The burden attributable to mental and substance use disorders as risk factors for suicide: findings from the Global Burden of Disease Study 2010

Alize J Ferrari, Rosana E Norman, Greg Freedman, Amanda J Baxter, Jane E Pirkis, Meredith G Harris, Andrew Page, Emily Carnahan, Louisa Degenhardt, Theo Vos, Harvey A Whiteford, Alize J Ferrari, Rosana E Norman, Greg Freedman, Amanda J Baxter, Jane E Pirkis, Meredith G Harris, Andrew Page, Emily Carnahan, Louisa Degenhardt, Theo Vos, Harvey A Whiteford

Abstract

Background: The Global Burden of Disease Study 2010 (GBD 2010) identified mental and substance use disorders as the 5th leading contributor of burden in 2010, measured by disability adjusted life years (DALYs). This estimate was incomplete as it excluded burden resulting from the increased risk of suicide captured elsewhere in GBD 2010's mutually exclusive list of diseases and injuries. Here, we estimate suicide DALYs attributable to mental and substance use disorders.

Methods: Relative-risk estimates of suicide due to mental and substance use disorders and the global prevalence of each disorder were used to estimate population attributable fractions. These were adjusted for global differences in the proportion of suicide due to mental and substance use disorders compared to other causes then multiplied by suicide DALYs reported in GBD 2010 to estimate attributable DALYs (with 95% uncertainty).

Results: Mental and substance use disorders were responsible for 22.5 million (14.8-29.8 million) of the 36.2 million (26.5-44.3 million) DALYs allocated to suicide in 2010. Depression was responsible for the largest proportion of suicide DALYs (46.1% (28.0%-60.8%)) and anorexia nervosa the lowest (0.2% (0.02%-0.5%)). DALYs occurred throughout the lifespan, with the largest proportion found in Eastern Europe and Asia, and males aged 20-30 years. The inclusion of attributable suicide DALYs would have increased the overall burden of mental and substance use disorders (assigned to them in GBD 2010 as a direct cause) from 7.4% (6.2%-8.6%) to 8.3% (7.1%-9.6%) of global DALYs, and would have changed the global ranking from 5th to 3rd leading cause of burden.

Conclusions: Capturing the suicide burden attributable to mental and substance use disorders allows for more accurate estimates of burden. More consideration needs to be given to interventions targeted to populations with, or at risk for, mental and substance use disorders as an effective strategy for suicide prevention.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Suicide DALYs attributable to mental…
Figure 1. Suicide DALYs attributable to mental and substance use disorders by age and sex, in 2010.
Figure 2. Suicide DALYs attributable to mental…
Figure 2. Suicide DALYs attributable to mental and substance use disorders by region, in 2010.
Figure 3. Suicide DALYs (rates per 100,000)…
Figure 3. Suicide DALYs (rates per 100,000) attributable to mental and substance use disorders by country, in 2010.
Figure 4. Suicide DALYs attributable to mental…
Figure 4. Suicide DALYs attributable to mental and substance use disorders by disorder, in 2010.

