Mental Illness and Substance Abuse Around the World: No End in Sight

Mental health and substance abuse disorders affect people of all countries

The world has long been a frightening, sad place for many of its citizens and it appears that things aren’t getting any better as we struggle through the first quarter of the twenty-first century. If this seems like old news, the depth of the current state of mental illness and substance abuse around the world may surprise you.

According to statistics released recently by Our World in Data, 1.1 billion people, or more than 15 percent of the world’s population, have some type of mental health or substance abuse disorder. No nation is immune.

Anxiety disorders and depression are nearly tied for the number one position, affecting 275 and 268 million people respectively, each disorder comprising about 4 percent of the world’s population. Other disorders, including bipolar disorder, eating disorders, schizophrenia and addiction are present globally, although in substantially smaller numbers.

Mental health and substance abuse disorders affect people of all countries — poor and rich, men and women, employed and unemployed, rural and urban. Problems can last for weeks, months, or even years, and without treatment, may be present for an entire lifetime.

The enormity of the problem is difficult to fathom, and the situation isn’t expected to get much better in the coming years. The World Health Organization predicts that by 2030, mental health disorders will move into the number one spot for the global burden of disease, outpacing heart disease and car accidents.

by 2030, mental health disorders will move into the number one spot for the global burden of disease, outpacing heart disease and car accidents. source: IHME, Global Burden of Disease

Anxiety: A World Living in Fear

If global mental disorders held a contest, anxiety would be in first place. Anxiety disorders affect 275 million people, or about 4 percent of the world’s population.

Anxiety is a mysterious, challenging disorder, and it isn’t well understood, even by the greatest minds in the medical and psychiatric world. The term “anxiety disorders” encompasses a range of related disorders, including generalized anxiety disorder, social anxiety, PTSD (post-traumatic stress disorder), phobias, and OCD (obsessive compulsive disorder). While each subset has unique symptoms, all share common characteristics.

WHO (World Health Organization) notes that anxiety is marked by apprehension and worry about the future, signs of tension such as headaches, fidgeting, and restlessness; and physical symptoms like dizziness, rapid breathing, sweating, rapid heartbeat, gastrointestinal distress, and a dry mouth.

Following extensive research, The Journal of the American Medical Association (JAMA) offers the conclusion that anxiety is more common in high-income countries as a whole, although the disorder is more likely to affect people of lower socioeconomic status within those countries.

Is this because mental health in the U.S. and other wealthy countries is readily available for those who can afford it, while people who live in impoverished communities, or those who lack health insurance have fewer healthcare options? Often, people who live in America’s inner cities or rural areas face tremendous challenges presented by a lack of quality healthcare.

Some might argue that anxiety is an outcome of the fast-paced world we have created for ourselves. Modernization and technology are wonderful things that bring us together and make life easier in many ways, but as the pace of life quickens, we face increasing stress and worry.

When it comes to rates of anxiety disorders, Australia and New Zealand are at the top of the chart, with anxiety affecting more than 6.5 percent of citizens. The United States, Norway, Brazil, Iran, and Argentina, where anxiety affects more than six percent of the population, aren’t far behind. Countries as disparate as Canada, France, Algeria, Sweden, Spain, and Sudan are catching up rapidly,

At the opposite end of the spectrum are economically challenged countries such as Columbia, Venezuela, Nigeria, Ghana, Mongolia, Mali, and Uzbekistan, where reporting, when available, indicates that less than three percent of the population is affected by anxiety.

Countries as disparate as Canada, France, Algeria, Sweden, Spain, and Sudan are catching up rapidly, source: IHME, Global Burden of Disease

Second Place: Depression

Depression is nearly as troublesome as anxiety disorder, affecting an estimated 268 million of the world’s population. The World Health Organization (WHO) estimates the number may be even higher, affecting as many 3 billion people around the globe.

Like anxiety, depression is a complex disorder with many different faces. People with mild forms of depression may notice fatigue, sadness or loss of interest in normally enjoyable activities, but they are generally able to continue with work and other activities of daily life. Those with a severe depressive disorder may experience feelings of extreme guilt, hopelessness and low self-esteem so severe that they are unable to function. Suicide is a possibility in the most extreme cases.

The National Institute of Mental Health notes that a person with depression, whether it’s mild, severe, or somewhere in-between, has some of the following symptoms for at least two weeks:

● Persistent feelings of sadness or emptiness,

● Hopelessness or pessimism about the future

● Irritability

● Decreased energy or fatigue

● Changes in appetite or weight

● Moving or talking more slowly

● Reduced concentration and difficulty paying attention or making decisions

● Diminished self-confidence and self-esteem

● Feelings of unworthiness and guilt

● Thoughts or acts of suicide or self-harm

● Sleep disturbances

● Aches or pain without a physical cause (digestive problems, headaches, etc.)

