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

Raghid Charara¹, Mohammad Forouzanfar¹, Mohsen Naghavi¹, Maziar Moradi-Lakeh^{1

2}, Ashkan Afshin¹, Theo Vos¹, Farah Daoud¹, Haidong Wang¹, Charbel El Bcheraoui¹, Ibrahim Khalil¹, Randah R Hamadeh³, Ardeshir Khosravi⁴, Vafa Rahimi-Movaghar⁵, Yousef Khader⁶, Nawal Al-Hamad⁷, Carla Makhlouf Obermeyer⁸, Anwar Rafay⁹, Rana Asghar¹⁰, Saleem M Rana⁹, Amira Shaheen¹¹, Niveen M E Abu-Rmeileh¹², Abdullatif Husseini¹², Laith J Abu-Raddad^{13

14}, Tawfik Khoja¹⁵, Zulfa A Al Rayess¹⁶, Fadia S AlBuhairan¹⁷, Mohamed Hsairi¹⁸, Mahmoud A Alomari¹⁹, Raghib Ali²⁰, Gholamreza Roshandel²¹, Abdullah Sulieman Terkawi^{22

23

24}, Samer Hamidi²⁵, Amany H Refaat^{26

27}, Ronny Westerman²⁸, Aliasghar Ahmad Kiadaliri²⁹, Ali S Akanda³⁰, Syed Danish Ali³¹, Umar Bacha³², Alaa Badawi³³, Shahrzad Bazargan-Hejazi^{34

35}, Imad A D Faghmous^{36

37}, Seyed-Mohammad Fereshtehnejad³⁸, Florian Fischer³⁹, Jost B Jonas⁴⁰, Barthelemy Kuate Defo⁴¹, Alem Mehari⁴², Saad B Omer⁴³, Farshad Pourmalek⁴⁴, Olalekan A Uthman⁴⁵, Ali A Mokdad⁴⁶, Fadi T Maalouf⁴⁷, Foad Abd-Allah⁴⁸, Nadia Akseer⁴⁹, Dinesh Arya⁵⁰, Rohan Borschmann⁵¹, Alexandra Brazinova⁵², Traolach S Brugha⁵³, Ferrán Catalá-López⁵⁴, Louisa Degenhardt⁵⁵, Alize Ferrari^{1

56

57}, Josep Maria Haro⁵⁸, Masako Horino⁵⁹, John C Hornberger^{60

61}, Hsiang Huang⁶², Christian Kieling⁶³, Daniel Kim⁶⁴, Yunjin Kim⁶⁵, Ann Kristin Knudsen⁶⁶, Philip B Mitchell⁶⁷, George Patton⁶⁸, Rajesh Sagar⁶⁹, Maheswar Satpathy⁷⁰, Kim Savuon^{71

