Introduction

A substantial proportion of the world’s health problems in high-income countries (HICs) and low- and middle-income countries (LMICs) arises from mental, neurological, and substance use disorders (Murray, Vos, and others 2012; WHO 2008). Treatment rates for these disorders are low, particularly in LMICs, where treatment gaps of more than 90 percent have been documented (Wang, Aguilar-Gaxiola, and others 2007). Even in HICs, where rates of treatment are comparatively higher, treatment for mental, neurological, and substance use disorders tends to be provided many years after the onset of the disorder (Wang, Aguilar-Gaxiola, and others 2007; Wang, Angermeyer, and others 2007).

Methodology

Annex 2A summarizes the mental, neurological, and substance use disorders investigated in GBD 2010 and describes how the YLDs, YLLs, and DALYs for each disorder were estimated. More detailed information about the input data and methods can be accessed elsewhere (Baxter and others 2013; Baxter and others 2014a; Baxter and others 2014b; Degenhardt and others 2011; Degenhardt, Baxter, and others 2014; Degenhardt, Charlson, and others 2014; Degenhardt, Ferrari, and others 2013; Degenhardt, Whiteford, and others 2013; Erskine and others 2014; Ferrari, Baxter, and Whiteford 2010; Ferrari and others 2013a; Ferrari and others 2013b; Saha and others 2005; Whiteford, Degenhardt, and others 2013; Whiteford, Ferrari, and others 2013).

To allow for comparability in measurement, the definitions of dementia and mental and substance use disorders used for GBD 2010 were restricted to diagnostic classifications provided in the Diagnostic and Statistical Manual of Mental Disorders (APA 2000) and the International Classification of Diseases (ICD-10) (WHO 1992). The epilepsy definition was based on ICD-10 (WHO 1992). For each disorder, YLDs and YLLs were summed to estimate DALYs. For disorders where there were insufficient data to estimate YLLs, YLDs were equated with DALYs. Uncertainty was estimated at all stages of the analysis through microsimulation methods and propagated to the final burden estimates. YLDs, YLLs, and DALYs in this chapter are presented for 1990 and 2010 at the following levels:

• Global
• Disaggregated by disorder type, age, gender, and year
• Disaggregated by the seven superregion groups in GBD 2010: East Asia and Pacific, Eastern Europe and Central Asia, high-income regions (North America, Australasia, Western Europe, high-income Asia Pacific, and southern Latin America), Latin America and the Caribbean, the Middle East and North Africa, South Asia, and Sub-Saharan Africa
• Disaggregated by developed and developing regions.

The terms developed and developing regions are used here rather than HICs and LMICs for consistency with the presentation of the GBD 2010 estimates. The classification of countries into regions and regions into superregions was based on geographical proximity and epidemiological likeness in cause of death patterns (Murray, Vos, and others 2012; Vos and others 2012). Whiteford, Degenhardt, and others (2013) provide a list of all countries in each region and superregions. Where age-standardized DALY rates are presented, these were estimated using direct standardization to the global standard population that WHO proposed in 2001 (http://www.who.int/healthinfo/paper31.pdf).

Burden of Mental, Neurological, and Substance Use Disorders

Mental, neurological, and substance use disorders accounted for 258 million DALYs in 2010, which was equivalent to 10.4 percent of total all-cause DALYs. Within mental, neurological, and substance use disorders, mental disorders accounted for the highest proportion of DALYs (56.7 percent), followed by neurological disorders (28.6 percent) and substance use disorders (14.7 percent). For all three groups of disorders, DALYs occurred across the lifespan (figure 2.1); however, there was a peak in early adulthood (between ages 20 and 30 years) for mental and substance use disorders compared with neurological disorders, where DALYs were highest in the elderly.

Figure 2.1

DALYs Attributable to Mental, Neurological, and Substance Use Disorders, by Age, 2010.

Absolute DALYs for mental, neurological, and substance use disorders increased by 41 percent between 1990 and 2010, from 182 million to 258 million DALYs. With the exception of substance use disorders, where age-standardized DALY rates for opioid, cocaine, and amphetamine dependence increased over time, the increase in absolute DALYs for the other disorders was largely caused by changes in population growth and aging. Table 2.1 summarizes the age-standardized DALY rates for 1990 and 2010.

Table 2.1

Age-Standardized DALY Rates Attributable to Mental, Neurological, and Substance Use Disorders, 1990 and 2010.

