In Asia‑Pacific countries, understanding the burden of mental disorders is limited due to a lack of comprehensive data. This chapter utilises the latest WHO Global Health Estimates (2021) data to highlight key findings through the prevalence of years of healthy life lost to disability (YLDs). The focus of the chapter is the burden of mental, neurological, substance use disorders, and self-harm (MNSS), including a specific analysis of the burden of these conditions among children. The analysis finds that MNSS conditions account for a significant percentage of the total non-fatal burden of disease, greater than communicable diseases and maternal, perinatal, and nutritional conditions – a situation that has hardly improved between 2000 and 2021. Strikingly, over 60% of the burden of MNSS was due to depressive disorders, migraine, anxiety disorders and schizophrenia. Addressing the high burden of mental health and neurological conditions in Asia‑Pacific countries requires strong promotion and prevention strategies as well as strengthening accessible and wide‑ranging services for diverse mental health conditions. There is an urgent need to re‑orient mental health care to compassionate, person-centred, timely, accessible, and affordable forms of care.
Health at a Glance: Asia/Pacific 2024
Abstract
Mental, neurological and substance use disorders and self-harm (MNSS) conditions account for a significant percentage of the total burden of disease in Asia‑Pacific countries. The overall prevalence of years lived with disability (YLDs) in 2021 ranged from 21.5% to 30% across the 38 Asia‑Pacific countries analysed – a situation that hardly changed in the years 2000‑21.
In 2021, depressive disorders constituted the biggest burden of MNSS, followed by migraine, anxiety disorders and schizophrenia. Together, these four conditions account for over 60% of YLDs in Asia‑Pacific countries.
In 2021, depressive and anxiety disorders accounted for approximately 60% of the burden of mental health conditions alone (i.e. without neurological conditions, self-harm and drug use).
Migraine, Alzheimer’s disease and other dementias and epilepsy were the top three causes of disability due to neurological conditions, accounting for almost 90% of the burden as measured by YLDs in 2021.
Opioid use disorders, cannabis use disorders and amphetamine use disorders are the cause of over 90% of YLDs attributed to substance use in Asia‑Pacific countries.
The number of suicides has reduced significantly between 2000 and 2021 in Asia‑Pacific countries. Among countries in SEAR, this can be considered a major public health achievement driven by the drop in estimated suicides in the below 30 age group. However, when the estimated number of suicides at age‑groups 30 and above is examined, a notable increase is observed between 2000 and 2021. Among countries in WPR, there has also been a notable drop in suicides in the below 45 age group, even more among females than males. However, of key concern is the unchanging if not increasing estimated suicides among those aged above 70 years of age.
Childhood behaviour disorders, migraine, anxiety disorders, autism and Aspergers syndrome accounted for more than 70% of the burden (as measured by YLDs) of MNSS conditions in children of the 5‑14‑year age group.
In Asia‑Pacific countries, mental health conditions represent a significant public health challenge, affecting approximately 475 million people, or about one in seven individuals in the region. Despite this high prevalence, there are substantial treatment gaps, with some countries reporting that up to 90% of those in need do not receive appropriate care. In response to these challenges, the WHO and OECD (OECD, 2021[1]) have taken many steps to enhance mental health services. WHO and OECD continue to advocate for a shift from institutional care to community-based mental health services (WHO, 2023[2]; OECD, 2021[3]), which are more accessible and respectful of human rights, and for an integrated whole‑of-government approach to tackle the poor social, education and employment outcomes of individuals with mental health conditions (OECD, 2021[4]). This approach aims to reduce stigma, improve treatment outcomes, and ensure that care is integrated into primary health services.
The regional and country estimates used in this chapter are those of the WHO Global Health Estimates (GHE), which follow the ICD-11 classification. Building on the global burden of disease (GBD) estimates (Institute of Health Metrics and Evaluation, 2021[5]), the GHE (WHO, 2024[6]) presents comprehensive and comparable time series data from 2000 onwards for the health-related indicators, including life expectancy, healthy life expectancy, mortality and morbidity, as well as the burden of diseases at global, regional and country levels, disaggregated by age, sex and individual causes. These are produced using data from multiple consolidated sources, including national vital registration data, the latest estimates from WHO technical programmes, interagency estimates for all-cause mortality and priority diseases and injuries, and other scientific studies.
