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

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• 作者：Harvey A Whiteford ; Louisa Degenhardt ; J眉rgen Rehm ; Am ; a J Baxter ; Alize J Ferrari ; Holly E Erskine ; Fiona J Charlson ; Rosana E Norman ; Abraham D Flaxman ; Nicole Johns ; Roy Burstein ; Christopher JL Murray ; Theo Vos
• 刊名：The Lancet
• 出版年：9-15 November, 2013
• 年：2013
• 卷：382
• 期：9904
• 页码：1575-1586
• 全文大小：8839 K

文摘

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Summary

Background

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).

Methods

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.

Findings

In 2010, mental and substance use disorders accounted for 183路9 million DALYs (95% UI 153路5 million-216路7 million), or 7路4% (6路2-8路6) of all DALYs worldwide. Such disorders accounted for 8路6 million YLLs (6路5 million-12路1 million; 0路5% [0路4-0路7] of all YLLs) and 175路3 million YLDs (144路5 million-207路8 million; 22路9% [18路6-27路2] of all YLDs). Mental and substance use disorders were the leading cause of YLDs worldwide. Depressive disorders accounted for 40路5% (31路7-49路2) of DALYs caused by mental and substance use disorders, with anxiety disorders accounting for 14路6% (11路2-18路4), illicit drug use disorders for 10路9% (8路9-13路2), alcohol use disorders for 9路6% (7路7-11路8), schizophrenia for 7路4% (5路0-9路8), bipolar disorder for 7路0% (4路4-10路3), pervasive developmental disorders for 4路2% (3路2-5路3), childhood behavioural disorders for 3路4% (2路2-4路7), and eating disorders for 1路2% (0路9-1路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路6% between 1990 and 2010, which for most disorders was driven by population growth and ageing.

Interpretation

Despite the apparently small contribution of YLLs鈥攚ith deaths in people with mental disorders coded to the physical cause of death and suicide coded to the category of injuries under self-harm鈥攐ur 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.

Funding

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 Universit盲t, Ontario Ministry of Health and Long Term Care, and the US National Institute of Alcohol Abuse and Alcoholism.