Table 2.2 summarizes the DALYs assigned to each mental, neurological, and substance use disorder in 2010. These disorders as a group ranked as the third-leading cause of DALYs (explaining 10.4 percent of DALYs), after cardiovascular and circulatory diseases (explaining 11.9 percent of DALYs), and diarrhea, lower respiratory infections, meningitis, and other common infectious diseases (explaining 11.4 percent of DALYs). Major depressive disorder was responsible for the highest proportion of mental, neurological, and substance use disorder DALYs (24.5 percent); attention-deficit hyperactivity disorder was responsible for the lowest (0.2 percent).

Table 2.2

DALYs Attributable to Mental, Neurological, and Substance Use Disorders, 2010.

Overall, in 2010, 124 million mental, neurological, and substance use DALYs occurred among males and 134 million among females. Figure 2.2 shows DALY rates for each mental, neurological, and substance use disorder by gender. Females accounted for more DALYs for most of the mental and neurological disorders, except for mental disorders occurring in childhood, schizophrenia, Parkinson’s disease, and epilepsy, where males accounted for more DALYs. Males also accounted for more DALYs than females in all substance use disorders.

Figure 2.2

Age-Standardized DALY Rates Attributable to Individual Mental, Neurological, and Substance Use Disorders, by Gender, 2010.

Figure 2.3 shows the burden attributable to mental, neurological, and substance use disorders as a group in 2010 by the GBD 2010 superregion groupings and by developed and developing world regions. Overall, the burden of these disorders as age-standardized rates was approximately 1.6 times higher in developed regions (explaining 15.5 percent of total DALYs) compared with developing regions (explaining 9.4 percent of total DALYs). When disaggregated by GBD superregions, the burden of mental, neurological, and substance use disorders was highest in Eastern Europe and Central Asia and lowest in East Asia and Pacific. Mental disorders maintained the highest proportion of DALYs in all superregions; the greatest variation in DALYs occurred within substance use disorders, where DALYs were almost three times higher in Eastern Europe and Central Asia, compared with Sub-Saharan Africa, where DALYs were lowest.

Figure 2.3

Age-Standardized DALY Rates Attributable to Mental, Neurological, and Substance Use Disorders, by Region, 2010.

Figure 2.4 illustrates the decomposition of global burden by YLDs and YLLs for the overall categories of communicable diseases, noncommunicable diseases, and injuries. Noncommunicable diseases explained a large proportion of YLDs and YLLs in 2010. Within this group, mental, neurological, and substance use disorders were responsible for 28.5 percent of all YLDs, making them the leading cause of YLDs worldwide.

Figure 2.4

Proportion of Global YLDs and YLLs Attributable to Mental, Neurological, and Substance Use Disorders, 2010.

In comparison, mental, neurological, and substance use disorders contributed to only 2.3 percent of YLLs. Deaths and YLLs could be assigned to a mental, neurological, or substance use disorder only when the disorder was considered as a direct cause of death in the ICD-10 cause-of-death directory. Using this approach, the majority of excess deaths in individuals with a mental disorder, in particular, were coded to the direct physical cause of death (for example, suicide deaths were coded under injuries as self-harm) rather than to the disorder. An analysis of excess mortality in individuals with mental, neurological, and substance use disorders and the implications for burden of disease estimates is presented in chapter 3 in this volume (Charlson and others 2015).

Implications of The GBD 2010 Findings for Mental, Neurological, and Substance Use Disorders

Mental, neurological, and substance use disorders are a leading cause of the disease burden worldwide, substantially contributing to health loss in individuals of all ages, from developed and developing regions.

In GBD 2010, the differences in DALYs between mental, neurological, and substance use disorders were guided by differences in the prevalence, death, and disability weights associated with each disorder. The input data that were used to estimate burden are presented in greater detail elsewhere (Baxter and others 2015; Baxter and others 2014a; Baxter and others 2014b; Degenhardt, Baxter, and others 2014; Degenhardt, Charlson, and others 2014; Degenhardt, Ferrari, and others 2013; Erskine and others 2013; Ferrari and others 2013a; Ferrari and others 2013b; Saha and others 2005). Mental disorders, such as anxiety and depressive disorders, were associated with high levels of prevalence and disability. In comparison, schizophrenia was associated with low prevalence but high levels of disability; an acute state of schizophrenia obtained the highest disability weight in GBD 2010. The same was true for opioid dependence, which, although it had lower prevalence in comparison with other substance use disorders like cannabis dependence, was associated with high disability and death. Migraine, in contrast, was associated with high levels of prevalence but low disability.

