It is only over the past few years, perhaps since the birth of the DALY, that we have given the idea of mental illness in developing countries much thought. The reason is not likely to be a surprise to many, which just don’t have the data systems in place to properly measure the burden from mental illness in these countries. Most of what we know about health in low-income settings come from household surveys, which tend to focus more on reproductive health and infectious diseases – the stuff we consider to only be problems in those countries.
Therefore the new publication by Jishnu Das, Quy-Toan Do, Jed Friedman, and David McKenzie (all from the World Bank) is very welcome and makes an important contribution to what we know about mental health in lower income countries.
They summarize the burden of mental illness as follows:
“According to widely circulated estimates, unipolar depressive disorders are the leading cause of loss of disability adjusted life-years (DALYs) in the Americas and the third leading cause in Europe, but they also rank highly in lower income countries. They are the second leading cause in the Western Pacific, the fourth in South-East Asia, and the fifth in the Eastern Mediterranean. While depression is not in the top 10 in Africa, it is recognized as a major source of disability, particularly in conjunction with HIV/AIDS epidemic.”
“The few low-income country estimates of poor psychological health suggest that prevalence is not systematically lower than it is in wealthier countries.”
So basically, the overall prevalence of mental illness is probably comparable in low and high income countries, but since other conditions are so much more prevalent in developing countries, it does not rank as high as it does in developed countries.
Their work finds two major finidngs. First, unlike in richer countries, there is no strong positive relationship between measures of income or consumption and mental illness. Mental illness is not a disease of “affluence” or “poverty” in developing countries. Second, they also find that shocks (e.g. illness or crisis) can have a greater impact on measures of mental illness than on measures of illness or poverty, suggesting that classical economists measures of well-being may neglect to consider the mental impact of such shocks in developing countries.
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