All of the symptoms generally aren’t present, or they may be mild or severe. Some people may experience a few symptoms, while others with more severe depression might experience several.

Rates of Depression Around the World

Depression is the world’s second most significant cause of disability, affecting slightly more than four percent of the global population. The rate of depression is relatively high in North America, where it affects around 4.5 percent of the population.

However, the rate of depression in North America is only in the middle of the pack, while other areas around the world have a significantly higher rate. According to an article published by the Washington Post, more than five percent of the populations of North Africa, Eastern Europe, the Caribbean, and the Middle East have depression.

Afghanistan, where the disorder reportedly affects one in five people, is reportedly the world’s most depressed country. Rates of depression are lowest in East and Southeast Asia, as well as Australia and New Zealand.

Suicide and Depression

There’s no doubt that suicide and mental health are closely linked. According to Our World in Data, the risk of suicide is 20 times higher for an individual with mental illness. Research indicates that in high-income nations, up to 90 percent of all suicides occur as a result of substance abuse or a mental health disorder. Suicide is also linked to anxiety disorder, bipolar disorder, schizophrenia, and other disorders, although to a lesser degree.

Afghanistan, where the disorder reportedly affects one in five people, is reportedly the world’s most depressed country. Rates of depression are lowest in East and Southeast Asia, as well as Australia and New Zealand. Source: https://www.washingtonpost.com/news/worldviews/wp/2013/11/07/a-stunning-map-of-depression-rates-around-the-world/?noredirect=on&utm_term=.4a61d2391e21

Research suggests that the rate of suicide due to major depressive order is significantly lower in countries such as India, Taiwan, and China. In those countries, suicide has been linked to other factors or cultural issues that aren’t considered to be mental health or substance abuse disorders. T.H. Chan School of Public Health at Harvard University notes that in some countries, suicides have often been considered “injuries,” and are excluded from statistics.

Bipolar Disorder

Also known as manic depression, bipolar disorder consists of swings between highs (mania) and lows (depression), separated by periods of normal mood. Like depression, bipolar disorder may be mild or severe. Some people cycle rapidly between highs and lows, while others experience symptoms of mania and depression at the same time.

A person who is experiencing a manic episode may exhibit symptoms such as high energy, elevated mood, euphoria, irritability, anger, inflated self-esteem, talkativeness, racing thoughts, little need for sleep, and in severe cases, a loss of touch with reality. Depressive periods are marked by typical symptoms of depression, including feelings of hopelessness and worthlessness, fatigue, and loss of interest in daily activities.

Currently, there is no known cure for bipolar disorder. However, symptoms can be managed and minimized with treatment consisting of a combination of medication and psychotherapy.

Our World in Data reports that bipolar disorder affects approximately 40 million people in the world.

Our World in Data reports that bipolar disorder affects approximately 40 million people in the world. Source: IHME, Global Burden of Disease

Schizophrenia

Schizophrenia is a complex brain disorder that causes distortions of thought and perception. A person with schizophrenia may hear voices or might have bizarre ideas and thoughts or delusions. Our World in Data estimates that approximately 21 million people had schizophrenia in 2016.

Other symptoms include inexpressive faces, apathy, monotone speech, an inability to feel pleasure or a lack of interest in other people. It may become difficult or impossible for a person with schizophrenia to hold down a job, live independently, or engage with others in social situations. Schizophrenia isn’t curable, but it is highly treatable and can be managed with medications.

Our World in Data estimates that approximately 21 million people had schizophrenia in 2016. Source: IHME, Global Burden of Disease

Eating Disorders

Eating disorders include a spectrum of disordered eating, including anorexia nervosa, bulimia nervosa, and other severe disturbances in eating behaviors.

People with anorexia nervosa may view themselves as extremely overweight. They may weigh themselves compulsively, restrict their food intake, exercise compulsively, force themselves to vomit, or take laxatives. Symptoms of anorexia include yellowish or dry skin, brittle hair or nails, osteoporosis, anemia, constipation, low blood pressure, infertility or brain damage. Anorexia can be deadly when it leads to starvation or suicide.