Analysis of burden estimates across time illustrated how population growth and a changing age profile between 1990 and 2010 produced a shift in the global disease burden from communicable to noncommunicable diseases and from YLLs to YLDs (Murray, Vos, and others 2012). With improvements in infant and maternal health and declining rates of mortality caused by infectious diseases, particularly in developing regions, more people are now living to the age where noncommunicable diseases such as mental, neurological, and substance use disorders are most prevalent. This demographic and epidemiological transition is contributing to a rise in the absolute burden of mental, neurological, and substance use disorders (Whiteford, Degenhardt, and others 2013).

Although not adopted in GBD 2010, the use of age weighting in many economic analyses and in earlier GBD studies (Murray and Acharya 1997) recognizes and attempts to incorporate the social preference for avoiding health loss in young adults. In spite of the absence of age weighting in the GBD 2010 estimates, the peak impact of mental, neurological, and substance use disorders in early adulthood remained and demonstrated the ubiquitous effect of these disorders at a time of life when individuals are starting to make significant social and economic contributions to their families and societies. The peak in the total burden of mental, neurological, and substance use disorders was found in young adults. However, unlike many chronic diseases, there is a significant burden in children, lending further evidence to the importance of early intervention strategies for mental, neurological, and substance use disorders.

The presentation of burden estimates by age in GBD 2010 facilitates the selection and tailoring of intervention strategies for mental, neurological, and substance use disorders. For instance, it allows us to identify the ages at which interventions would be most beneficial. Historically, mental, neurological, and substance use disorders occurring in childhood have not been well represented in burden of disease analyses. GBD 2010 was the first study to estimate the burden associated with childhood mental disorders like autism, Asperger’s disorder, attention-deficit hyperactivity disorder, and conduct disorder. For countries such as those in Sub-Saharan Africa, where children constitute 40 percent of the population (UN 2011), these findings highlight the need for prevention and treatment services targeted to children and adolescents. The availability of such services is often more sporadic than that of adult services. In addition, the high burden of neurological disorders in elderly persons emphasizes the need for the development and implementation of more effective prevention strategies for these disorders, especially given the worldwide aging of the population, as well as the need for equitable health care resource allocation for people affected by neurological disorders.

The GBD 2010 burden estimates also underlined the extent of the challenge faced by health systems in developed and developing regions as a result of mental, neurological, and substance use disorders. Mental disorder DALYs are highest in the Middle East and North Africa, substance use disorder DALYs are highest in Eastern Europe and Central Asia, and neurological disorder DALYs are highest in South Asia. These regional differences are driven by the global distribution of disorder prevalence and, in some instances, deaths. Analysis of GBD 2010 prevalence data for mental disorders highlighted the effect of conflict status on the estimates. The prevalence of major depressive disorder and anxiety disorders was highest in countries with a history of conflict or war, many of which are in the Middle East and North Africa (Baxter and others 2014b; Ferrari and others 2013a).

The prevalence of opioid and cannabis dependence was highest in Australasia and Western Europe (Degenhardt, Charlson, and others 2014; Degenhardt, Ferrari, and others 2013). Cocaine dependence was highest in the North America, high-income, and southern Latin America. Although there was less regional variation in the prevalence of amphetamine dependence, the rates were highest in Southeast Asia and Australasia (Degenhardt, Baxter, and others 2014). The largest contributor of deaths and YLLs for drug use disorders was opioid dependence, with particularly high proportions of deaths caused by opioid dependence occurring in the North America high-income region, Eastern Europe, and southern Sub-Saharan Africa.

In many Eastern European and Sub-Saharan African countries, access to interventions found to be effective in reducing the risk of mortality from opioid dependence—such as opioid substitution therapy, needle and syringe programs, and HIV treatment for those who are HIV-positive—is limited. Access to these interventions in the North America High-income region varies subnationally, with insufficient data to determine access rates at the national level (Degenhardt, Charlson, and others 2014). Prevalence and deaths attributable to Alzheimer’s disease were highest in North America, high-income Western Europe, and Australasia. In contrast, prevalence and deaths attributable to epilepsy were highest in Sub-Saharan Africa. The geographic differences in the burden of such neurological disorders should be used to inform research priorities and evidence-based, region-specific service delivery and health care planning. Effective interventions have been identified for mental, neurological, and substance use disorders and are described in the following chapters.

