Mental disorders now top causes of disability

Every so often, a collaborate team of researchers publishes estimates of the leading causes of illness and disability in the world.

The latest data from this effort were published in the influential Lancet journal about three weeks ago.

The study tracked the leading causes of disease and disability between the first study in 1990 and the latest one in 2013. The findings make for compelling reading, and any serious health technocrat must be acquainted with at least the main messages from this study.

While low-back pain continued to be the leading cause of years lived with disability (YLDs) globally, major depressive disorder crept to second place, up from third place in 1990.

Additionally, anxiety disorders and schizophrenia continued to contribute significantly to YLDs, emphasising the role of mental disorders in impaired productivity.

The study concluded that the non-fatal dimensions of disease and injury will require more and more attention from health systems.

One might argue that the global focus of these major findings gives a misleading assessment with regard to poorer countries such as Kenya.

And I would be constrained to agree, but not in the way anyone might expect.

LEADS THE PACK

Among the richer countries with ageing populations, low-back pain is the leading contributor to YLDs.

But in poorer countries with younger populations (including Kenya), major depressive disorder leads the pack.

In the Middle East and areas sharing the same lifestyle, other chronic diseases like diabetes mellitus predominate.

If evidence really guided interventions, it would stand to reason that a significant proportion of our health and social expenditure would go towards addressing the high and rising burden of mental and neurological disorders.

Research and programme funding agencies elsewhere have come to this realisation, and funding for mental health activities is increasing.

However, in the most affected regions of the world, including Kenya, authorities continue to turn a blind eye to these debilitating conditions.

The result is that the amount of disability imposed by mental and neurological conditions drags us into poverty, and keeps us there.

SUICIDES

It is time for concerted action if we are to begin to change the tide against these conditions and create a healthier legacy for future generations.

While one may be tempted to dismiss the data presented in this study as more of the same advocacy noise, anecdotal and research evidence from this country proves otherwise.

Every week, several cases of actual and attempted suicide are reported in the media. Interpersonal violence and substance-related problems have become so common that they are hardly ever news any more, unless “interesting” dimensions like genital mutilation are included.

At the workplace, increasing absenteeism and presenteeism is undermining productivity. Even among our political and other leaders, I can bet that there are many who are struggling with mental disorders including depression, bipolar disorder, anxiety disorders and substance use disorders.

What needs to be done? We must invest more in training, recruitment and retention of mental health workers, and acquiring the tools they need to work effectively.

We must allocate more resources to mental health research to provide the necessary evidence base. Finally, we must continue talking about these conditions in order to make it easier for those living with them to seek the help they so sorely need.

Prof Lukoye is associate professor of psychiatry and dean, Moi University’s school of medicine; [email protected]