Challenging assumptions; exploring the burden of mental disorders among adolescents and young adults in high-income countries

Abstract Background. The burden of diseases is generally higher in low- and middle-income compared to high-income countries. Mental disorders are among the rare categories that have the highest disability-adjusted life year (DALY) rates in high-income countries. This is a paradox when we consider the higher percentage of socioeconomic stressors, such as poverty, violence, and political instability in many of the low- and middle-income countries. This study aims to review potential reasons for the higher burden of mental disorders in countries with higher incomes, focusing on adolescents and young adults. Methods. Utilizing the data from the Global Burden of Diseases, Injuries and Risk Factors (GBD) 2019 study, this study explores the distribution of population-level prevalence, mortality, and DALY rates of mental disorders classified by income levels of the countries. Results. In 2019, the DALY rate for mental disorders was 2,118 per 100,000 adolescents/young adults in high-income countries compared to 1,558 in low-income, 1,363 in lower-middle-income, and 1,516 in upper-middle-income countries. The DALY rate for “substance use disorders” is also higher in high-income, compared to other countries. self-harm did not follow the same pattern and was highest in lower-middle-income countries. Conclusions. Our assessment supports the fact that the burden of mental disorders is a real issue in high-income countries, but the difference could be at least partially related to higher stigma and limited access to high-quality data in middle- and low-income countries. Mental disorders and substance use disorders in high-income countries both need comprehensive policies addressing mental health and its social determinants; our study also underscores the need for low- and middle-income countries to prioritize the collection of high-quality data and the reduction of the stigma of mental disorders to ensure more accurate assessments.