YLDs explained a larger proportion of the burden due to mental, neurological, and substance use disorders compared with YLLs. To estimate YLLs, GBD 2010 followed the ICD-10 cause-of-death categories, whereby deaths can only be assigned to a given condition when it is considered a direct cause of death. This approach can only account for some of the excess deaths attributable to mental, neurological, and substance use disorders, given that deaths will also be coded to the direct physical cause of death. For instance, ischemic heart disease or suicide deaths occurring as a result of major depressive disorder will be coded to cardiovascular disease or injuries rather than to major depressive disorder.

The additional burden attributable to mental, neurological, and substance use disorders as a risk factor for other health outcomes can be investigated through comparative risk assessment analysis, which compares the current health status with a theoretical minimum risk exposure, in this case, the counterfactual status of the absence of mental, neurological, and substance use disorders in the population. The use of this method to estimate the additional burden due to mental and substance use disorders as risk factors for suicide showed that these disorders could account for approximately 60 percent of suicide YLLs in GBD 2010; this would have increased the overall burden of mental and substance use disorders in 2010 from 7.4 percent to 8.3 percent of global DALYs (Ferrari and others 2014). Chapter 3 in this volume (Charlson and others 2015) explores this issue further and presents an analysis of excess mortality in individuals with mental, neurological, and substance use disorders and the implications of this for burden of disease estimates.

Limitations of GBD 2010 and Directions for Future Research

Although it represents the most comprehensive assessment of the burden due to mental, neurological, and substance use disorders to date, not all elements of the burden were captured in GBD 2010. By focusing on health loss, the burden in GBD 2010 does not extend to welfare loss; hence, it does not capture all the consequences of mental, neurological, and substance use disorders for families or societies. For a more complete picture of the burden imposed by mental, neurological, and substance use disorders, future research should focus on quantifying the associated welfare losses.

Disability weights in GBD 2010 were derived by surveying the general population (rather than by clinicians, as in previous GBD studies), with the aim of better capturing the societal view of health loss. Nevertheless, adequately encompassing the complexity of health states that represent mental, neurological, and substance use disorders within the survey was challenging; the extent to which the GBD 2010 disability weights entirely reflected the associated health loss is an important area for further research.

Furthermore, the established definitions of mental, neurological, and substance use disorders used in the study may not be sensitive to non-Western presentations of these disorders, which may have led to an underestimation of burden in developing regions. Although these disorders exist in all countries, cultures influence their development and presentation. The predominantly Western-based definitions of mental, neurological, and substance use disorders can be in conflict with cultural contexts (Jorm 2006), leading to challenges in assembling data on global epidemiology. For example, some languages do not have the words to describe concepts such as “sadness” or “depression” consistent with how they are described in Western countries. Explanations for the onset and progression of mental, neurological, and substance use disorders may be explained through mechanisms such the presence of spirits or curses, rather than as medical disorders (Jorm 2006).

Epidemiological surveys in many LMICs tend to capture somatic manifestations of disorders such as depression and anxiety, which may not be as relevant to other countries and cultures (Cheng 2001; Whiteford, Ferrari, and others 2013; Yang and Link 2009). In their survey of mental disorders in China, Phillips and others (2009) concluded that some cases of minor depression were likely misdiagnosed cases of major depressive disorder, given that standard diagnostic criteria were not sensitive to cross-cultural presentations of this disorder. A task for upcoming GBD analyses will be to explore the extent to which certain disorders are misdiagnosed as other mental or physical disorders in developing countries and the consequence on burden.

Finally, regular updating of burden of disease estimates, using the most up-to-date epidemiological data and burden estimation methodology is important. After GBD 2010 was published, the Institute for Health Metrics and Evaluation at the University of Washington endeavored to make available yearly updates of burden of disease estimates. The Global Burden of Disease Study 2013 (GBD 2013) published in 2015 was the first of these updates (GBD 2013 DALYs Hale Collaborators 2015). Although high-level findings were largely consistent between GBD 2010 and GBD 2013, continued updating of estimates presented in this chapter is required.

