We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study
2010 (GBD 2010) to estimate the burden of disease attributable to mental and substance
use disorders in terms of disability-adjusted life years (DALYs), years of life lost
to premature mortality (YLLs), and years lived with disability (YLDs).
For each of the 20 mental and substance use disorders included in GBD 2010, we systematically
reviewed epidemiological data and used a Bayesian meta-regression tool, DisMod-MR,
to model prevalence by age, sex, country, region, and year. We obtained disability
weights from representative community surveys and an internet-based survey to calculate
YLDs. We calculated premature mortality as YLLs from cause of death estimates for
1980-2010 for 20 age groups, both sexes, and 187 countries. We derived DALYs from
the sum of YLDs and YLLs. We adjusted burden estimates for comorbidity and present
them with 95% uncertainty intervals.
In 2010, mental and substance use disorders accounted for 183·9 million DALYs (95%
UI 153·5 million-216·7 million), or 7·4% (6·2-8·6) of all DALYs worldwide. Such disorders
accounted for 8·6 million YLLs (6·5 million-12·1 million; 0·5% [0·4-0·7] of all YLLs)
and 175·3 million YLDs (144·5 million-207·8 million; 22·9% [18·6-27·2] of all YLDs).
Mental and substance use disorders were the leading cause of YLDs worldwide. Depressive
disorders accounted for 40·5% (31·7-49·2) of DALYs caused by mental and substance
use disorders, with anxiety disorders accounting for 14·6% (11·2-18·4), illicit drug
use disorders for 10·9% (8·9-13·2), alcohol use disorders for 9·6% (7·7-11·8), schizophrenia
for 7·4% (5·0-9·8), bipolar disorder for 7·0% (4·4-10·3), pervasive developmental
disorders for 4·2% (3·2-5·3), childhood behavioural disorders for 3·4% (2·2-4·7),
and eating disorders for 1·2% (0·9-1·5). DALYs varied by age and sex, with the highest
proportion of total DALYs occurring in people aged 10-29 years. The burden of mental
and substance use disorders increased by 37·6% between 1990 and 2010, which for most
disorders was driven by population growth and ageing.
Despite the apparently small contribution of YLLs--with deaths in people with mental
disorders coded to the physical cause of death and suicide coded to the category of
injuries under self-harm--our findings show the striking and growing challenge that
these disorders pose for health systems in developed and developing regions. In view
of the magnitude of their contribution, improvement in population health is only possible
if countries make the prevention and treatment of mental and substance use disorders
a public health priority.
Queensland Department of Health, National Health and Medical Research Council of Australia,
National Drug and Alcohol Research Centre-University of New South Wales, Bill & Melinda
Gates Foundation, University of Toronto, Technische Universität, Ontario Ministry
of Health and Long Term Care, and the US National Institute of Alcohol Abuse and Alcoholism.
Copyright © 2013 Elsevier Ltd. All rights reserved.