72}, Soraya Seedat⁷³, Ivy Shiue⁷⁴, Jens Christoffer Skogen^{75

76}, Dan J Stein^{77

78}, Karen M Tabb⁷⁹, Harvey A Whiteford⁸⁰, Paul Yip^{81

82}, Naohiro Yonemoto⁸³, Christopher J L Murray¹, Ali H Mokdad¹

Affiliations

¹ Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America.
² Preventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran.
³ Arabian Gulf University, Manama, Bahrain.
⁴ Iranian Ministry of Health and Medical Education, Tehran, Iran.
⁵ Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
⁶ Jordan University of Science and Technology, Irbid, Jordan.
⁷ Public Authority for Food and Nutrition, Kuwait, Kuwait.
⁸ Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
⁹ Contech International Health Consultants, Lahore, Pakistan.
¹⁰ South Asian Public Health Forum, Islamabad, Pakistan.
¹¹ Department of Public Health, An-Najah University, Nablus, Palestine.
¹² Institute of Community and Public Health, Birzeit University, Ramallah, Palestine.
¹³ Harvard University, Boston, MA, United States of America.
¹⁴ Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar.
¹⁵ Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia.
¹⁶ The Saudi Center for Evidence Based Healthcare, Riyadh, Saudi Arabia.
¹⁷ King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
¹⁸ Ministry of Health-Tunisia (Faculty of Medicine Tunis), Tunis, Tunisia.
¹⁹ Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan.
²⁰ University of Oxford, Oxford, United Kingdom.
²¹ Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
²² Department of Anesthesiology, University of Virginia, Charlottesville, VA, United States of America.
²³ Department of Anesthesiology, King Fahad medical city, Riyadh, Saudi Arabia.
²⁴ OUTCOMES RESEARCH Consortium, Cleveland, OH, United States of America.
²⁵ Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates.
²⁶ Suez Canal University, Ismailia, Egypt.
²⁷ Walden University, Minneapolis, MN, United States of America.
²⁸ Federal Institute for Population Research, Wiesbaden, Germany.
²⁹ Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
³⁰ University of Rhode Island, Kingston, RI, United States of America.
³¹ SIR Consultants, Sindh, Pakistan.
³² School of Health Sciences, University of Management and Technology, Lahore, Pakistan.
³³ Public Health Agency of Canada, Toronto, ON, Canada.
³⁴ Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America.
³⁵ David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America.
³⁶ Tehran University of Medical Sciences, Tehran, Iran.
³⁷ London School of Hygiene & Tropical Medicine, London, United Kingdom.
³⁸ Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
³⁹ Bielefeld University, Bielefeld, Germany.
⁴⁰ Department of Ophthalmology, Medical Faculty Mannheim, University Heidelberg, Heidelberg, Germany.
⁴¹ Department of Social and Preventive Medicine, School of Public Health of the University of Montreal, Montreal, Quebec, Canada.
⁴² Howard University College of Medicine, Howard University, Washington DC, United States of America.
⁴³ Emory University, Atlanta, GA, United States of America.
⁴⁴ University of British Columbia, Vancouver, BC, Canada.
⁴⁵ Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
⁴⁶ Department of Surgery, University of Texas Southwestern, Dallas, Texas, United States of America.
⁴⁷ Department of Psychiatry, American University of Beirut, Beirut, Lebanon.
⁴⁸ Department of Neurology, Cairo University, Cairo, Egypt.
⁴⁹ The Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Ontario, Canada.
⁵⁰ Northern Territory Department of Health, Darwin, Northern Territory, Australia.
⁵¹ Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
⁵² Trnava University, Trnava, Slovakia.
⁵³ University of Leicester, Leicester, United Kingdom.
⁵⁴ Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain.
⁵⁵ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
⁵⁶ School of Public Health, University of Queensland, Herston, Queensland, Australia.
⁵⁷ Queensland Centre for Mental Health Research, Wacol, Queensland, Australia.
⁵⁸ Parc Sanitari Sant Joan de Déu-CIBERSAM, Sant Boi de Llobregat, Spain.
⁵⁹ Nevada Division of Behavior and Public Health, Carson City, NV, United States of America.
⁶⁰ National Institutes of Health, Bethesda, MD, United States of America.
⁶¹ Cedar Associates, Menlo Park, CA, United States of America.
⁶² Cambridge Health Alliance, Cambridge, MA, United States of America.
⁶³ Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
⁶⁴ Department of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America.
⁶⁵ Southern University College, Johor, Malaysia.
⁶⁶ Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway.
⁶⁷ School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
⁶⁸ Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
⁶⁹ Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
⁷⁰ UGC Centre for Advanced Studies in Psychology, Utkal University, Vani Vihar, Bhubaneswar, Odisha, INDIA.
⁷¹ Department of Hospital Services, Ministry of Health, Phnom Penh, Cambodia.
⁷² Mental Health Association of Cambodia, Phnom Penh, Cambodia.
⁷³ Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.
⁷⁴ Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
⁷⁵ Domain for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway.
⁷⁶ Center for Alcohol & Drug Research, Stavanger University Hospital, Stavanger, Norway.
⁷⁷ Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
⁷⁸ MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa.
⁷⁹ School of Social Work, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America.
⁸⁰ University of Queensland, Brisbane, QLD, Australia.
⁸¹ Centre for Suicide Research and Prevention, The University of Hong Kong, Pok Fu Lam, Hong Kong.
⁸² Social Work and Social Administration Department, The University of Hong Kong, Pok Fu Lam, Hong Kong.
⁸³ Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan.

PMID: 28095477
PMCID: PMC5240956
DOI: 10.1371/journal.pone.0169575

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

Raghid Charara et al. PLoS One. 2017.

. 2017 Jan 17;12(1):e0169575.

doi: 10.1371/journal.pone.0169575. eCollection 2017.

