Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
- PMID: 35026139
- PMCID: PMC8776563
- DOI: 10.1016/S2215-0366(21)00395-3
Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
Abstract
Background: The mental disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, eating disorders, idiopathic developmental intellectual disability, and a residual category of other mental disorders. We aimed to measure the global, regional, and national prevalence, disability-adjusted life-years (DALYS), years lived with disability (YLDs), and years of life lost (YLLs) for mental disorders from 1990 to 2019.
Methods: In this study, we assessed prevalence and burden estimates from GBD 2019 for 12 mental disorders, males and females, 23 age groups, 204 countries and territories, between 1990 and 2019. DALYs were estimated as the sum of YLDs and YLLs to premature mortality. We systematically reviewed PsycINFO, Embase, PubMed, and the Global Health Data Exchange to obtain data on prevalence, incidence, remission, duration, severity, and excess mortality for each mental disorder. These data informed a Bayesian meta-regression analysis to estimate prevalence by disorder, age, sex, year, and location. Prevalence was multiplied by corresponding disability weights to estimate YLDs. Cause-specific deaths were compiled from mortality surveillance databases. The Cause of Death Ensemble modelling strategy was used to estimate death rate by age, sex, year, and location. The death rates were multiplied by the years of life expected to be remaining at death based on a normative life expectancy to estimate YLLs. Deaths and YLLs could be calculated only for anorexia nervosa and bulimia nervosa, since these were the only mental disorders identified as underlying causes of death in GBD 2019.
Findings: Between 1990 and 2019, the global number of DALYs due to mental disorders increased from 80·8 million (95% uncertainty interval [UI] 59·5-105·9) to 125·3 million (93·0-163·2), and the proportion of global DALYs attributed to mental disorders increased from 3·1% (95% UI 2·4-3·9) to 4·9% (3·9-6·1). Age-standardised DALY rates remained largely consistent between 1990 (1581·2 DALYs [1170·9-2061·4] per 100 000 people) and 2019 (1566·2 DALYs [1160·1-2042·8] per 100 000 people). YLDs contributed to most of the mental disorder burden, with 125·3 million YLDs (95% UI 93·0-163·2; 14·6% [12·2-16·8] of global YLDs) in 2019 attributable to mental disorders. Eating disorders accounted for 17 361·5 YLLs (95% UI 15 518·5-21 459·8). Globally, the age-standardised DALY rate for mental disorders was 1426·5 (95% UI 1056·4-1869·5) per 100 000 population among males and 1703·3 (1261·5-2237·8) per 100 000 population among females. Age-standardised DALY rates were highest in Australasia, Tropical Latin America, and high-income North America.
Interpretation: GBD 2019 showed that mental disorders remained among the top ten leading causes of burden worldwide, with no evidence of global reduction in the burden since 1990. The estimated YLLs for mental disorders were extremely low and do not reflect premature mortality in individuals with mental disorders. Research to establish causal pathways between mental disorders and other fatal health outcomes is recommended so that this may be addressed within the GBD study. To reduce the burden of mental disorders, coordinated delivery of effective prevention and treatment programmes by governments and the global health community is imperative.
Funding: Bill & Melinda Gates Foundation, Australian National Health and Medical Research Council, Queensland Department of Health, Australia.
Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of interests C Kieling reports grants from MQ: Transforming Mental Health, the Royal Academy of Engineering, the US Academy of Medical Sciences, the US National Institutes of Health, Conselho Nacional de Desenvolvimento Científico e Tecnológico, the UK Medical Research Council, and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul; and consulting fees from the United Nations Children's Fund, outside the submitted work. P B Mitchell reports grants from the Australian National Health and Medical Research Council; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Janssen Australia, outside the submitted work. G C Patton reports support for the present manuscript from the Australia National Health and Medical Research Council. J B Soriano reports participation in the Institute for Health Metrics and Evaluation's Tobacco Advisory board, outside the submitted work. D J Stein reports royalties or licenses from Elsevier and the American Psychiatric Press; consulting fees from Johnson & Johnson, Lundbeck, Sanofi, and Vistagen; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Servier and Takeda, outside the submitted work. M B Stein reports grants or contracts from the US National Institute of Mental Health, US Department of Defense, and US Department of Veterans Affairs; consulting fees from Aptinyx, Acadia Pharmaceuticals, Bionomics, Boehringer-Ingelheim, Clexio, EmpowerPharm, Engrail, GW Pharmaceuticals, Janssen, Kazz Pharmaceuticals, and Roche/Genentech; stocks from Pfizer; holds stock options in Epivario and Oxeia Biopharmaceuticals, and owns mutual funds that might contain pharmaceutical stocks; and is the Editor-in-Chief of Depression and Anxiety, Deputy Editor of Biological Psychiatry, and Co-Editor-in-Chief of UptoDate (Psychiatry), outside the submitted work. C E I Szoeke acknowledges support for the present manuscript from National Health and Medical Research Council Australia funding (1032350 and 1062133) paid to the University of Melbourne; and acknowledges payment for expert testimony from the Victorian Department of Health, and for leadership or fiduciary role in board, society, committee or advocacy group, paid or unpaid with the American Medical Association, outside the submitted work. All other authors declare no competing interests.
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Comment in
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The true global disease burden of mental illness: still elusive.Lancet Psychiatry. 2022 Feb;9(2):98-100. doi: 10.1016/S2215-0366(22)00002-5. Epub 2022 Jan 10. Lancet Psychiatry. 2022. PMID: 35026138 No abstract available.
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