National and subnational burden of mental disorders in Iran (1990-2019): findings of the Global Burden of Disease 2019 study

Abstract

Background: Mental and behavioural disorders account for a large proportion of the burden of diseases in Iran. Identifying the pattern of change can help in policy making and provision of mental health services. We aimed to analyse the burden of mental disorders (excluding substance use disorders) in Iran at national and subnational levels with data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019.

Methods: We used data from 1990 to 2019 on anxiety disorders, attention-deficit hyperactivity disorder, autism spectrum disorders, bipolar disorder, conduct disorder, depressive disorders, eating disorders, idiopathic developmental intellectual disability, schizophrenia, and other mental disorders in Iran and its 31 provinces. We calculated total disability-adjusted life-years (DALYs), age-standardised DALYs, and prevalence rates in 1990 and 2019, as well as the percentage change between these time periods.

Findings: Mental disorders accounted for 1 159 410 (4·6%) of 25 007 732 all-cause DALYs in Iran in 1990 and 2 053 871 (10·3%) of 19 828 721 in 2019. Although total DALYs for mental disorders increased by 77·1% (95% uncertainty interval 76·7 to 77·6%) during this period, age-standardised DALY rate increased by 1·8% (-4·1 to 7·7%). The overall patterns of change were similar at the subnational level as the national level, although the rates differed between provinces with a highest-to-lowest ratio of 1·22 for age-standardised DALY rates in 2019.

Interpretation: The increase in the burden of mental disorders in Iran is higher than the general trend in the world. The slight change in age-standardised DALYs suggests that the increase is mainly attributable to changes in the size and structure of the population. Considering the absolute and relative increase in the burden of mental disorders during the past 30 years at national and provincial levels, there is an urgent need to address the determinants of mental health and upgrade mental health services across all levels of care in Iran.

Funding: Bill & Melinda Gates Foundation.

Figure 1

Age-standardised DALY rates of mental disorders in the provinces of Iran (2019) for males and females, compared with national and global levels DALYs=disability-adjusted life-years.

Figure 2

All-age DALYs for different mental disorders as a percentage of total national DALYs in 1990 and 2019 DALYs=disability-adjusted life-years.

Figure 3

The change in the order of share of percentage for all-age DALYs for different mental disorders between 1990 and 2019 DALYs=disability-adjusted life-years.