The Eastern Mediterranean Region shows higher rates of mental health disorders than the rest of the world; women suffer disproportionately

New study underscores insufficient services in a region where continued unrest will cause increased challenges in the coming years

SEATTLE – A new study shows that the Eastern Mediterranean Region is witnessing an increase in chronic disorders, including mental illness.

Mental disorders such as depression and anxiety accounted for 19% of years lived with disability (YLDs), making them the leading cause of nonfatal disease burden in the region. Globally, mental illness accounts for 17.4% of total YLDs.

In 2013, depression accounted for 44.6% of total disease burden from mental illness in the Eastern Mediterranean Region, which consists of nations in the Middle East and North Africa, as well as Afghanistan and Pakistan. Total disease burden is measured using the disability-adjusted life year (DALY), which is a combination of YLDs and years of life lost to early death (YLLs). The second-greatest cause of total disease burden from mental illness is anxiety. The rate of both of these disorders spikes during adolescence. The highest proportion of disease burden occurred in people aged 25-49 years, and women are more likely to suffer from these disorders in all age groups except when they are 15 years old or younger.

“Mental health disorders are taking an alarming toll on people in the Eastern Mediterranean Region. Women – often in the prime of their lives – are losing years of good health to depression, anxiety, and other mental disorders,” said Raghid Charara, MD, a postdoctoral researcher at the American University of Beirut Medical Center, and lead author. “This is unacceptable and must be addressed by governments, public health experts, and citizens in the region.”

The current study supports previous study findings that have identified a strong link between ongoing war and unrest and citizens of Eastern Mediterranean countries developing mental illness. For example, Palestine has seen regular conflict and military intervention for more than 50 years and has the highest burden of mental health disorders in the region. In Palestine, depressive disorders accounted for 1,392 DALYs of every 100,000 people in 2013.

There are, however, exceptions to these patterns. Some countries with complex emergency conflict situations, like Yemen, do not report the expected high levels of depression. In Yemen, only 622 DALYs per 100,000 people were due to depression in 2013, compared to the global number of 860. This could be explained by the lack of quality data coming from countries like Yemen, or the reduced likelihood that people in conflict situations seek help for depression or mental health issues in times of crisis.

Women suffer a higher mental health burden across the region. Women lost 3.3 million total DALYs to depression, compared to men’s nearly 2 million DALYs, in 2013. Anxiety exhibits a similar gender divide. Women in the region lost more than 1.4 million DALYs due to anxiety, while men lost nearly half that number, almost 800,000 DALYs.

The study, “The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013,” underscores that stigma compounds the challenges of mental illness in the region. Stigma may cause people suffering with these disorders to remain quiet, leading to underreported cases across all income levels. In addition, recent data show that resources allocated to the screening and treatment of mental health services are insufficient to meet the region’s needs.  

“The world is changing and the Eastern Mediterranean Region needs to change with it,” said IHME Director for Middle Eastern Initiatives Dr. Ali Mokdad. “With conflicts in many countries in the region, the challenge of mental health for children and adults is likely to increase. We need to equip our health systems to tackle this head-on. That means ramping up treatment options for people with mental health disorders and boosting prevention efforts that will encourage people to seek help.”

The paper, published in the journal PLOS ONE, also finds that chronic mental health disorders are greater in high-income countries in the Eastern Mediterranean Region. This is consistent with the global trend that suggests mental illness grows with increased living standards. However, this trend may simply reflect the fact that people with greater incomes have more stable lives and can tend to mental health needs. People coping with the instability caused by conflict or poverty place a higher priority on basic survival and physical well-being.

This study is based on findings from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) coordinated by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle. With more than 2,000 collaborators in over 125 countries, GBD is the largest and most comprehensive effort measuring epidemiological levels and trends worldwide.

Link to the study in PLOS ONE: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0169575

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Established in 2007, the Institute for Health Metrics and Evaluation (IHME) is an independent global health research center at the University of Washington in Seattle that provides rigorous and comparable measurement of the world’s most important health problems and evaluates strategies to address them. IHME makes this information available so that policymakers, donors, practitioners, researchers, and local and global decision-makers have the evidence they need to make informed decisions about how to allocate resources to best improve population health. For more information, visit www.healthdata.org.