Mariann Bhabes D. Subillaga, RNApril 24, 2015

PREVAILING MENTAL DISORDERS IN THE WORLD

INTRODUCTION

Mental illness is a highly prevalent, life-threatening disease that affects millions of people all around the world

It does not discriminate: it strikes people of all ethnic groups and economic brackets

About 450 million people suffer from mental and behavioural disorders worldwide (2001)

1 person in 4 will develop one or more mental or behavioural disorders during their lifetime (2001)

Mental and neurological disorders account for a higher proportion of disease burden and disability than any other category of noncommunicable disease (2008)

Four of the ten leading causes of disability worldwide are neuropsychiatric disorders which accounts for 13% of the total Disability Adjusted Life Years (DALYs) lost due to all diseases and injuries in the world and are estimated to increase to 15% by the year 2020 (2004)

The burden of mental disorders continues to grow with significant impacts on health and major social, human rights and economic consequences in all countries of the world

Mental illness has a significant impact on human productivity

Major depression is the leading cause of disability worldwide among persons aged five or older

Mental disorders account for about 160 million lost years of healthy life

Mental illness causes as many lost days of work as any physical problem

Mental illness, including suicide, accounts for over 15% of the lost years of healthy life, also known as Disability Adjusted Life Years (DALYS)

Mental illness has a staggering impact on the global economy

Major depression cost an estimated $23 billion in lost workdays

At the government level, mental diseases account for 12% of the global burden of disease, but the mental healthcare budgets of most countries are less than 1% of total healthcare expenditures

Around the world, the stigma associated with mental illness creates a vicious cycle of alienation and discrimination that results in social and political isolation and inadequate treatment approaches and resources within the community

DEPRESSION

One of the most prevalent psychiatric disorders affecting around 340 million people worldwide (WHO, 2004)

The leading cause of disability worldwide, and is a major contributor to the global burden of disease the third most important cause of disease burden worldwide in 2004

Unipolar depression was in eighth place in low-income countries, but at first place in middle- and high-income countries.

More women are affected by depression than men. Between two and four of every ten mothers in developing countries suffer from depression during pregnancy or after childbirth

In 2002 unipolar depression accounted for 4.5% of all DALYs and is expected to become the second-ranked cause of disease burden in 2020, accounting for 5.7% of DALYs

Major depression is linked to suicide. Most people who commit suicide are also clinically depressed. If we take suicide into account, then the already huge burden associated with depression increases much more (2001)

ANXIETY

Includes panic disorder, generalized anxiety disorder, post-traumatic stress disorder, phobias, and separation anxiety disorder, are the most common class of mental disorders present in the general population

It has been estimated that anxiety disorders affect between 5 and 7% of the general population, and that up to 29% of people will suffer from an anxiety disorder at least once during their lifetime. In 2004, over 28 million people worldwide had obsessivecompulsive disorder, and over 30 million experienced panic disorder

Most anxiety disorders are more prevalent in women than in men

The estimated lifetime prevalence of any anxiety disorder is over 15%, while the 12-month prevalence is more than 10%

Prevalence estimates of anxiety disorders are generally higher in developed countries than in developing countries

SCHIZOPHRENIA

Schizophrenia is the most frequently encountered psychotic illness

Schizophrenia is a severe mental disorder affecting more than 21 million people worldwide (2014)

One in one hundred people in the world develop schizophrenia

More common among males (12 million), than females (9 million)

Also commonly starts earlier among men (about 21 years of age) than women (27 years)

People with schizophrenia are 2-2.5 times more likely to die early than the general population

Persons with schizophrenia pose a high risk for suicide. Approximately one-third will attempt suicide and, eventually, about 1 out of 10 will take their own lives

BIPOLAR DISORDER

This disorder affects about 60 million people worldwide

Lifetime prevalence of nearly 4% (The National Comorbidity Study)

More than two in one hundred people in the world develop bi-polar disorder

More common in women than men, with a ratio of approximately 3:2

The median age of onset for bipolar disorder is 25 years, with men having an earlier age of onset than women

Bipolar disorder has been deemed the most expensive behavioral health care diagnosis, costing more than twice as much as depression per affected individual

One in five people suffering from bipolar disorder will commit suicide

SUBSTANCE ABUSE DISORDER

Mental disorders and substance use disorders were the fifth leading cause of death and disease worldwide

Globally, tobacco as a risk factor causes 4.1% of the total burden of disability (WHO, 2002)

In the 21st century, it is estimated that tobacco will be the cause of one billion deaths worldwide, with three quarters of these deaths occurring in low income countries

In 2012, about 3.3 million net deaths, or 5.9% of all global deaths, were attributable to alcohol consumption

Worldwide, about two billion people consume alcoholic beverages and over 75 million are diagnosed with alcohol use disorders (WHO, 2004)

