The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013

Raghid Charara 1, Mohammad Forouzanfar 1, Mohsen Naghavi 1, Maziar Moradi-Lakeh 1 2, Ashkan Afshin 1, Theo Vos 1, Farah Daoud 1, Haidong Wang 1, Charbel El Bcheraoui 1, Ibrahim Khalil 1, Randah R Hamadeh 3, Ardeshir Khosravi 4, Vafa Rahimi-Movaghar 5, Yousef Khader 6, Nawal Al-Hamad 7, Carla Makhlouf Obermeyer 8, Anwar Rafay 9, Rana Asghar 10, Saleem M Rana 9, Amira Shaheen 11, Niveen M E Abu-Rmeileh 12, Abdullatif Husseini 12, Laith J Abu-Raddad 13 14, Tawfik Khoja 15, Zulfa A Al Rayess 16, Fadia S AlBuhairan 17, Mohamed Hsairi 18, Mahmoud A Alomari 19, Raghib Ali 20, Gholamreza Roshandel 21, Abdullah Sulieman Terkawi 22 23 24, Samer Hamidi 25, Amany H Refaat 26 27, Ronny Westerman 28, Aliasghar Ahmad Kiadaliri 29, Ali S Akanda 30, Syed Danish Ali 31, Umar Bacha 32, Alaa Badawi 33, Shahrzad Bazargan-Hejazi 34 35, Imad A D Faghmous 36 37, Seyed-Mohammad Fereshtehnejad 38, Florian Fischer 39, Jost B Jonas 40, Barthelemy Kuate Defo 41, Alem Mehari 42, Saad B Omer 43, Farshad Pourmalek 44, Olalekan A Uthman 45, Ali A Mokdad 46, Fadi T Maalouf 47, Foad Abd-Allah 48, Nadia Akseer 49, Dinesh Arya 50, Rohan Borschmann 51, Alexandra Brazinova 52, Traolach S Brugha 53, Ferrán Catalá-López 54, Louisa Degenhardt 55, Alize Ferrari 1 56 57, Josep Maria Haro 58, Masako Horino 59, John C Hornberger 60 61, Hsiang Huang 62, Christian Kieling 63, Daniel Kim 64, Yunjin Kim 65, Ann Kristin Knudsen 66, Philip B Mitchell 67, George Patton 68, Rajesh Sagar 69, Maheswar Satpathy 70, Kim Savuon 71 72, Soraya Seedat 73, Ivy Shiue 74, Jens Christoffer Skogen 75 76, Dan J Stein 77 78, Karen M Tabb 79, Harvey A Whiteford 80, Paul Yip 81 82, Naohiro Yonemoto 83, Christopher J L Murray 1, Ali H Mokdad 1

Affiliations

17 January 2017

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doi: 10.1371/journal.pone.0169575

Abstract

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25-49 age group, with a peak in the 35-39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region.

Conflict of interest statement

We would like to declare the following commercial affiliations: Dr. Anwar Rafay is employed by Contech International health consultants. Syed Danish Ali is employed by SIR Consultants. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Rate of DALYs due to mental disorders in EMR and globally, by income level and gender.

Fig 1. Rate of DALYs due to mental disorders in EMR and globally, by income level and gender.

Fig 2. Rate of DALYs in EMR, by age and gender.

Fig 2. Rate of DALYs in EMR, by age and gender.

Fig 3. Rate of DALYs in EMR in 2013, by age and disorder.

Fig 3. Rate of DALYs in EMR in 2013, by age and disorder.

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