The burden attributable to mental and substance use disorders as risk factors for suicide: findings from the Global Burden of Disease Study 2010.
BACKGROUND
The Global Burden of Disease Study 2010 (GBD 2010) identified mental and substance use disorders as the 5th leading contributor of burden in 2010, measured by disability adjusted life years (DALYs). This estimate was incomplete as it excluded burden resulting from the increased risk of suicide captured elsewhere in GBD 2010's mutually exclusive list of diseases and injuries. Here, we estimate suicide DALYs attributable to mental and substance use disorders.


METHODS
Relative-risk estimates of suicide due to mental and substance use disorders and the global prevalence of each disorder were used to estimate population attributable fractions. These were adjusted for global differences in the proportion of suicide due to mental and substance use disorders compared to other causes then multiplied by suicide DALYs reported in GBD 2010 to estimate attributable DALYs (with 95% uncertainty).


RESULTS
Mental and substance use disorders were responsible for 22.5 million (14.8-29.8 million) of the 36.2 million (26.5-44.3 million) DALYs allocated to suicide in 2010. Depression was responsible for the largest proportion of suicide DALYs (46.1% (28.0%-60.8%)) and anorexia nervosa the lowest (0.2% (0.02%-0.5%)). DALYs occurred throughout the lifespan, with the largest proportion found in Eastern Europe and Asia, and males aged 20-30 years. The inclusion of attributable suicide DALYs would have increased the overall burden of mental and substance use disorders (assigned to them in GBD 2010 as a direct cause) from 7.4% (6.2%-8.6%) to 8.3% (7.1%-9.6%) of global DALYs, and would have changed the global ranking from 5th to 3rd leading cause of burden.


CONCLUSIONS
Capturing the suicide burden attributable to mental and substance use disorders allows for more accurate estimates of burden. More consideration needs to be given to interventions targeted to populations with, or at risk for, mental and substance use disorders as an effective strategy for suicide prevention.
University of Queensland, School of Population Health, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia.
Alize J
AJ
Ferrari
University of Queensland, School of Population Health, Herston, Queensland, Australia; Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia.
Rosana E
RE
Norman
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
Greg
G
Freedman
University of Queensland, School of Population Health, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia.
Amanda J
AJ
Baxter
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Jane E
JE
Pirkis
University of Queensland, School of Population Health, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia.
Meredith G
MG
Harris
School of Science and Health, University of Western Sydney, Campbelltown, New South Wales, Australia.
Andrew
A
Page
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
Emily
E
Carnahan
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Louisa
L
Degenhardt
University of Queensland, School of Population Health, Herston, Queensland, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
Theo
T
Vos
University of Queensland, School of Population Health, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia.
Harvey A
HA
Whiteford
D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D000092864:Suicide Prevention