The burden of mental illness

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Using the DALY as the basic statistic, the World Development Report(2) concludes that mental health problems make up 8.1 per cent of the total GBD. Of that 8.1 per cent, the largest contributors are depressive disorders, self-inflicted injuries. Alzheimer's disease and other dementia, and alcohol dependence, followed by epilepsy, psychoses, drug dependence, and post-traumatic stress disorder. Depressive and anxiety disorders account for between one-quarter and one-third of all primary-health-care visits worldwide.(3,,4) When appropriately diagnosed and treated, suffering is alleviated, disability prevented, and function restored; when ignored, major losses persist.(5) By the year 2025, three-quarters of all elderly persons with dementia (about 80 million) will live in low-income societies. Mental retardation and epilepsy rates are three to five times higher in low-income societies compared with industrialized countries. In some Asian and African countries, up to 90 per cent of patients with epilepsy—a treatable condition for which cost-effective drug therapy is available—do not receive anticonvulsants. (6)

In addition to that 8 per cent, as much as an additional 34 per cent of the GBD is due to disorders that are behaviour related, such as violence, smoking and drinking, AIDS and other sexually transmitted diseases, motor vehicle and other unintentional injuries, and gastrointestinal diseases that stem from failure to follow sanitary practices. An estimated 5 to 10 per cent of all persons on Earth are affected by alcohol-related diseases. Narcotics and other illicit drugs constitute a large and rapidly increasing source of morbidity in poor and rich societies alike. Thus, more than one-third of the GBD is potentially preventable by changing behaviour, a challenge that will require large-scale interventions to influence social messages, as well as counselling for individuals.

The World Health Report(I) lists, in separate tables, the 10 leading causes of mortality, the 10 leading causes of morbidity, and the 10 leading causes of disability. No psychiatric disorder appears on the mortality list; neurotic, stress-related, and somatoform disorders together make up the third most important cause of morbidity. However, in terms of chronically disabled persons, mood disorders are the most important single cause; mental retardation is fourth, epilepsy sixth, dementia seventh, and schizophrenia ninth.

Even more striking is a recent analysis undertaken by Murray and Lopez(8) of the Harvard Center for Population and Development Studies. Depression was the fourth leading cause of DALYs in 1990, exceeded only by lower respiratory infections, diarrhoeal diseases, and perinatal conditions ( Table,!).

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Table 1 Top 10 causes of DALYs worldwide for both sexes in 1990

Twenty-five years from now, depression will be second only to ischaemic heart disease as a cause of GBD ( Table d). Whereas ischaemic heart disease will account for 5.9 per cent of the total GBD, depression will account for 5.7 per cent. Despite the fact that neuropsychiatric conditions make up five of the 10 most important causes of long-term disability, despite the fact that depression alone is currently the fourth most important cause of DALYs, and despite the fact that depression will be the second leading cause 25 years from now, mental health is largely missing from the international health agenda.

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Table 2 Top 10 causes of DALYs worldwide for both sexes in 2020

Table 2 Top 10 causes of DALYs worldwide for both sexes in 2020

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