Conclusions

According to the findings in GBD 2010, mental, neurological, and substance use disorders contribute to a significant proportion of the global burden of disease and will continue to do so as the shift in burden from communicable to noncommunicable diseases continues. Health systems worldwide can respond to these findings by implementing proven, cost-effective interventions; where these are limited, it will be important to support the research necessary to develop better prevention and treatment options.

Although GBD 2010 represents the most comprehensive assessment of the burden due to mental, neurological, and substance use disorders to date, some limitations need to be acknowledged. For instance, the definition of burden in GBD 2010 does not extend to welfare loss; accordingly, it does not capture all the consequences of mental, neurological, and substance use disorders on societies. Definitions of mental, neurological, and substance use disorders and the subsequent quantification of disability may not be fully representative of non-Western presentations of these disorders. Further research into the cross-cultural presentations of these disorders is required for a more comprehensive analysis of burden.

Annex

The annex to this chapter is as follows. It is available at http://www.dcp-3.org/mentalhealth.

• Annex 2A. Global Burden of Mental, Neurological, and Substance Use Disorders: An Analysis from the Global Burden of Disease Study 2010

References

1. Alonso J, Chatterji S, He Y. eds. 2013. The Burdens of Mental Disorders: Global Perspectives from the WHO World Mental Health Surveys. Cambridge, U.K.: Cambridge University Press.
2. APA (American Psychiatric Association). 2000. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Text Revision ed. Washington, DC: APA.
3. Baxter A J, Brugha T S, Erskine H E, Scheurer R W, Vos T. and others. 2015. “The Epidemiology and Global Burden of Autism Spectrum Disorders.” Psychological Medicine 45 (3): 601–13. doi:21.1017/S003329171400172X. [PubMed: 25108395]
4. Baxter A J, Patton G, Degenhardt L, Scott K M, Whiteford H A. 2013. “Global Epidemiology of Mental Disorders: What Are We Missing?” PLoS One 8 (6): e65514. [PMC free article: PMC3691161] [PubMed: 23826081]
5. Baxter A J, Vos T, Scott K M, Ferrari A J, Whiteford H A. 2014a. “The Global Burden of Anxiety Disorders in 2010.” Psychological Medicine 44 (11): 2363–74. [PubMed: 24451993]
6. Baxter A J, Vos T, Scott K M, Norman R E, Flaxman A D. and others. 2014b. “The Regional Distribution of Anxiety Disorders: Implications for the Global Burden of Disease Study, 2010.” International Journal of Methods in Psychiatric Research 23 (4): 422–38. doi:10.1002/mpr.1444. [PMC free article: PMC6878273] [PubMed: 25048296]
7. Charlson F J, Baxter A J, Dua T, Degenhardt L, Whiteford H A, Vos T. 2015. “Excess Mortality from Mental, Neurological, and Substance Use Disorders in the Global Burden of Disease Study 2010.” In Disease Control Priorities (third edition): Volume 4, Mental, Neurological, and Substance Use Disorders, edited by Patel V, Chisholm D, Dua T, Laxminarayan R, Medina-Mora M E, editors. . Washington, DC: World Bank.
8. Cheng A T. 2001. “Case Definition and Culture: Are People All the Same?” British Journal of Psychiatry 179 1–3. [PubMed: 11435259]
9. Degenhardt L, Baxter A J, Lee Y Y, Hall W, Sara G E. and others. 2014. “The Global Epidemiology and Burden of Psychostimulant Dependence: Findings from the Global Burden of Disease Study 2010.” Drug and Alcohol Dependence 137 37–47. [PubMed: 24559607]
10. Degenhardt L, Bucello C, Calabria B, Nelson P, Roberts A. and others. 2011. “What Data Are Available on the Extent of Illicit Drug Use and Dependence Globally? Results of Four Systematic Reviews.” Drug and Alcohol Dependence 117 (2–3): 85–101. [PubMed: 21377813]