References

    1. Wang H, Dwyer-Lindgren L, Lofgren KT, Rajaratnam JK, Marcus JR, et al. (2012) Age-specifi c and sex-specifi c mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2071–2094.
    1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, et al. (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2163–2196.
    1. Salomon JA, Wang H, Freeman MK, Vos T, Flaxman AD, et al. (2012) Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet 380: 2144–2162.
    1. Salomon JA, Vos T, Hogan DR, Gagnon M, Naghavi M, et al. (2012) Common values in assessing health outcomes from disease and injury:disability weights measurement study for the Global Burden of Disease 2010. Lancet 380: 2129–2143.
    1. Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, et al. (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. Lancet 380: 2197–2223.
    1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, et al. (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. Lancet 380: 2095–2128.
    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, et al. (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. Lancet 380: 2224–2260.
    1. Murray CJL, Lopez AD, editors (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: Published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank ; Distributed by Harvard University Press.
    1. World Health Organization (2008) The Global Burden of Disease: 2004 update. Switzerland.
    1. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, et al. (2013) The Global Burden of Mental and Substance Use Disorders, 2010. The Lancet Published online August 28. Available: .
    1. Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Murray CJL, et al. (2013) Burden of depressive disorders by country, sex, age and year: Findings from the Global Burden of Disease Study 2010. PloS Medicine In press.
    1. Degenhardt L, Whiteford HA, Ferrari AJ, Baxter AJ, Charlson FJ, et al. (2013) The global burden of disease attributable to illicit drug use: Results from the GBD 2010 study. The Lancet Published online August 28. Available: .
    1. World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines Geneva: World Health Organisation.
    1. Prince M, Patel V, Saxena S, Maj M, Maselko J, et al. (2007) No health without mental health. Lancet 370: 859–877.
    1. Phillips MR, Cheng HG (2012) The changing global face of suicide. Lancet 379: 2318–2319.
    1. Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, et al. (2012) Suicide mortality in India: a nationally representative survey. Lancet 379: 2343–2351.
    1. Vijayakumar L (2005) Suicide and mental disorders in Asia. International Review of Psychiatry 17: 109–114.
    1. Arsenault-Lapierre G, Kim C, Turecki G (2004) Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry 37: 1–11.
    1. Harris EC, Barraclough B (1997) Suicide as an outcome for mental disorders: A meta-analysis. British Journal of Psychiatry 170: 205–228.
    1. Li Z, Page A, Martin G, Taylor R (2011) Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: a systematic review. Soc Sci Med 72: 608–616.
    1. Yoshimasu K, Kiyohara C, Miyashita K (2008) Suicidal risk factors and completed suicide: meta-analyses based on psychological autopsy studies. Environmental Health and Preventive Medicine 13: 243–256.
    1. Baxter AJ, Charlson FJ, Somerville AJ, Whiteford HA (2011) Mental disorders as risk factors: assessing the evidence for the global burden of disease study. BMC Medicine 9: 1–7.
    1. American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Washington DC: American Psychiatric Association.
    1. Degenhardt L, Bucello C, Mathers B, Briegleb C, Ali H, et al. (2011) Mortality among problematic users of heroin and other illicit opioids: A systematic review and meta-analysis. Addiction 106: 32–51.
    1. Degenhardt L, Singleton J, Calabria B, McLaren J, Kerr T, et al. (2011) Mortality among cocaine users: A systematic review of cohort studies. Drug and Alcohol Dependence 113: 88–95.
    1. Singleton J, Degenhardt L, Hall W, Zabransky T (2009) Mortality among people who use amphetamines: A systematic review of cohort studies. Drug & Alcohol Dependence 105: 1–8.
    1. Wilcox HC, Conner KR, Caine ED (2004) Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depend 76 Suppl: S11–19.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, The PG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med 6: e1000097.
    1. Epigear (2012) MetaXL
    1. Doi SA, Thalib L (2008) A quality-effects model for meta-analysis. Epidemiology 19: 94–100.
    1. Barendregt JJ, Doi SA (2010) MetaXL User Guide: Version 1.0. Wilston, Australia: EpiGear International Pty Ltd.
