Q&A: Mental health disorders in the ASEAN region

In 2021, there were an estimated 80.4 million cases of mental disorders in the Association of Southeast Asian Nations (ASEAN) region, representing a 70% increase since 1990. The greatest burden was observed among adolescents, and a growing number of cases were also seen in older adults.

New research studied 10 mental disorder conditions: depressive disorders and anxiety disorders, bipolar disorders, schizophrenia, autism spectrum disorder, conduct disorder, attention deficit hyperactivity disorder, eating disorders, idiopathic developmental intellectual disability, and the general category of all other mental disorders.

Lead author Dr. Marie Ng, Affiliate Associate Professor at IHME and Associate Professor at National University of Singapore’s Yong Loo Lin School of Medicine, discusses the findings.

Video transcript

This transcript has been lightly edited for clarity

What challenges did you face researching mental health in the ASEAN region?

Mental disorders are sparse in ASEAN. Routine screening is rare. The number of population-level surveys is also very limited. High levels of stigma, low awareness, and reluctance to recognize these conditions further hinder accurate data collection. We attempted to overcome these data gaps with extensive data and literature searches, and by applying rigorous modeling techniques. Despite these challenges, we believe it is important to present the best results currently available, to raise awareness of mental disorders, to stimulate debate, and to encourage improved surveillance.

Mental disorders pose a growing public health crisis in many countries, and inaction carries a high cost. It is very important to use the best available results to inform policy change in this area.

What mental health disorders were studied, and what were the key findings?

We studied 10 mental disorder conditions, including depressive disorders and anxiety disorders, bipolar disorders, schizophrenia, autism spectrum disorder, conduct disorder, attention deficit hyperactivity disorder, eating disorders, idiopathic developmental intellectual disability, and the general category of all other mental disorders. Our study found that in 2021, there were an estimated 80.4 million cases of mental disorders in the ASEAN region, representing a 70% increase since 1990. The greatest burden was observed among adolescents, and a growing number of cases were also seen in older adults.

Map A shows the age-standardized performance across the 10 ASEAN countries. Country variation is small. Prevalence ranged from 10% in Vietnam to 13% in Malaysia.

Map B shows the age-standardized disability-adjusted life years (DALY) rate for mental disorders across the 10 ASEAN countries. DALYs reflect health loss due to disability caused by a condition. Malaysia had the highest rate, with an estimated 1,800 DALYs per 100,000 people, followed by the Philippines with an estimate of 1,700 per 100,000. This indicates that overall, people in Malaysia experienced the greatest health loss due to mental disorders among ASEAN countries.

Figure 2 shows the relative contribution of different mental disorders with respect to the total disease burden. Each color represents a specific mental disorder condition, and the y-axis here refers to percentage out of total DALYs caused by a specific mental disorder.

The graph shows that, in general, anxiety disorder and depressive disorder accounted for the largest share of mental disorder burden.

This figure illustrates the age and sex variation across mental disorders. Each color represents a specific mental disorder, with the y-axis indicating each group and the x-axis indicating DALY count. The width of each bar reflects the burden of a particular condition within each group. Among females, anxiety disorder, represented in dark green, accounts for the largest share of disease burden. And, across age groups, the burden of mental disorders begins to rise around the age of 10 to 14 and continues to contribute significantly throughout adolescence and adulthood.

What should be done to address mental health in the ASEAN region?

Addressing mental disorders in ASEAN requires a multifaceted approach. First, improving awareness and changing the perception of mental health is crucial. While recent efforts in several ASEAN countries have increased public awareness and encouraged health-seeking behavior, studies have shown that mental disorders remain frequently undiagnosed and untreated. Second, special attention should be given to adolescents’ mental health. Beyond commonly discussed stressors like social media, fundamental social and environmental factors such as low education attainment, poverty, and food insecurity in low- and middle-income ASEAN countries still significantly impact mental health.

Improving mental health will require tackling these broader determinants. Finally, mental health issues have not been sufficiently addressed in current healthy aging strategies. With an aging population, it is important to ensure the integration of mental health into geriatric care and services.