25% of men and 10% of women consume alcohol at levels hazardous and harmful to their health

The lifetime prevalence rate for alcohol dependence is more than twice as high for men as for women

At least 15.3 million persons have drug use disorders

155 to 250 million people, or 3.5% to 5.7% of the world's population aged 15-64, used other psychoactive substances, such as cannabis, amphetamines, cocaine, opioids, and non-prescribed psychoactive prescription medication (2008)

Mental disorders and harmful use of alcohol contribute to many suicides around the world

DEMENTIA

For people over 60, it is the main cause of disability

Dementia affects over 35 million people worldwide

As the number of older people increases, the total number of people with dementia worldwide is set to nearly double every 20 years to 65.7 million in 2030 and 115.4 million in 2050 (World Alzheimer Report, 2009), and these increases will be more evident in countries where the population is ageing more rapidly

It has an impact on the quality of life that is similar to that experienced with many mental health conditions and is a significant and growing factor in age-related disability across the world

ALZHEIMERS DISEASE

Represent the fourth highest source of overall disease burden in the high-income countries, according to WHO statistics. But the disease is also a major burden in less wealthy countries and is expected to grow rapidly

Worldwide, Alzheimer's Disease International (ADI) estimates in its 2010 report that there are 35.6 million people with AD worldwide as of 2010, and that this will grow to 115.4 million people by 2050

CHILD AND ADOLESCENT MENTAL HEALTH

Around 20% of the world's children and adolescents have mental disorders or problems

According to data from the WHO, mental health disorders account for nearly half of the disease burden in the worlds adolescents and young adults. Young people aged 10 to 24 years equal 27% of the worlds population

Overall, mental health disorders were the most prevalent source of disability for young people worldwide, accounting for 45% of total morbidity

The most common childhood mental disorders are anxiety disorders, depression, and attention deficit hyperactivity disorder (ADHD)

ADHD affects 8%-10% of school-aged children

Depression occurs at a rate of about 2% during childhood and from 4%-7% during adolescence, affecting up to about 20% of adolescents by the time they reach adulthood

Girls are more likely to be diagnosed with mood disorders like depression and anxiety compared to boys, while disorders like attention deficit hyperactivity disorder and autism spectrum disorders are more often assigned to boys

In teens more frequently than in younger children, addictions, bipolar disorder, and less often early onset schizophrenia may manifest

Although not as commonly occurring, developmental disabilities like autism spectrum disorders can have a significant lifelong impact on the life of the child and his or her family. Autism spectrum disorder is a developmental disorder that is characterized by impaired development in communication, social interaction, and behavior. Statistics about autism include that it afflicts one out of every 88 children, a 78% increase in the past 10 years

Mental disorders that are prevalent in later life can appear during adolescence or young adulthood, and some can appear in early childhood years

Not only does a childhood mental health disorder increase the risk for an adult mental health disorder, it also increases the prevalence of risky health behaviors and other chronic diseases, all of which contribute to morbidity and mortality worldwide

SUICIDE

According to WHO estimates, in 2001 approximately 849,000 people died from suicide worldwide (WHO, 2002)

Over 800 000 people die due to suicide every year (2014)

In 2020, approximately 1.2 million suicides are estimated (Murray and Lopez, 1996) and 1020 times more people than this will attempt suicide

Suicide occurs throughout the lifespan and was the second leading cause of death among 1529-year-olds globally in 2012

Mental disorders are associated with over 90% of all reported suicide cases.

75% of global suicides occur in low- and middle-income countries

Ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally

World Health Organization response to Suicide

WHO recognizes suicide as a public health priority. The first WHO World Suicide Report Preventing suicide: a global imperative published in 2014, aims to:

1. increase the awareness of the public health significance of suicide and suicide attempts

2. make suicide prevention a high priority on the global public health agenda

3. encourage and support countries to develop or strengthen comprehensive suicide prevention strategies in a multisectoral public health approach

Suicide is one of the priority conditions in the WHO Mental Health Gap Action Programme (mhGAP) launched in 2008, which provides evidence-based technical guidance to scale up service provision and care in countries for mental, neurological and substance use disorders. In the WHO Mental Health Action Plan 2013-2020, WHO Member States have committed themselves to working towards the global target of reducing the suicide rate in countries by 10% by 2020.

Factors restraining the implementation of national strategies on prevention, treatment and care of mental problems

Gro Harlem Brundtland

Director General World Health Organization (2001)

1. Rapid economic reforms and social change including economic transitions are bringing about alarming rates of unemployment, family breakdown, personal insecurity and income inequality.

2. Political instability, violence especially against women, natural disasters, armed conflicts, and the HIV/AIDS crisis are seriously challenging the coping capacity of the affected populations

3. Managerial weakness in health systems persist. Most importantly, the serious shortage of mental health resources, especially service providers, was noted in many countries.