Authors

Affiliations

¹ Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America.
² Preventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran.
³ Arabian Gulf University, Manama, Bahrain.
⁴ Iranian Ministry of Health and Medical Education, Tehran, Iran.
⁵ Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
⁶ Jordan University of Science and Technology, Irbid, Jordan.
⁷ Public Authority for Food and Nutrition, Kuwait, Kuwait.
⁸ Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
⁹ Contech International Health Consultants, Lahore, Pakistan.
¹⁰ South Asian Public Health Forum, Islamabad, Pakistan.
¹¹ Department of Public Health, An-Najah University, Nablus, Palestine.
¹² Institute of Community and Public Health, Birzeit University, Ramallah, Palestine.
¹³ Harvard University, Boston, MA, United States of America.
¹⁴ Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar.
¹⁵ Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia.
¹⁶ The Saudi Center for Evidence Based Healthcare, Riyadh, Saudi Arabia.
¹⁷ King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
¹⁸ Ministry of Health-Tunisia (Faculty of Medicine Tunis), Tunis, Tunisia.
¹⁹ Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan.
²⁰ University of Oxford, Oxford, United Kingdom.
²¹ Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
²² Department of Anesthesiology, University of Virginia, Charlottesville, VA, United States of America.
²³ Department of Anesthesiology, King Fahad medical city, Riyadh, Saudi Arabia.
²⁴ OUTCOMES RESEARCH Consortium, Cleveland, OH, United States of America.
²⁵ Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates.
²⁶ Suez Canal University, Ismailia, Egypt.
²⁷ Walden University, Minneapolis, MN, United States of America.
²⁸ Federal Institute for Population Research, Wiesbaden, Germany.
²⁹ Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
³⁰ University of Rhode Island, Kingston, RI, United States of America.
³¹ SIR Consultants, Sindh, Pakistan.
³² School of Health Sciences, University of Management and Technology, Lahore, Pakistan.
³³ Public Health Agency of Canada, Toronto, ON, Canada.
³⁴ Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America.
³⁵ David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America.
³⁶ Tehran University of Medical Sciences, Tehran, Iran.
³⁷ London School of Hygiene & Tropical Medicine, London, United Kingdom.
³⁸ Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
³⁹ Bielefeld University, Bielefeld, Germany.
⁴⁰ Department of Ophthalmology, Medical Faculty Mannheim, University Heidelberg, Heidelberg, Germany.
⁴¹ Department of Social and Preventive Medicine, School of Public Health of the University of Montreal, Montreal, Quebec, Canada.
⁴² Howard University College of Medicine, Howard University, Washington DC, United States of America.
⁴³ Emory University, Atlanta, GA, United States of America.
⁴⁴ University of British Columbia, Vancouver, BC, Canada.
⁴⁵ Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
⁴⁶ Department of Surgery, University of Texas Southwestern, Dallas, Texas, United States of America.
⁴⁷ Department of Psychiatry, American University of Beirut, Beirut, Lebanon.
⁴⁸ Department of Neurology, Cairo University, Cairo, Egypt.
⁴⁹ The Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Ontario, Canada.
⁵⁰ Northern Territory Department of Health, Darwin, Northern Territory, Australia.
⁵¹ Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
⁵² Trnava University, Trnava, Slovakia.
⁵³ University of Leicester, Leicester, United Kingdom.
⁵⁴ Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain.
⁵⁵ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
⁵⁶ School of Public Health, University of Queensland, Herston, Queensland, Australia.
⁵⁷ Queensland Centre for Mental Health Research, Wacol, Queensland, Australia.
⁵⁸ Parc Sanitari Sant Joan de Déu-CIBERSAM, Sant Boi de Llobregat, Spain.
⁵⁹ Nevada Division of Behavior and Public Health, Carson City, NV, United States of America.
⁶⁰ National Institutes of Health, Bethesda, MD, United States of America.
⁶¹ Cedar Associates, Menlo Park, CA, United States of America.
⁶² Cambridge Health Alliance, Cambridge, MA, United States of America.
⁶³ Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
⁶⁴ Department of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America.
⁶⁵ Southern University College, Johor, Malaysia.
⁶⁶ Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway.
⁶⁷ School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
⁶⁸ Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
⁶⁹ Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
⁷⁰ UGC Centre for Advanced Studies in Psychology, Utkal University, Vani Vihar, Bhubaneswar, Odisha, INDIA.
⁷¹ Department of Hospital Services, Ministry of Health, Phnom Penh, Cambodia.
⁷² Mental Health Association of Cambodia, Phnom Penh, Cambodia.
⁷³ Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.
⁷⁴ Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
⁷⁵ Domain for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway.
⁷⁶ Center for Alcohol & Drug Research, Stavanger University Hospital, Stavanger, Norway.
⁷⁷ Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
⁷⁸ MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa.
⁷⁹ School of Social Work, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America.
⁸⁰ University of Queensland, Brisbane, QLD, Australia.
⁸¹ Centre for Suicide Research and Prevention, The University of Hong Kong, Pok Fu Lam, Hong Kong.
⁸² Social Work and Social Administration Department, The University of Hong Kong, Pok Fu Lam, Hong Kong.
⁸³ Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan.

PMID: 28095477
PMCID: PMC5240956
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.

PubMed Disclaimer

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

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

**Fig 4. Change in DALY rates from 1990–2013, by gender.**

**Fig 5. Change in DALYS/100,000 from 1990–2013, by income.**

**Fig 6. Proportion of DALYs explained by each mental disorder within the EMR.**

**Fig 7. Age-standardized rates of mental disorder DALYs, by country and sex.**

See this image and copyright information in PMC

References

1. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA. 2004;291(21):2581–90. 10.1001/jama.291.21.2581 - DOI - PubMed
1. World Health O. Mental Health Gap Action Programme: scaling up care for mental, neurological and substance use disorders World Health Organisation (WHO); 2008. - PubMed
1. World Health O. The World Health Report 2001 Mental Health: New Understanding, New Hope: World Health Organization (WHO); 2001.
1. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545–602. 10.1016/S0140-6736(16)31678-6 - DOI - PMC - PubMed
1. Arsenault-Lapierre G, Kim C, Turecki G. Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry. 2004;4:37 10.1186/1471-244X-4-37 - DOI - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- ClinicalTrials.gov
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous