Reacción a "Nearly 1.2 billion people worldwide suffer from mental health disorders"

Does the press release accurately reflect the study?

“The key data points are accurately reported: the 1.17 billion people with a mental disorder in 2023, the prominent role of anxiety and depression, differences by sex and age, and the warning about limited access to treatment. There are, however, some simplifications that warrant clarification: the release states that mental disorders account for “about 6% of all DALYs,” which is correct, but it fails to mention perhaps the most striking finding of the study: that in 1990, mental disorders ranked 12th in the global DALY rankings, and by 2023 they had risen to 5th place. That jump in the ranking is one of the most significant findings and deserves explicit mention. Also omitted from the article is the fact that anxiety disorders surpassed depression in burden for the first time in 2023, in part because they resolve spontaneously less frequently.”

Is the study of high quality?

“This is the most comprehensive global disease burden analysis available. The GBD 2023 covers 204 countries and territories, incorporated more than 5,000 new epidemiological data points, and has updated and improved its Bayesian modeling statistical tools compared to previous versions. The estimates include uncertainty intervals, which provide transparency regarding their reliability. It is an internationally recognized reference study, with independent funding (Gates Foundation, Queensland Health, and the University of Queensland) and no involvement of the funders in the analysis or interpretation.”

How does this study fit with existing evidence?

“It reinforces and updates previous evidence. The most recent comparable estimate by the same authors was from GBD 2019 (published in 2022). This new analysis incorporates the effects of the COVID-19 pandemic, which caused rates of depression and anxiety to skyrocket, especially in 2020–2021. It confirms already known trends (a higher burden among adult women, higher prevalence of neurodevelopmental disorders among male children and adolescents) and quantifies them more precisely. The finding that mental disorders are now the leading cause of years lived with disability (YLDs) globally is consistent with what other sources, such as the WHO’s 2022 World Mental Health Report, had been pointing out.”

Have confounding factors been taken into account? Are there significant limitations?

“The authors themselves are very transparent about the limitations, which is a sign of rigor. The most relevant ones are:

• Uneven geographic coverage: 75 countries (mostly low- and middle-income) lack their own data, which requires extrapolation using models. Estimates for those regions should be interpreted with caution.
• Data mostly pre-pandemic: most diagnostic surveys are from before 2019, which limits the ability to accurately capture recent trends.
• Diagnostic definitions: the study relies primarily on DSM-IV-TR criteria, which do not always translate well across cultures. Many measurement instruments have not been validated cross-culturally.
• Substance use disorders excluded: the analysis does not include alcohol or drugs, which frequently co-occur with mental disorders. This underestimates the total burden addressed by mental health systems.
• Does not capture all attributable mortality: suicide is classified in another GBD category, so the lethal impact of mental disorders is underestimated.”

What are the real-world implications?

“They are very significant. The study shows that mental disorders are now the leading cause of disability worldwide and that the gap between need and treatment remains enormous: only about 9% of people with depression or anxiety receive minimally adequate care. In low-income countries, that percentage may be less than 5%. The peak burden among 15- to 19-year-olds indicates that early interventions (school programs, screening in primary care, support for families) are indispensable. The fact that even countries with advanced health systems have failed to reduce the burden suggests that the problem cannot be solved by clinical resources alone: systemic changes are needed to address social determinants such as violence, inequality, or social isolation.

The main finding of this study is the combination of a growing burden (peaking in the adolescent population) and an insufficient therapeutic response, where barely 9% of those with depression receive adequate treatment. The data serve as an unequivocal wake-up call for governments to act with policies for early prevention, care tailored to young people and women, and real, coordinated investment in mental health.

When scientists speak of a disease’s “burden,” they are not referring only to how many people suffer from it, but to how much real harm it causes in people’s lives. It is a way of measuring collective suffering: how many years of healthy life are lost because someone cannot work, socialize, or simply live normally due to their illness. In the case of mental disorders, that harm comes from living for years or decades with constant anxiety, with depression that prevents one from getting out of bed in the morning, or with schizophrenia that completely isolates the person suffering from it. This study shows that mental disorders are now the leading cause of disability worldwide (or, in other words, that no other illness limits the daily lives of so many people on the planet more, even if it is not the one that kills the most directly).

Spain allocates less than 7% of its healthcare budget to mental health, and waiting lists to see a psychologist or psychiatrist in the public healthcare system are measured in months. It is not surprising that only one in ten patients with depression receives adequate treatment globally when, in our own system, mental health care remains, in practice, a privilege reserved for those who can afford it.