    1. Doi SA, Barendregt JJ, Mozurkewich EL (2011) Meta-analysis Of heterogenous clinical trials: An empirical example. Contemporary Clinical Trials 32: 288–298.
    1. Baxter AJ, Scott K, Vos T, Whiteford HA (2012) Global prevalence of anxiety disorders: A systematic review and meta-regression. Psychological Medicine 43: 897–910.
    1. Degenhardt L, Bucello C, Calabria B, Nelson P, Roberts A, et al. (2011) What data are available on the extent of illicit drug use and dependence globally? Results of four systematic reviews. Drug Alcohol Depend 117: 85–101.
    1. Ferrari AJ, Baxter AJ, Whiteford HA (2010) A systematic review of the global distribution and availability of prevalence data for bipolar disorder. Journal of Affective Disorders 34: 1–13.
    1. Ferrari AJ, Somerville AJ, Baxter AJ, Norman R, Patten SB, et al. (2013) Global variation in the prevalence and incidence of major depressive disorder: A systematic review of the epidemiological literature. Psychological Medicine 43: 471–481.
    1. Saha S, Chant D, Welham J, McGrath J (2005) A systematic review of the prevalence of schizophrenia. PLoS Medicine 2: e141.
    1. Whiteford HA, Ferrari AJ, Baxter AJ, Charlson FJ, 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: 376–383.
    1. Kruijshaar ME, Barendregt J, Vos T, de Graaf R, Spijker J, et al. (2005) Lifetime prevalence estimates of major depression: An indirect estimation method and a quantification of recall bias. European Journal of Epidemiology 20: 103–111.
    1. Moffitt TE, Caspi A, Taylor AJ, Kokaua J, Milne BJ, et al. (2010) How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine 40: 899–909.
    1. Flaxman AD, Vos T, Murray CJL, editors (2013) An integrative metaregression framework for descriptive epidemiology. Washington: University of Washington Press, In press.
    1. Bonita R, Beaglehole R, Kjellstrom T (2006) Basic epidemiology. Geneva World Health Organization
    1. Haagsma JA, van Beeck EF, Polinder S, Toet H, Panneman M, et al. (2011) The effect of comorbidity on health-related quality of life for injury patients in the first year following injury: comparison of three comorbidity adjustment approaches. Popul Health Metr 9: 10.
    1. Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM (2003) Psychological autopsy studies of suicide: a systematic review. Psychological Medicine 33: 395–405.
    1. Conner KR, Phillips MR, Meldrum S, Knox KL, Zhang Y, et al. (2005) Low-planned suicides in China. Psychol Med 35: 1197–1204.
    1. Phillips MR (2010) Rethinking the role of mental illness in suicide. Am J Psychiatry 167: 731–733.
    1. Yang GH, Phillips MR, Zhou MG, Wang LJ, Zhang YP, et al. (2005) Understanding the unique characteristics of suicide in China: national psychological autopsy study. Biomed Environ Sci 18: 379–389.
    1. Zhang J, Xiao S, Zhou L (2010) Mental disorders and suicide among young rural Chinese: A case-control psychological autopsy study. American Journal of Psychiatry 167: 773–781.
    1. Isometsa ET (2001) Psychological autopsy studies – a review. European Psychiatry 16: 379–385.
    1. Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano R, et al. (2001) Age standardization of rates: A new WHO standard. WHO
    1. Silverman MM, Maris RW (1995) The prevention of suicidal behaviors: an overview. Suicide Life Threat Behav 25: 10–21.
    1. Scott A, Guo B (2012) For which strategies of suicide prevention is there evidence of effectiveness? Copenhagen: World Health Organization.
    1. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, et al. (2005) Suicide prevention strategies: a systematic review. JAMA 294: 2064–2074.
    1. Briffault X, Morvan Y, Rouillon F, Dardennes R, Lamboy B (2010) [Use of services and treatment adequacy of major depressive episodes in France]. Encephale 36 Suppl 2: D48–58.
    1. Gabilondo A, Rojas-Farreras S, Rodriguez A, Fernandez A, Pinto-Meza A, et al. (2011) Use of primary and specialized mental health care for a major depressive episode in Spain by ESEMeD respondents. Psychiatr Serv 62: 152–161.
    1. Katz C, Bolton SL, Katz LY, Isaak C, Tilston-Jones T, et al. (2013) A Systematic Review of School-Based Suicide Prevention Programs. Depress Anxiety
    1. Robinson J, Hetrick SE, Martin C (2011) Preventing suicide in young people: systematic review. Aust N Z J Psychiatry 45: 3–26.
    1. Khan MM (2005) Suicide prevention and developing countries. J R Soc Med 98: 459–463.
    1. Pritchard C, Amanullah S (2007) An analysis of suicide and undetermined deaths in 17 predominantly Islamic countries contrasted with the UK. Psychol Med 37: 421–430.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever