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The Burden of Mental Disorders in the Region of the Americas, 2018

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The Burden of Mental Disorders in the Region of the Americas, 2018 The Burden of Mental Disorders in the Region of the Americas, 2018 The Burden of Mental Disorders in the Region of the Americas, 2018 Washington, DC 2018 Also published in Spanish La carga de los trastornos mentales en la Región de las Américas, 2018 ISBN: 9789275320280 The Burden of Mental Disorders in the Region of the Americas, 2018 ISBN: 9789275120286 © Pan American Health Organization 2018 All rights reserved. Publications of the Pan American Health Organization are available on the PAHO website (www.paho.org). Requests for per- mission to reproduce or translate PAHO Publications should be addressed to the Communications Department through the PAHO website (www. paho.org/permissions). Suggested citation. Pan American Health Organization. The Burden of Mental Disorders in the Region of the Americas, 2018. Washington, D.C.: PAHO; 2018. Cataloguing-in-Publication (CIP) data. CIP data are available at http://iris.paho.org. Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan Ameri- can Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the Pan American Health Organization to verify the information contained in this publication. How- ever, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the Pan American Health Organization be liable for damages arising from its use. All photos © PAHO. Contents Foreword vii Acknowledgments viii List of acronyms ix Main findings x Introduction 1 Disease burden distribution in the Americas 3 Regional disability and mortality: disability-adjusted life years (DALYs) 4 Regional disability: years lived with disability (YLDs) 4 Country-level analysis 5 Country-level disability and mortality (DALYs) 7 Country-level disability (YLDs) 7 Common mental disorders 11 Disability resulting from specific disorders 11 Depressive disorders 12 Anxiety disorders 13 Self-harm and suicide 14 Somatoform disorders/persistent somatoform pain disorder 15 Severe mental disorders 17 Schizophrenia 17 Bipolar disorders 17 Substance use and eating disorders 18 Disorders due to use of alcohol 18 Disorders due to substance use (not alcohol) 19 Eating disorders 20 Disorders with onset usually occurring in childhood and adolescence 21 Neurological disorders 22 Neurocognitive disorders 22 Epilepsy 22 Migraine and tension-type headaches 23 Health system response in the Americas: Government funding for mental health services 25 Mental health spending as a percentage of government health spending 26 Mental health spending allocation 27 Conclusion 31 References 33 Annex 1. Non-Latin Caribbean Subregion Countries and Population 35 List of Figures Figure 1: Regional disability-adjusted life years (DALYs) distribution tree map (%) 4 Figure 2: Ranked mental, neurological, disorders due to substance use, and suicide DALYs 5 Figure 3: Regional years lived with disability (YLD) distribution (%) 6 Figure 4: Ranked mental, neurological, disorders due to substance use, and suicide years lived with disability (YLDs) 6 Figure 5: Population distribution of the countries in the Americas 7 Figure 6: Disability-adjusted life years (DALYs) distribution by country (%) 8 Figure 7: Years lived with disability (YLDs) by country (% of total YLDs) 9 Figure 8: Mental, neurological, disorders due to substance use and suicide disability tree map (YLDs by country as a percentage of total disability) 10 Figure 9: Depressive disorder disability tree map (YLDs by country as a percentage of total disability) 12 Figure 10: Depressive disorder: years lived with disability by age groups (total of YLDs) 13 Figure 11: Anxiety disorders disability tree map (YLDs by country as a percentage of total disability) 14 Figure 12: Suicide and self-harm burden tree map (DALYs by country as a percentage of total disability) 15 Figure 13: Total years of life lost by age group 16 Figure 14: Schizophrenia disability tree map (YLDs by country as a percentage of total disability) 18 Figure 15: Bipolar affective disorder disability tree map (YLDs by country as a percentage of total disability) 19 Figure 16: Disorders due to use of alcohol disability tree map (YLDs by country as a percentage of total disability) 20 Figure 17: Disorders due to substance use (not alcohol) disability tree map (YLDs by country as a percentage of total disability) 21 Figure 18: Disorders with onset usually occurring in childhood and adolescence disability tree map 22 Figure 19: Dementia disability tree map 23 Figure 20: Epilepsy disability tree map 24 Figure 21: Mental health spending vs. per-capita GDP (PPP) 27 Figure 22: Ratio of % of total DALYs attributable to MNSS to % of health spending allocated to mental health, ordered from smallest to largest 28 Figure 23: MNSS spending allocated to mental hospitals vs. GDP (PPP) 29 Figure 24: Imbalance in spending: ratio of MNSS burden to efficiently allocated spending 30 Foreword This report aims to improve the assessment of mental health needs in the Americas by providing an updated and nuanced picture of: (a) the disability resulting from mental, substance use, and specific neurological disorders, plus self-harm, alone and in combination with premature mortality; (b) the imbalance between mental health spending and its related disease burden; and (c) the inadequate allocation of the meager mental health spending by countries of the Region. Consistent with global trends, the epidemiologic transition in the Americas has resulted in a shift from communicable diseases, nutritional deficiencies, and maternal and child health conditions being the major causes of ill health and death, to noncommunicable diseases, which are responsible for increasingly higher levels of disability and premature mortality. A substantial proportion of the health problems in the Americas also arise from mental, neurological, and substance use disorders. Data show that people with mental disorders have high levels of disability as well as high mortality rates. The Global Burden of Disease (GBD) approach is a systematic, scientific process to quantify the comparative magnitude of health lost due to diseases, injuries, and risk factors by age, sex and geography, for specific time periods. The GBD has had a profound impact on health policy as it is able to reveal the hidden burden of mental illness around the world. The Burden of Mental Disorders in the Region of Americas, 2018 documents the latest available estimates of the burden of these conditions at the regional level. The data also reveal the consequences of these disorders in terms of lost health. Furthermore, this report provides data that demonstrate the limited resources within countries to adequately meet mental health needs, while underlining the often inequitable distribution and inefficient uses of such resources. This report seeks to inform governments, civil society, and other stakeholders, and in so doing, raise the level of awareness about mental disorders in the Region, so as to mobilize political will and the necessary resources to combat mental, neurological, and substance use disorders and suicide in the Americas. Dr. Anselm Hennis Director Department of Noncommunicable Diseases and Mental Health Pan American Health Organization The Burden of Mental Disorders in the Region of the Americas, 2018 vii Acknowledgments The Mental Health and Substance Use Unit of the Pan American Health Organization (PAHO/WHO) wishes to express its sincere thanks to all who diligently collaborated during the development and implementation of this research. This assessment of mental health needs in the Americas takes into account information from various sources concerning the burden related to mental, neurological, substance use, and suicide as well as government spending. This report would not have been possible without these contributions. Dr. Daniel Vigo (Centre for Applied Research in Mental Health and Addictions, Simon Fraser University; Department of Global Health and Social Medicine, Harvard Medical School) was responsible for collecting and analyzing data and was the principal author of the text. Mrs. Dévora Kestel (PAHO) coordinated the production of this report, supervised its content, and was responsible for writing sections of the text. Dr. Anselm Hennis (PAHO) contributed to the review process of the report. Dr. Jorge Rodriguez (Consultant) and Dr. Wendel Abel (University of the West Indies) provided valuable peer review comments. Dr. Matías Irarrázaval (PAHO) participated in the review process of the report and was responsible for writing some sections of the text along with Drs. Andrea Bruni (PAHO), Claudina Cayetano (PAHO), and Carmen Martinez (PAHO). Drs. Arthur Kleinman, Graham
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