4. There were large technical gaps in countries regarding prevalence, diagnosis and treatment issues compounded by lack of knowledge about financing schemes, anti-stigma and legislation issues as well as intersectoral collaboration in mental health.

5. More than 40% of countries have no mental health policy and over 30% have no mental health programme. Even countries that do have mental health policies often disappointingly neglect some of the more vulnerable populations.

6. In most countries, stigma and human rights violations of persons with mental illness are rampant. Few efforts are in place to address discrimination and stigmatization both of which represent a substantial hidden burden of mental illness. WHO and Ministers of Health have concluded that this lack of investment in mental health is now unacceptable

World Health Organization response to Mental Health

WHOs Mental Health Action Plan 2013-2020, endorsed by the World Health Assembly in 2013, recognizes the essential role of mental health in achieving health for all people. The plan includes 4 major objectives:

1. more effective leadership and governance for mental health;

2. the provision of comprehensive, integrated mental health and social care services in community-based settings;

3. the implementation of strategies for promotion and prevention; and

4. strengthened information systems, evidence and research

WHO's Mental Health Gap Action Programme (mhGAP), launched in 2008, uses evidence-based technical guidance, tools and training packages to expand service in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care.

There is hope for people living with mental illness

People can regain their mental health, but not with medication alone

People with mental illness are successfully participating in society through a combination of medication, community support services and relationships that ease the way from isolation to full participation in life

Thousands of good examples exist around the world of people with mental illness not merely integrated into their communities, but playing a socially productive and economically important role

The emergence of Clubhouses and other rehabilitation services in many countries around the world demonstrates through a growing body of evidence that people with mental illness can successfully participate in society through education, employment and other social activities

There is clear evidence that old-style mental hospitals are not effective in providing the treatment that people with mental disorders need and violate basic human rights of persons with mental disorders. Efforts to transfer care from mental health institutions to the community need to be expanded and accelerated. The engagement of family members and the wider community in providing support is very important

Access to health care and social services capable of providing treatment and social support is key

References

Burden of Mental Illness Centers for Disease Control and Prevention, Burden of Mental Illness, http://www.cdc.gov/mentalhealth/basics/burden.htm

Mental Health Disorders Prevalent Among Youth Worldwide, by Jennifer Gibson, PharmD | August 13, 2011, http://brainblogger.com/2011/08/13/mental-health-disorders-prevalent-among-youth-worldwide/

Humanosphere, GLOBAL HEALTH Visualizing Mental Illness Worldwide, BY GUEST ON 27 JUNE 2013, http://www.humanosphere.org/global-health/2013/06/visualize-mental-illness/ Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washingtons Institute for Health Metrics and Evaluation.

WHO, Depression Fact sheet N369 October 2012, http://www.who.int/mediacentre/factsheets/fs369/en/

MINISTERIAL ROUND TABLES 2001, 54TH WORLD HEALTH ASSEMBLY, MENTAL HEALTH, A Call for Action by World Health Ministers, http://www.who.int/mental_health/advocacy/en/Call_for_Action_MoH_Intro.pdf, MINISTERIAL ROUND TABLES 2001

Voices of the Marginalized: Persons with Disabilities, Older People, People with Mental Health Issues, Emma Cain, October 2012, http://www.addc.org.au/documents/resources/voices-of-the-marginalized-persons-with-disabilities-older-people-people-with-mental-health-issues_927.pdf

http://cogprints.org/4207/1/Jiacam05_1_3.pdf, Child and Adolescent Mental Health Around, The World: Challenges for Progress

http://www2.nami.org/factsheets/mentalillness_factsheet.pdf

http://www.apa.org/international/outreach/icd-reed.pdf, Toward ICD-11: Improving the Clinical Utility of WHOs International

MedicineNet.com, Mental Illness in Children, http://www.medicinenet.com/mental_illness_in_children/page2.htm

American Journal of Epidemiology, http://aje.oxfordjournals.org/content/168/9/977.long

http://www.nationsencyclopedia.com/United-Nations-Related-Agencies/The-World-Health-Organization-WHO-ACTIVITIES.html

http://www.paho.org/bulletins/index.php?option=com_content&view=article&id=1273:world-mental-health-day-depression-the-most-common-mental-disorder&Itemid=0&lang=en

http://www.iccd.org/keyfacts.html

http://www.cdc.gov/mentalhealth/basics/burden.htm

http://www.who.int/mediacentre/factsheets/fs396/en/

http://www.who.int/mediacentre/factsheets/fs397/en/

http://www.who.int/mediacentre/factsheets/fs398/en/

http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/

http://www.who.int/substance_abuse/facts/en/

http://www.lundbeck.com/ie/patient-information/mood-disorders/anxiety