11. Degenhardt L, Charlson F, Mathers B, Hall W D, Flaxman A D., and others. 2014. “The Global Epidemiology and Burden of Opioid Dependence: Results from the Global Burden of Disease 2010 Study.” Addiction 109 (8): 1320–33. [PubMed: 24661272]
12. Degenhardt L, Ferrari A J, Calabria B, Hall W D, Norman R E., and others. 2013. “The Global Epidemiology and Contribution of Cannabis Use and Dependence to the Global Burden of Disease: Results from the GBD 2010 Study.” PLoS One 8 (10): e76635. [PMC free article: PMC3811989] [PubMed: 24204649]
13. Degenhardt L, Whiteford H A, Ferrari A J, Baxter A J, Charlson F J., and others. 2013. “The Global Burden of Disease Attributable to Illicit Drug Use: Results from the GBD 2010 Study.” The Lancet 382 (9904): 1564–74. [PubMed: 23993281]
14. Erskine H E, Ferrari A J, Nelson P, Polanczyk G V, Flaxman A D., and others. 2013. “Research Review: Epidemiological Modelling of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder for the Global Burden of Disease Study 2010.” Journal of Child Psychology and Psychiatry 54 (12): 1263–74. [PubMed: 24117530]
15. Erskine H E, Ferrari A J, Polanczyk G V, Moffitt T E, Murray C J L. and others. 2014. “The Global Burden of Conduct Disorder and Attention-Deficit/Hyperactivity Disorder in 2010.” Journal of Child Psychology and Psychiatry, and Allied Disciplines 55 (4): 328–36. [PubMed: 24447211]
16. Ferrari A J, Baxter A J, Whiteford H A. 2010. “A Systematic Review of the Global Distribution and Availability of Prevalence Data for Bipolar Disorder.” Journal of Affective Disorders 34 (1–3):1–13. [PubMed: 21131055]
17. Ferrari A J, Charlson F J, Norman R, Flaxman A D, Patten S B. and others. 2013. “The Epidemiological Modelling of Major Depressive Disorder: Application for the Global Burden of Disease Study 2010.” PLoS One 8 (7): e69637. [PMC free article: PMC3726670] [PubMed: 23922765]
18. Ferrari A J, Charlson F J, Norman R E, Patten S B, Murray C J L. and others. 2013. “Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010.” PLoS Medicine 10 (11): e1001547. [PMC free article: PMC3818162] [PubMed: 24223526]
19. Ferrari A J, Norman R E, Freedman G, Baxter A J, Pirkis J E., and others. 2014. “The Burden Attributable to Mental and Substance Use Disorders as Risk Factors for Suicide: Findings from the Global Burden of Disease Study 2010.” PLoS One 9 (4): e91936. [PMC free article: PMC3973668] [PubMed: 24694747]
20. GBD 2013 DALYs Hale Collaborators. 2015. “Global, Regional, and National Disability-Adjusted Life Years (DALYs) for 306 Diseases and Injuries and Healthy Life Expectancy (HALE) for 188 countries, 1990–2013: Quantifying the Epidemiological Transition.” The Lancet Epub August 26. doi: http://dx​.doi.org/10​.1016/S0140-6736(15)61340-X. [PMC free article: PMC4673910] [PubMed: 26321261]
21. Jorm A F. 2006. “National Surveys of Mental Disorders: Are They Researching Scientific Facts or Constructing Useful Myths?”Australian and New Zealand Journal of Psychiatry 40 830–34. [PubMed: 16959008]
22. Lim S S, Vos T, Flaxman A D, Danaei G, Shibuya K. and others. 2012. “A Comparative Risk Assessment of Burden of Disease and Injury Attributable to 67 Risk Factors and Risk Factor Clusters in 21 Regions, 1990–2010: A Systematic Analysis for the Global Burden of Disease Study 2010.” The Lancet 380 2224–60. [PMC free article: PMC4156511] [PubMed: 23245609]
23. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K. and others. 2012. “Global and Regional Mortality from 235 Causes of Death for 20 Age Groups in 1990 and 2010: A Systematic Analysis for the Global Burden of Disease Study 2010.” The Lancet 380 (9859): 2095–128. [PubMed: 23245604]
24. Murray C J L, Acharya A K. 1997. “Understanding DALYs.” Journal of Health Economics 16 703–30. [PubMed: 10176780]
25. Murray C J, Ezzati L M, Flaxman A, Lim S, Lozano R. and others. 2012. “GBD 2010: Design, Definitions, and Metrics.” The Lancet 380 (9859): 2063–66. [PubMed: 23245602]