The comparative analyses presented in this chapter utilise the metric years lived with disability (YLD) to represent the equivalent of one full year of healthy life lost due to disability or ill health. YLDs are calculated as the prevalence of each non-fatal condition multiplied by its disability weight (WHO, 2024[7]). Disability weights represent the magnitude of the health loss associated with a specific health outcome in each population. The weights are measured on a scale from 0 to 1, where 0 equals a state of full health and 1 equals death. It is worth noting that the GHE estimates of YLDs draw on the GBD analyses, with selected revisions to disability weights and prevalence estimates, as noted below.
This chapter presents a comparative analysis of the burden of MNSS in Asia‑Pacific countries, using estimates and prevalence of the YLDs from WHO GHE (2021) and, where possible, disaggregation by sex and age. A broad spectrum of robust and well-established scientific methods was applied for the processing, synthesis and analysis of the data (WHO, 2021[8]). Estimates are provided for 183 WHO Member States with populations greater than 90 000 in 2021. Estimates for 11 Member States that are excluded and for the largest non-Member States territories and areas are not released at the country level. Still, those member states are included in the relevant regional and global totals.
Table 2.2 presents the MNSS conditions analysed in this chapter. Overall, the chapter presents comparative analyses of the GHE (2021) YLDs for all 11 countries of the WHO South-East Asia Region (SEAR) and 27 countries in the WHO Western Pacific Region (WPR) listed in Table 2.1.
Note: * Country level estimates are not provided because the populations are smaller than 90 000.
Among Asia‑Pacific countries, mental, neurological and substance use disorders and self-harm (MNSS) conditions are responsible for a quarter of the overall YLDs attributable to the total non-fatal burden of disease (Figure 2.1), greater than that attributable to communicable diseases and maternal, perinatal and nutritional conditions – a situation that has hardly improved between 2000 and 2021 and appears to have worsened in recent years (OECD, 2023[9]).
Note: The figure above represents the combined analysis of 38 Asia‑Pacific countries of which 27 countries belong to WHO Western Pacific Region (WPR) and 11 countries to WHO South-East Asia Region (SEAR). SEAR countries are: Bangladesh, Bhutan, DPRK, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. WPR countries are: Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Korea, Lao People’s Democratic Republic, Marshall Islands, Malaysia, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam.
Source: WHO Global Health Estimates (GHE), 2021.
Taking a closer look at country-specific estimates, Figure 2.2 shows that MNSS conditions account for a significant percentage of the total non-fatal burden of disease in all Asia‑Pacific countries. The 2021 estimates show that the overall percentage of YLDs attributed to MNSS conditions ranged from 21.5% to 31.3% across countries. The average non-fatal burden of MNSS conditions did not vary significantly between income groups, averaging 27% across all income groups in 2021. However, while the average burden of MNSS decreased in high-income countries in the Asia-Pacific between 2000 and 2021, the burden increased for lower-middle- and low-income Asia-Pacific countries (Figure 2.3).
Note: The figure above represents the combined analysis of 38 Asia‑Pacific countries of which 27 countries belong to WHO Western Pacific Region (WPR) and 11 countries to WHO South-East Asia Region (SEAR). SEAR countries are: Bangladesh, Bhutan, DPRK, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. WPR countries are: Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Korea, Lao People’s Democratic Republic, Marshall Islands, Malaysia, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam.
Source: WHO Global Health Estimates (GHE), 2021.
Note: The figure above represents the combined analysis of 38 Asia‑Pacific countries of which 27 countries belong to WHO Western Pacific Region (WPR) and 11 countries to WHO South-East Asia Region (SEAR). SEAR countries are: Bangladesh, Bhutan, DPRK, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. WPR countries are: Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Korea, Lao People’s Democratic Republic, Marshall Islands, Malaysia, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam.
Source: WHO Global Health Estimates (GHE), 2021.