Bulimia nervosa is characterized by episodes of eating huge amounts of food followed by forced vomiting, use of laxatives, excessive exercise or periods of fasting. Symptoms of bulimia include chronic sore throat, worn tooth enamel, decaying teeth worn down by stomach acid, severe dehydration, and acid reflux disorder.

Our World in Data estimates that around 10.5 million people around the world had anorexia or bulimia in 2016. This estimate doesn’t include a range of disordered eating behaviours that aren’t easily quantified, such as compulsive overeating and binge eating disorder.

Our World in Data estimates that around 10.5 million people around the world had anorexia or bulimia in 2016. Source: IHME, Global Burden of Disease

Substance Abuse Disorders and Mental Health

The World Health Organization defines substance abuse as the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.

According to Our World in Data, 164 million people around the world had a substance abuse disorder in 2016 (not including tobacco).

There’s no doubt that mental health disorders and substance abuse are closely linked. In the United States, NIDA (the National Institute on Drug Abuse) estimates that about half of all people with substance abuse disorders are also diagnosed with mental health disorders, and vice versa.

According to Our World in Data, 164 million people around the world had a substance abuse disorder in 2016 (not including tobacco). Source: IHME, Global Burden of Disease

Substance abuse disorders often occur along with anxiety disorder and depression, as well as bipolar disorder, schizophrenia, attention deficit disorder, and others. Substance abuse and addiction frequently happens when people use substances to relieve distress when their mental health needs are unmet,

Our World in Data reports that in 2016, alcohol use disorders claimed the lives of nearly 174,000 people around the world, while drug use disorders were responsible for the deaths of nearly 144,000 people.

The rate of alcohol use around the world varies substantially. In Russia, for instance, nearly one in twenty people are dependent on alcohol, compared to 2.5 percent of the population in the United States 1.4 percent in Canada, or 0.57 percent in Japan.

alcohol use disorders claimed the lives of nearly 174,000 people around the world, while drug use disorders were responsible for the deaths of nearly 144,000 people. Source: IHME, Global Burden of Disease

Treatment for Substance Abuse and Addiction

Addiction is a chronic disease that changes the function and structure of the brain. Like other chronic illnesses such as diabetes, asthma, and high blood pressure, addiction is treatable. However, most people find it difficult or impossible to stop using drugs or alcohol without help.

The fundamental goals of treatment are to help people stop abusing drugs and alcohol, while assisting them as they regain control of their lives and return to healthy functioning in their family, workplace, and community.

According to the National Institute on Drug Abuse (NIDA), most people who enter and remain in treatment for the recommended time are able to stop using drugs or alcohol. Ongoing treatment is often needed, as relapse is common. However, a lapse should never be considered a failure, no more than a recurrence of high blood pressure or any other chronic illness. Relapse is a critical sign that more treatment is needed, or that treatment needs to be adjusted to fit the changing needs of the individual.

Paracelsus Recovery, a treatment center in Zurich, Switzerland, notes that while addiction is a complex brain disease, sustainable recovery requires awareness and treatment of underlying reasons, or triggers. Paracelsus treats drug and alcohol addiction, eating disorders, behavioral addictions such as gambling or sex addiction, and emotional problems, including depression, anxiety, phobias, post-traumatic stress (PTSD), obsessive-compulsive disorder (OCD), and others.

According to the addiction treatment experts at Paracelsus Recovery, factors underlying addiction are generally biochemical, psychological, physical, social or spiritual. A quality treatment center will address all underlying factors, which may be manifold.

Paracelsus stresses the importance of aftercare and relapse prevention following completion of treatment, which substantially increases the chance of long-term recovery and sustained sobriety. Aftercare may require a few weeks or a few months, depending on individual needs and circumstances.

Risk Factors for Mental Health and Substance Abuse: Global Conflict and Epidemics

Researchers have yet to determine the exact reason why depression and other mental health disorders are high in some countries and low in others, but they have put forth a few interesting theories worth considering. Global conflict and epidemics are at the top of the list.

As the International Journal of Health Sciences notes in “Life in Conflict: Characteristics of Depression in Kashmir,” depression is more likely to occur following disruptive experiences such as conflict and war accompanied by death, torture, genocide, displacement, loss of property, humiliation and economic adversity.

Once the conflict ends, activity is usually focused on the reconstruction of infrastructures such as bridges, roads, and buildings. Mental health programs are rarely funded and the psychological damage to victims of conflict, which isn’t easily detected by the naked eye, often goes unnoticed for many years. The long-term consequences of trauma are enormous.

