|Year : 2016 | Volume
| Issue : 3 | Page : 249-250
Global burden of psychiatric disorders: Has it increased?
Abhijit R Rozatkar1, Nitin Gupta2
1 Department of Psychiatry, SHKM Government Medical College, Mewat, Haryana, India
2 Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
|Date of Web Publication||3-Nov-2016|
Dr. Nitin Gupta
Professor, Department of Psychiatry, Government Medical College and Hospital, Sector-32, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rozatkar AR, Gupta N. Global burden of psychiatric disorders: Has it increased?. Indian J Soc Psychiatry 2016;32:249-50
Morbidity and mortality related to mental health assumed importance when the first report documenting the global burden of disease using disability adjusted life years (DALYs) was published. Subsequent studies conducted in 2000 and 2010 have included more psychiatric disorders such as eating disorders, childhood behavioral disorders, pervasive developmental disorders, and also variations of enlisted disorders such as dysthymia and cyclothymia. The report by Murray et al. also stratifies disability by age (20 subgroups) and sex, giving fairly detailed assessment of burden due to mental and substance-use disorder. From a methodological point of view, this latest study by Murray et al. estimates burden on the basis of a systemic review of community-based prevalence studies rather than the previous incidence-based study. Also, using special statistical analysis, it provides estimates for regions from where data is unavailable.
In 2010, Whiteford et al. reported that mental and substance disorders accounted for 7.4% (6.2–8.6%) of all DALYs. Although mental and substance disorders contributed only 0.5% (0.4–0.7%) of years of life lost (YLL), yet they accounted for 22.9% (18.6–27.2%) of all years lived with disability (YLD). Among the various mental and substance-use disorders, depressive disorder including dysthymia 40.5% (31.7–49.2%) is the largest contributor to burden followed by anxiety disorders 14.6% (11.2–18.4%), illicit drug-use disorders 10.9% (8.9–13.2%), alcohol-use disorders 9.6% (7.7–11.8%), schizophrenia 7.4% (5.0–9.8%), bipolar disorder including cyclothymia 7% (4.4–10.3%), pervasive developmental disorders 4.2% (3.2–5.3%), childhood behavioral disorders 3.4% (2.2–4.7%), and eating disorders 1.2% (0.9–1.5%). Except for the age group of 10 years or less, girls and women bear more burden than men in all other age groups. Age-standardized DALY rates do not significantly deviate from the global mean except in certain countries (China, North Korea, Japan, and Nigeria)
As there was significant change in methodology in the newer study, the data pertaining to previous study was reanalyzed and compared with current estimates. It was found that among men, alcohol-use disorder and other drug-use disorders showed an increased burden in 2010 as compared to 1990; whereas among women, increase in burden was noted for opioid use disorders and eating disorders. In both genders, marginal decrease in burden for schizophrenia and alcohol-use disorders was noted and decrease in idiopathic intellectual disability was significant. For major depressive disorders, bipolar affective disorder, anxiety disorders, autism, and attention-deficit hyperactivity disorder the age-adjusted DALY rates were nearly the same.
Between 1990 and 2010, the burden due to mental and substance-use disorders increased from 133.6 million DALYs to 183.9 million DALYs, an increase of nearly 37%. Despite the absolute increase in numbers, it was suggested by the authors that this increase is more likely a reflection of an increase in population rather than changes in prevalence of most psychiatric disorders; the exception being opioid and cocaine dependence where an actual increase in prevalence was noted. Burden related studies have,,,, presented an opportunity to highlight the plight of mental-health issues worldwide and also give an impetus for remedial action. However, their methodological issues seem to blunt ground realities known to mental-health workers. For example, one cannot fail to notice that although mental and substance-use disorders are the leading cause of disability worldwide, but when measured as the composite score (DALY), they are 5th in terms of global burden of diseases. Years of life lost (YLL) due to mental and substance-use disorders is only 0.5% of all cases of YLLs; this appears quite an understatement.
Measurement of mental-health disorders continues to suffer from a few conceptual and methodological flaws which limit/reduce their proper reporting/recording. If we study the aspect of burden of mortality, in a study from Ethiopia, patients with severe mental illness died 30 years prematurely – suicide being the cause in about 15% of the cohort. Walker et al. (2015), in their recent systematic review and meta-analysis, estimated that eight million deaths per year, that is, 14.3% of worldwide deaths can be attributed to mental and substance-use disorders, and additionally demonstrated that the median years of potential life lost was about 10 years. Nevertheless, it needs to be highlighted and kept in perspective that under the current classificatory system, deaths due to suicides are more likely to be coded as intentional self-harm or accidents; thus, not being represented in mental and substance-use disorders. The same applies to morbidity arising by nonlethal self-harm. This disregard of underlying mental disorders in cases of self-harm, lethal or otherwise, needs to be corrected. For mortality estimation of the global burden of diseases, only death directly attributed to mental disorders and recorded likewise in death certificates is included. Thus schizophrenia and substance misuse are reported as the major causes of death whereas illnesses such as bipolar disorder and depression are reported to cause negligible deaths! To further exemplify, death in a patient with schizophrenia due to cardiovascular event which was precipitated by his smoking and antipsychotic induced metabolic disorder is not included under mental and substance-use disorders but under cardiovascular and circulatory disorder cause.
This methodological issue of attributing a single disease to mortality, disregarding the more frequently observed scenario of multiple noncommunicable disease comorbidities also needs to be revised.
Last but not the least, as of now, the global burden of disease study does not encompass all psychiatric disorders. Personality disorders are highly prevalent (4–15%), can lead to significant burden on the individual and their family, and are also likely to have multiple psychiatric and physical comorbidities which can compromise their life span and hence must be included in future global burden of disease studies. This issue has been very aptly highlighted in lucid detail by Kallivayallil and Enara (2016) in this section where they discuss how the various estimates of the global burden of mental and substance-use disorders have failed to acknowledge the massive economic and social consequences of these disorders. Similar considerations will apply for somatoform disorders, which currently are more likely to be included as chronic pain syndromes (under musculoskeletal conditions).
We have tried to provide not only an evidence-based background but also a brief bird’s eye view into the theme of this subsection, that is, “increasing global burden of psychiatric disorders.” We do believe that the global burden has increased, a view endorsed by Chavan and Aneja (2016) too, though from a different conceptual framework and debated by them due to it facing numerous hurdles. Prospective solutions to the increased burden have been offered and discussed in the global context by Chavan and Aneja (2016) with a special emphasis on the family in the Indian context by Murali et al. (2016). Also, as highlighted by Kastrup (2016) in this section subsequently, the current health systems and responsible stakeholders have not sufficiently responded to this enormous burden of mental disorders, which is at least twice in the less developed as compared to the well-developed countries.
The myriad of articles in this section should help put in perspective and guide the readers to make up their own mind regarding the “ever-increasing burden of psychiatric disorders!”
| Acknowledgment|| |
Financial support and sponsorship
Conflict of interest
| References|| |
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