The top causes of disability attributed to MNSS in the Asia‑Pacific region
With respect to the distribution of the top causes of disability, the analysis reveals subtle differences between Asia‑Pacific countries. In countries of the SEAR, Figure 2.4 shows that there are 4 MNSS-related disabilities that are ranked among the top 20 causes of YLDs: depressive disorders (2nd rank), migraine (4th rank), anxiety disorders (7th rank) and Schizophrenia (16th rank). In the case of WPR countries, there are 6 MNSS-related disabilities that are ranked among the top 20 causes of YLDs: depressive disorders (4th rank), migraine (6th rank), anxiety disorders (7th rank), Alzheimer disease and other dementias (8th rank), Schizophrenia (9th rank), Autism and Asperger syndrome (11th rank) and Alcohol use disorders (13th rank).
Note: The figure above represents the combined analysis of 38 Asia‑Pacific countries of which 27 countries belong to WHO Western Pacific Region (WPR) and 11 countries to WHO South-East Asia Region (SEAR). SEAR countries are: Bangladesh, Bhutan, DPRK, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. WPR countries are: Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Korea, Lao People’s Democratic Republic, Marshall Islands, Malaysia, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam.
Source: WHO Global Health Estimates (GHE), 2021.
Unravelling the burden of MNSS
This section examines the distribution of individual causes of MNSS conditions in Asia‑Pacific countries using the latest GHE (2021). Figure 2.5 shows that depressive disorders account for almost a quarter of the years lived with disability (YLDs) due to MNSS in Asia‑Pacific countries. This is a significant disease burden because of the impact this condition has on individuals, families, communities, and workplaces. As there are also correlations between depression and other medical conditions this is a major concern. Among the severe mental disorders, depression causes the highest burden. Migraine, anxiety disorders and schizophrenia are the other conditions leading to significant morbidity.
Note: The figure above represents the combined analysis of 38 Asia‑Pacific countries of which 27 countries belong to WHO Western Pacific Region (WPR) and 11 countries to WHO South-East Asia Region (SEAR). SEAR countries are: Bangladesh, Bhutan, DPRK, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. WPR countries are: Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Korea, Lao People’s Democratic Republic, Marshall Islands, Malaysia, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam.
Source: WHO Global Health Estimates (GHE), 2021.
Mental disorders
Mental disorders consist of 9 key conditions: depressive disorders, bipolar disorder, Schizophrenia, anxiety disorders, eating disorders, autism and Asperger Syndrome, childhood behavioural disorders, idiopathic intellectual disability, and other mental and behavioural disorders (Table 2.2). Depressive and anxiety disorders account for approximately 60% of the burden of mental health conditions alone (i.e. without neurological conditions, self-harm, and drug use) (Figure 2.6).
Note: The figure above represents the combined analysis of 38 Asia‑Pacific countries of which 27 countries belong to WHO Western Pacific Region (WPR) and 11 countries to WHO South-East Asia Region (SEAR). SEAR countries are: Bangladesh, Bhutan, DPRK, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. WPR countries are: Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Korea, Lao People’s Democratic Republic, Marshall Islands, Malaysia, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam.
Source: WHO Global Health Estimates (GHE), 2021.
Neurological disorders
Neurological disorders consist of 7 main conditions: Alzheimer disease and other dementias, Parkinson disease, Epilepsy, Multiple sclerosis, Migraine, nonmigraine headache, and other neurological conditions. Among Asia‑Pacific countries, migraine was by far the most disabling neurological disorder measured in terms of YLDs due to neurological disorders. With respect to other neurological conditions, the distribution was different between WHO SEAR and WPR countries as shown in Figure 2.7. Overall, Migraine, Alzheimer’s disease and other dementias and epilepsy were the top three causes of disability accounting for almost 90% of the burden as measured by YLDs.
Note: The figure above represents the combined analysis of 38 Asia‑Pacific countries of which 27 countries belong to WHO Western Pacific Region (WPR) and 11 countries to WHO South-East Asia Region (SEAR). SEAR countries are: Bangladesh, Bhutan, DPRK, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. WPR countries are: Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Korea, Lao People’s Democratic Republic, Marshall Islands, Malaysia, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam.
Source: WHO Global Health Estimates (GHE), 2021.
