in the USA. MethodsMental burden estimates were derived as part of the Global Burden of Disease Study (GBD) 2010. To make meaningful comparisons across time, age-standardised DALY rates were utilised to adjust for changes in population size and age structure. FindingsAge-standardised DALY rates for mental disorders in the USA increased 13% between 1990 and 2010, from 3162 to 3576 DALYs per 100 000; by contrast, all developed countries increased 5% from 3016 to 3169. This increase in the USA was primarily due to substance abuse (65%) and major depression (13%). Across the 187 countries analysed, with highest rank indicating worst burden, the USA ranked 162nd for mental disorders in 2010. For specific conditions, ordered from highest to lowest burden, the USA ranked 56th for major depression (945 per 100 000), 183rd for drug use (743), 164th for anxiety (594), 138th for alcohol use (354), 179th for schizophrenia (242), and 52nd for bipolar disorder (186). Taking uncertainty into account, drug abuse was the only condition for which the USA performed significantly worse (p<0·0001) compared with the global mean. InterpretationThe USA consistently ranks below other developed nations and many developing nations for mental disorders despite spending 17·6% (US$2·5 trillion) of its gross domestic product on health in 2010, with 5% of that on mental health, among the highest of any country. This makes a compelling case for re-examination of how the USA should reprioritise mental health policy and funding. For substance abuse, countries that emphasise harm reduction policies (Netherlands, Belgium, Germany) perform substantially better than do those focused on penalisation (USA, UK, Italy, Spain). For anxiety and depression, prescription of psychotropic drugs in lieu of the more effective types of psychotherapy may have led to little improvement despite large expenditure. Further data collection on prevalence and severity of mental disorders is necessary to improve comparisons between countries. FundingBill & Melinda Gates Foundation.
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