26. Murray C J L, Lopez A D. eds. 1996. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Cambridge, MA: Harvard University Press.
27. Murray C J L, Vos T, Lozano R, Naghavi M, Flaxman A D. and others. 2012. “Disability-Adjusted Life Years (DALYs) for 291 Diseases and Injuries in 21 Regions, 1990–2010: A Systematic Analysis for the Global Burden of Disease Study 2010.” The Lancet 380 (9859): 2197–223. [PubMed: 23245608]
28. Phillips M R, Zhang J, Shi Q, Song Z, Ding Z. and others. 2009. “Prevalence, Treatment, and Associated Disability of Mental Disorders in Four Provinces in China during 2001–05: An Epidemiological Survey.” The Lancet 373 (9680): 2041–53. [PubMed: 19524780]
29. Saha S, Chant D, Welham J, McGrath J. 2005. “A Systematic Review of the Prevalence of Schizophrenia.” PLoS Medicine 2 (5): e141. [PMC free article: PMC1140952] [PubMed: 15916472]
30. Salomon J A, Wang H, Freeman M K, Vos T, Flaxman A D. others. 2012. “Healthy Life Expectancy for 187 Countries, 1990–2010: A Systematic Analysis for the Global Burden of Disease Study 2010.” The Lancet 380 (9859): 2144–62. [PubMed: 23245606]
31. Sassi F. 2006. “Calculating QALYs, Comparing QALY and DALY Calculations.” Health Policy and Planning 21 (5): 402–08. [PubMed: 16877455]
32. UN (United Nations). 2011. World Population Prospects: The 2010 Revision. New York: UN.
33. Vos T, Flaxman A D, Naghavi M, Lozano R, Michaud C. and others. 2012. “Years Lived with Disability (YLDs) for 1,160 Sequelae of 289 Diseases and Injuries 1990–2010: A Systematic Analysis for the Global Burden of Disease Study 2010.” The Lancet 380 (9859): 2163–96. [PMC free article: PMC6350784] [PubMed: 23245607]
34. Wang H, Dwyer-Lindgren L, Lofgren K T, Rajaratnam J K, Marcus J R., and others. 2012. “Age-Specific and Sex-Specific Mortality in 187 Countries, 1970–2010: A Systematic Analysis for the Global Burden of Disease Study 2010.” The Lancet 380 2071–94. [PubMed: 23245603]
35. Wang P S, Aguilar-Gaxiola S, Alonso J, Angermeyer M C, Borges G. and others. 2007. “Use of Mental Health Services for Anxiety, Mood, and Substance Disorders in 17 Countries in the WHO World Mental Health Surveys.” The Lancet 370 (9590): 841–50. [PMC free article: PMC2847360] [PubMed: 17826169]
36. Wang P S, Angermeyer M, Borges G, Bruffaerts R, Tat Chiu W. and others. 2007. “Delay and Failure in Treatment Seeking after First Onset of Mental Disorders in the World Health Organization’s World Mental Health Survey Initiative.” World Psychiatry 6 (3): 177–85. [PMC free article: PMC2174579] [PubMed: 18188443]
37. Whiteford H A, Degenhardt L, Rehm J, Baxter A J, Ferrari A J. and others. 2013. “The Global Burden of Mental and Substance Use Disorders, 2010.” The Lancet 382 (9904): 1575–86. [PubMed: 23993280]
38. Whiteford H A, Ferrari A J, Baxter A J, Charlson F J, Degenhardt L. 2013. “How Did We Arrive at Burden of Disease Estimates for Mental and Illicit Drug Use Disorders in the Global Burden of Disease Study 2010?” Current Opinion in Psychiatry 26 (4): 376–83. [PubMed: 23689547]
39. WHO (World Health Organization). 1992. The ICD-10 Classification of Diseases: Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.
40. WHO (World Health Organization). 2008. The Global Burden of Disease: 2004 Update. Geneva: WHO.
41. Yang L H, Link B G. 2009. “Comparing Diagnostic Methods for Mental Disorders in China.” The Lancet 373 (9680): 2002–04. [PubMed: 19524763]

Footnotes

This chapter was previously published in an article by H. A. Whiteford, A. J. Ferrari, L. Degenhardt, V. Feigin, and T. Vos, entitled “The Global Burden of Mental, Neurological, and Substance Use Disorders: An Analysis for the Global Burden of Disease Study 2010.” PLoS ONE, 2015: 10 (2): e0116820. doi:10.1371/journal.pone.0116820. http://www​.ncbi.nlm.nih​.gov/pmc/articles​/PMC4320057/pdf/pone.0116820.pdf.