Substance use include two main conditions: alcohol use disorder and drug use disorder. Opioid use was the leading cause of YLDs attributable to substance use among countries in Asia‑Pacific countries. With respect to other neurological conditions, the distribution was different between WHO SEAR and WPR countries as shown in Figure 2.8. Opioid use disorders, cannabis use disorders and amphetamine use disorders are the cause of over 90% of YLD in Asia‑Pacific countries. Disability from amphetamine use disorders was higher among countries in WPR while cannabis use disorders were higher among countries in SEAR.
Note: SEAR countries are: Bangladesh, Bhutan, DPRK, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. WPR countries are: Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Korea, Lao People’s Democratic Republic, Marshall Islands, Malaysia, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam.
Source: WHO Global Health Estimates (GHE), 2021.
Self-harm (suicide and self-harm behaviour)
A proxy measure for this burden is the estimated number of suicides by sex and age group with different patterns and interpretations for countries in the WHO South-East Asia region (Figure 2.9). Among countries in SEAR, there has been a significant reduction in deaths from suicide between 2000 and 2021, a major public health achievement driven by the drop in estimated suicides in the below 30 age group. However, when the estimated number of suicides at age‑groups 30 and above is examined, a notable increase is observed between 2000 and 2021. Among countries in WPR (Figure 2.10), there has also been a notable drop in suicides in the below 45 age group, even more among females than males. However, of more concern is the unchanging if not increasing estimated suicides in the above 70 age group.
Note: The figure above represents the 11 countries to WHO South-East Asia Region (SEAR).
Source: WHO 2021 Global Health Estimates.
Note: The figure above represents the 27 countries in the WHO Western Pacific Region (WPR).
Source: WHO 2021 Global Health Estimates.
The burden of mental health conditions among children in the Asia‑Pacific region
Globally, half of all mental health disorders manifesting in adulthood start by the age of 14, but most cases remain undetected and untreated. Early onset of substance use disorder is associated with higher risks of developing dependence and other problems during adult life; younger ages are disproportionately affected by substance use disorder, compared with people belonging to older age groups. Depression is one of the leading causes of illness and disability among adolescents while self-harm is the second leading cause of death among people aged 15‑19 years. Mental health conditions account for 16% of the global burden of disease and injury among people aged 10‑19 years.
Across the world, more than a quarter of all people, aged 15‑19 years, are current drinkers, adding up to 155 million adolescents. The prevalence of heavy episodic drinking among adolescents, aged 15‑19 years, was 13.6% in 2016, with males most at risk. Cannabis is the most widely used psychoactive drug among young people, with about 4.7% of people, aged 15‑16 years, using it at least once in 2018.
Figure 2.12 shows that the burden of MNSS among 5‑14 year‑old children is variable among Asia‑Pacific countries. In SEAR, MNSS account for 25.5% of burden of YLDs, while it is 35.4% for children living in WPR countries.
Note: The figure above represents the combined analysis of 38 Asia‑Pacific countries of which 27 countries belong to WHO Western Pacific Region (WPR) and 11 countries to WHO South-East Asia Region (SEAR). SEAR countries are: Bangladesh, Bhutan, DPRK, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. WPR countries are: Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Korea, Lao People’s Democratic Republic, Marshall Islands, Malaysia, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam.
Source: WHO Global Health Estimates (GHE), 2021.
With respect to the burden of specific MNSS conditions among 5‑14 year‑old children, childhood behaviour disorders, anxiety disorders, migraine and autism and Aspergers syndrome for more than 70% of the burden attributed to MNSS conditions (Figure 2.12). This pattern of the MNSS burden underscores the need for different types and different ranges of services that are accessible and acceptable to this age group.
Note: SEAR countries are: Bangladesh, Bhutan, DPRK, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. WPR countries are: Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Korea, Lao People’s Democratic Republic, Marshall Islands, Malaysia, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam.
Source: WHO Global Health Estimates (GHE), 2021.
Mental health conditions constitute a significant disease burden in Asia‑Pacific countries compared with other health conditions. Key policy recommendations (Table 2.3) can be considered that can strengthen countries health systems response and can provide guidance on where countries can prioritise strategic actions for tackling mental health disease and lifelong related disabilities (WHO, 2023[2]; OECD, 2021[3]). An integrated whole-of-government approach to the challenges posed by mental health conditions not only requires cross-sectoral action, but also changes in delivery of policies and services (OECD, 2021[4]) and more, better, internationally comparable mental health data.
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