A study by the Institute for Health Metrics and Evaluation (IHME) found a distinct correlation between conflict and disorders such as depression and anxiety, including PTSD. The disorders may be relatively mild, or so severe that they threaten daily function and long-term survival.

In some areas, depression takes a back seat in comparison to serious epidemics such as HIV. It’s not that depression is ignored, but HIV is responsible for even greater pain and suffering. The psychological distress and misery associated with diseases with high mortality rates, including SARS (Sudden Acute Respiratory Syndrome) and Ebola create far-reaching effects that continue longer than the actual disease has ended.

O’Neill Institute for National and Global Health Law at Georgetown University in Washington, D.C. notes that “Epidemics can tear down social support structures when they are needed the most, leaving individuals feeling vulnerable and isolated.” Churches, schools and other places people tend to gather for support are often closed in an attempt to staunch the spread of disease.

Often, individuals suffering from certain diseases are subject to severe isolation and loneliness stemming from stigmatization so pervasive that entire communities can be shunned. As a result, people who are ill, especially those with HIV or AIDS, may fail to seek treatment. Healthcare workers who work with diseased populations are also subject to depression and anxiety.

How Aging Affects Mental Health Around the World

The average age of the population is increasing in most of the world, with Canada, Japan, India, China, and the United States expecting substantial growth to continue for at least the next few decades.

The World Health Organization notes that globally, 15 percent of individuals age 60 and over suffer from a mental disorder, often associated with chronic pain, reduced mobility, loneliness, isolation, and real or perceived loss of respect and dignity. Depression presents the biggest problem for the elderly.

However, older people, often thought to be “past their prime,” or “over the hill,” continue to bear the brunt of societal stigma and are understandably hesitant to seek help from mental health providers.

A senior citizen struggling with depression is more likely to seek help from their primary physician. Typically, they don’t complain of feeling sad or depressed, but instead, they may mention symptoms such as insomnia, fatigue, difficulty concentrating or loss of appetite.

Depressive disorders among the elderly are often underdiagnosed, undertreated or entirely ignored by primary care providers. It’s apparent that clinicians around the world need better training in the proper diagnosis and treatment of mental health issues affecting the elderly.

Cultural Issues: Reporting Mental Health Problems

Reporting of mental health disorders around the world is uneven at best, often because people are understandably afraid to discuss or admit problems. In some nations, mental health is still a taboo subject, and people struggling with certain mental health issues may face the possibility of prison or other human rights violations.

According to a survey conducted by Unite for Sight, a global health program based in the U.S., more than 22 percent of participants from developing nations experience discrimination, embarrassment or humiliation due to mental illness, compared to around 12 percent in developed nations. As a result, the repercussions of an individual’s mental illness can affect entire families, preventing the person from getting married, acquiring a good job, finding housing, or having children.

Low rates of reporting in these areas ultimately drive down statistics and rates of diagnosis. For example, the rate of mental illness appears to be nearly non-existent in low-income nations such as Iraq, where there are virtually no mental health services and no reporting at all.

Symptoms of mental health disorders and addiction are similar in every nation around the world, but individual cultures may affect how those symptoms are described. For instance, a person who is depressed or anxious may tell her doctor she is feeling exhausted or dizzy. A man who is struggling with depression may tell his friends he is angry or “pissed off.”

Countries where people have access to mental health services are diagnosed at a much higher rate, but still, even in developed nations such as the United States, mental health issues are underreported by men, who are often reluctant to discuss their feelings, and are less likely than women to seek treatment.

Treatment for Mental Health Disorders

Globally, it has been estimated that a vast majority of people affected by mental illness don’t receive the help they need. Harvard School of Public Health has determined that soon, depression, anxiety, and substance abuse will disable more people than heart disease, traffic accidents, AIDS and wars combined.

The need for mental health care is tremendous among children and adolescents, with 10 to 20 percent affected by at least one mental health or behavioral problem. The World Health Organization estimates that only 15 to 30 percent of young people receive help for those conditions.

Quality mental health care isn’t always readily available, even in high-income nations. In the United States, an estimated 20 percent of children and adolescents suffer from a mental disorder, and one in ten has a severe mental or emotional disturbance. The rate may be as high as 35 percent in areas of the world affected by war and conflict.

Mental health treatment should be a global priority, but the cost, lingering stigma, and traditional taboos associated with mental disorders prevent many governments from funding treatment.

Many global organizations, including International Federation of Red Cross, World Federation for Mental Health, Movement for Global Mental Health, and World Mental Health Congress are working to boost public awareness and improve quality and availability of mental health prevention and treatment in countries around the world.

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