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Levy Library Blog

Article in the Spotlight: January 2018

by Angelyn Thornton on 2018-01-10T11:09:00-05:00

Each month the Levy Library showcases the achievements of Mount Sinai faculty and researchers by highlighting an article and its altmetrics. Altmetrics are alternative measures of impact that capture non-traditional data like abstract views, article downloads, and social media activity.

This month we highlight The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013, written by a team of researchers including Mount Sinai’s Dan Stein, Visiting Professor with the Department of Psychiatry. 

Citation: Charara R, Forouzanfar M, Naghavi M, Moradi-Lakeh M, Afshin A, Vos T, et al. (2017) The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013. PLoS ONE 12(1): e0169575.


The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost–YLLs) and nonfatal outcomes (years lived with disability–YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25–49 age group, with a peak in the 35–39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region.


GBD 2013 estimated burden for 306 diseases and injuries and 79 risk factors. The DALY was used as a measure of total burden. One DALY represented one healthy year of life lost to a given disease or injury and was estimated by summing the fatal burden (as Years of Life Lost–YLLs) and non-fatal burden (as YLDs) associated with the disease or injury.

In GBD 2013, YLLs were computed by multiplying numbers of deaths from each cause in each age group by the reference life expectancy at the average age of death for those who die in the age group following the standard GBD 2010 methods. Mortality rates and causes of death for each country-age-sex-year group were estimated in accordance with some general principles: identification of all available data sources, evaluation of the quality and correction for known bias in each data source, consistent statistical estimation including uncertainty analysis, and cross-validation analysis to assess model performance. Detailed information on the YLL estimation process has been published elsewhere.




In 2013, mental disorders in the EMR contributed to 11·9 million DALYs (95% Uncertainty Interval (UI): 7·6 million– 17·2 million) equivalent to 1894 DALYS/100,000 population. In comparison, mental disorders contributed to 1834 DALYs/100,000 globally in 2013.

Mental disorders were the leading cause of all nonfatal burden of disease (YLDs) in the EMR. In 2013, they accounted for 11·9 million YLDs or 19·0% of nonfatal burden. Globally, mental disorders contributed to 17·4% of nonfatal burden in 2013, ranking as second-largest contributor to nonfatal burden following musculoskeletal disorders. Depressive disorders accounted for most YLDs followed by anxiety disorders, both in the EMR and globally.


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