The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies
China and India, which together contain 37% of the world’s population, are both undergoing rapid social change. Therefore understanding the burden attributed to mental, neurological, and substance use disorders within these two countries is essential. Because mental disorders account for a high proportion of morbidity, detailed knowledge of the mental health status of the populations in these two countries and the evidence-base regarding the treatment of those disorders are of paramount concern.
China-India Mental Health Alliance Series
The China-India Mental Health Alliance comprises experts from both countries and elsewhere who have worked to produce a collection of systematic reviews based on extensive literature searches of both international and national databases. It is hoped that this series will encourage further collaboration between Chinese and Indian mental health research communities to address shared concerns.
As part of the Lancet and Lancet Psychiatry China–India Mental Health Alliance Series, the researchers aim to provide estimates of the burden of mental, neurological, and substance use disorders for China and India from the Global Burden of Disease Study 2013 (GBD 2013).
Methodology
In this systematic analysis for community representative epidemiological studies, the researchers conducted systematic reviews in line with PRISMA guidelines for community representative epidemiological studies.They extracted estimates of prevalence, incidence, remission and duration, and mortality along with associated uncertainty intervals from GBD 2013. Using these data as primary inputs, DisMod-MR 2.0, a Bayesian meta-regression instrument, used a log rate and incidence-prevalence-mortality mathematical model to develop internally consistent epidemiological models. Disability-adjusted life-year (DALY) changes between 1990 and 2013 were decomposed to quantify change attributable to population growth and aging. We projected DALYs from 2013 to 2025 for mental, neurological, and substance use disorders using United Nations population data.
Findings
Around a third of global DALYs attributable to mental, neurological, and substance use disorders were found in China and India (66 million DALYs), a number greater than all developed countries combined (50 million DALYs).
Disease burden profiles differed:
- India showed similarities with other developing countries (around 50% of DALYs attributable to NCDs)
- China more closely resembled developed countries (around 80% of DALYs attributable to NCDs.
The overall population growth in India explains a greater proportion of the increase in mental, neurological, and substance use disorder burden from 1990 to 2013 (44%) than in China (20%).
The burden of mental, neurological, and substance use disorders is estimated to increase by 10% in China and 23% in India between 2013 and 2025.
Discussion and conclusions
The current and projected burden of mental, neurological, and substance use disorders in China and India warrants the urgent prioritization of programs focused on targeted prevention, early identification, and effective treatment.