The Global Burden of Disease 2010 Study: what does it tell us about mental disorders in Latin America?

Theywere found to be the leading cause of disability amongall groups of disorders. In fact, they ranked higher, asmeasured by years lived with disability (YLDs), than allcommunicable disease (including HIV/AIDs), maternaland neonatal disorders, cancers, and cardiovasculardisease, highlighting their significant role in populationhealth. When premature mortality and disability wereconsidered together (disability-adjusted life years,DALYs), they directly accounted for 7.4% of all diseaseburden, more than HIV/tuberculosis, diabetes, or trans-port injuries.While the findings of a high burden, similar to earlierGBD studies, are not unexpected, major changes to theway GBD 2010 was carried out make the findings moresurprising than most in the psychiatric community realize.The neuropsychiatric grouping used in GBD 1990 wasdisaggregated, with neurological disorders now con-sidered a separate category. The number of mentaland substance use disorders was increased. Anxietydisorders were considered together, compared with three(panic disorder, obsessive compulsive disorder and post-traumatic stress disorder), each modeled separately, inGBD 1990. Bipolar disorder in GBD 2010 was expandedto include cyclothymic disorder, and depressive disordersincluded major depressive disorder (MDD) and dysthy-mia. Substance use disorders were expanded to estimatedrug-specific burden for alcohol dependence, opioiddependence, cannabis dependence, cocaine depen-dence, and amphetamine dependence. Eating disorders(anorexia nervosa and bulimia nervosa), childhoodbehavioral disorders (attention-deficit hyperactivity dis-order and conduct disorder), pervasive developmentaldisorders (autism and Asperger’s disorder) were includedthis time. The inclusion of childhood disorders isparticularly important in regions such as Africa, wherechildren constitute up to 40% of the total population.Idiopathic intellectual disability was included as a mentaldisorder, but dementia was recategorized as a neuro-logical disorder.In GBD 1990 and in its 1999-2004 updates, the rankingof disorders in terms of disability relied heavily on expertopinion. This approach has been criticized.