The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990-2017
The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990-2017
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DOI：
10.1016/s2215-0366(19)30475-4
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发表时间：
2020-02-01
影响因子：
64.3
通讯作者：
Dandona, Lalit
中科院分区：
文献类型：
--
作者：
Sagar, Rajesh;Dandona, Rakhi;Dandona, Lalit
背景精神障碍是印度非致命性疾病负担的主要原因之一，但印度每个邦都不容易系统地了解其患病率、疾病负担和风险因素。在这份报告中，我们描述了从1990年到2017年印度各州每种精神疾病的患病率和疾病负担。方法作为全球疾病负担、伤害和风险因素研究的一部分，我们使用来自多个来源的所有可获得的数据来估计从1990年到2017年印度所有邦由这些疾病造成的精神障碍的患病率、残疾生活年数(YLD)和残疾调整寿命年(DALY)。我们评估了印度各州精神障碍的异质性和时间趋势。我们根据各州的社会人口指数(SDI)对其进行分组，SDI是对25岁以下女性的人均收入、平均教育和生育率的综合衡量。我们还评估了严重精神障碍与自杀死亡的关系。我们计算了点估计的95%不确定区间(UI)。2017年，印度有1.973亿人(95%UI 178.4-216.4)患有精神障碍，其中4,570万人(4,240万-49.8)患有抑郁症，4,490万(41.2-48.9)人患有焦虑症。我们发现女性(r(2)=0.33，p=0.0009)和男性(r(2)=0.19，p=0.015)抑郁障碍的患病率与州水平的自杀死亡率之间存在显著但温和的相关性。在印度，精神障碍占DALY总数的比例从1990年的2.5%(2.0-3.1)上升到2017年的4.7%(3.7-5.6)。2017年，抑郁症在精神障碍DALYs中所占比例最大(33.8%，29.5-38.5)，其次是焦虑症(19.0%，15.9-22.4)，特发性发展性智能障碍(IDID；10.8%，6.3-15.9)，精神分裂症(9.8%，7.7-12.4)，双相情感障碍(6.9%，4.9-9.6)，品行障碍(5.9%，4.0-8.1)，自闭症谱系障碍(3.2%，2.7-3.8)，进食障碍(2.2%，1.7-2.8)，注意力缺陷多动障碍(ADHD；0.3%，0.2-0.5)；其他精神障碍占DALY的8.0%(6.1~10.1)。几乎所有这些DALY(>；99.9%)都由YLD组成。2017年，主要发生在儿童和青春期(IDID、品行障碍、自闭症谱系障碍和ADHD)的精神障碍的DALY比率点估计在低SDI状态下高于中等SDI和高SDI状态，而主要在成年期表现的精神障碍的趋势则相反。虽然从1990年到2017年，印度儿童和青春期精神障碍的患病率有所下降，高SDI和中等SDI邦的下降幅度大于低SDI邦，但在这段时间里，主要表现在成年期间的精神障碍的流行率有所上升。自1990年以来，印度精神疾病占总疾病负担的比例几乎翻了一番。不同精神障碍的负担在不同的状态之间存在着很大的差异，随着时间的推移，它们的趋势也存在着很大的差异。这里报告的每一种精神障碍的这些特定于邦的趋势可以指导适当的政策和卫生系统的反应，以更有效地解决印度的精神障碍负担。版权所有(C)2019年世界卫生组织；被许可人爱思唯尔。这是一篇根据CC by 3.0 IGO许可证发布的开放获取文章，该许可证允许在任何媒体上不受限制地使用、分发和复制，前提是正确引用原始作品。在使用本条时，不应暗示世卫组织认可任何特定组织、产品或服务。不允许使用世卫组织徽标。此通知应与文章的原始URL一起保存。
Background Mental disorders are among the leading causes of non-fatal disease burden in India, but a systematic understanding of their prevalence, disease burden, and risk factors is not readily available for each state of India. In this report, we describe the prevalence and disease burden of each mental disorder for the states of India, from 1990 to 2017.Methods We used all accessible data from multiple sources to estimate the prevalence of mental disorders, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by these disorders for all the states of India from 1990 to 2017, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We assessed the heterogeneity and time trends of mental disorders across the states of India. We grouped states on the basis of their Socio-demographic Index (SDI), which is a composite measure of per-capita income, mean education, and fertility rate in women younger than 25 years. We also assessed the association of major mental disorders with suicide deaths. We calculated 95% uncertainty intervals (UIs) for the point estimates.Findings In 2017, 197.3 million (95% UI 178.4-216.4) people had mental disorders in India, including 45.7 million (42.4-49.8) with depressive disorders and 44.9 million (41.2-48.9) with anxiety disorders. We found a significant, but modest, correlation between the prevalence of depressive disorders and suicide death rate at the state level for females (r(2)=0.33, p=0.0009) and males (r(2)=0.19, p=0.015). The contribution of mental disorders to the total DALYs in India increased from 2.5% (2.0-3.1) in 1990 to 4.7% (3.7-5.6) in 2017. In 2017, depressive disorders contributed the most to the total mental disorders DALYs (33.8%, 29.5-38.5), followed by anxiety disorders (19.0%, 15.9-22.4), idiopathic developmental intellectual disability (IDID; 10.8%, 6.3-15.9), schizophrenia (9.8%, 7.7-12.4), bipolar disorder (6.9%, 4.9-9.6), conduct disorder (5.9%, 4.0-8.1), autism spectrum disorders (3.2%, 2.7-3.8), eating disorders (2.2%, 1.7-2.8), and attention-deficit hyperactivity disorder (ADHD; 0.3%, 0.2-0.5); other mental disorders comprised 8.0% (6.1-10.1) of DALYs. Almost all (>99.9%) of these DALYs were made up of YLDs. The DALY rate point estimates of mental disorders with onset predominantly in childhood and adolescence (IDID, conduct disorder, autism spectrum disorders, and ADHD) were higher in low SDI states than in middle SDI and high SDI states in 2017, whereas the trend was reversed for mental disorders that manifest predominantly during adulthood. Although the prevalence of mental disorders with onset in childhood and adolescence decreased in India from 1990 to 2017, with a stronger decrease in high SDI and middle SDI states than in low SDI states, the prevalence of mental disorders that manifest predominantly during adulthood increased during this period.Interpretation One in seven Indians were affected by mental disorders of varying severity in 2017. The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. Substantial variations exist between states in the burden from different mental disorders and in their trends over time. These state-specific trends of each mental disorder reported here could guide appropriate policies and health system response to more effectively address the burden of mental disorders in India. Copyright (c) 2019 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.