Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 1
Overarching Themes
Mental Disorders are Disabling
The burden of mental illness on health and productivity in the United States and
throughout the world has long been profoundly underestimated. Data developed by
the massive Global Burden of Disease study,1 conducted by the World Health
Organization, the World Bank, and Harvard University, reveal that mental
illness, including suicide,2 ranks second in the burden of disease in
established market economies, such as the United States (Table 1-1).
Mental illness emerged from the Global Burden of Disease study as a surprisingly
significant contributor to the burden of disease. The measure of calculating
disease burden in this study, called Disability Adjusted Life Years (DALYs),
allows comparison of the burden
Table 1-1. Disease burden by selected illness categories in established market
economies, 1990
Percent of Total DALYs*
All cardiovascular conditions 18.6
All mental illness** 15.4
All malignant diseases (cancer) 15.0
All respiratory conditions 4.8
All alcohol use 4.7<
All infectious and parasitic diseases 2.8
All drug use 1.5
*Disability-adjusted life year (DALY) is a measure that expresses years of life
lost to premature death and years lived with a disability of specified severity
and duration (Murray & Lopez, 1996).
**Disease burden associated with“mental illness” includes suicide.
of disease across many different disease conditions. DALYs account for lost
years of healthy life regardless of whether the years were lost to premature
death or disability. The disability component of this measure is weighted for
severity of the disability. For example, major depression is equivalent in
burden to blindness or paraplegia, whereas active psychosis seen in
schizophrenia is equal in disability burden to quadriplegia.
By this measure, major depression alone ranked second only to ischemic heart
disease in magnitude of disease burden (see Table 1-2 ). Schizophrenia, bipolar
disorder, obsessive-compulsive disorder, panic disorder, and post-traumatic
stress disorder also contributed significantly to the burden represented by
mental illness.
Total DALYs (millions) |
Percent of Total |
||
| . | All causes | 98.7 | . |
1 |
Ischemic heart disease | 8.9 | 9.0 |
|
2 |
Unipolar major depression | 6.7 | 6.8 |
3 |
Cardiovascular disease | 5.0 | 5.0 |
|
4 |
Alcohol use | 4.7 | 4.7 |
5 |
Road traffic accidents | 4.3 | 4.4 |
Source: Murray & Lopez, 1996.
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