The Burden of Mental Disorders in The Arab-Muslim World
Most countries in the Eastern Mediterranean region (Arab World) have seen an increase in the burden of mental health conditions, including depression, anxiety, bipolar disorder, and schizophrenia, as well as a rise in intentional injuries such as suicide, homicide, and sexual assault, from 1990 to 2015, according to 2 studies that appeared in the International Journal of Public Health.
In the first study, the international team of investigators analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 to estimate the burden of mental disorders in The Eastern Mediterranean Region, (Arab World) which is a WHO-defined group of 22 countries comprising Afghanistan, Arab Republic of Egypt, Bahrain, Djibouti, Iraq, Islamic Republic of Iran, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Republic of Yemen, Somalia, Sudan, Syrian Arab Republic, Tunisia, and the United Arab Emirates., and is inhabited by more than 600 million people.
Overall, Muslim countries have a higher burden of mental health disorders compared to global levels. Depression and anxiety disorders contributed most to the mental health burden. Women had a higher burden of mental disorders than men. An increasing mental health burden is mainly attributable to population growth and aging. A severe shortage of psychologists and psychiatrists in the region presents a challenge to epidemiological surveillance of mental disorders and adequate prevention and treatment services.
Methods
We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 to examine the burden of mental disorders in the Eastern Mediterranean Region (Arab World). We defined mental disorders according to criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders 5 and the 10th International Classification of Diseases.
Results
Mental disorders contributed to 4.7% of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the Arab World had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the Muslim World , observed mental disorder rates exceeded the expected values.
Conclusions
The burden of mental disorders in the Arab World is higher than global levels, particularly for women. To properly address this burden, Middle East governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.
Depression and anxiety disorders are the most frequent mental disorders, and rates in women are up to double those in men.
Given the religious and cultural specificities of the region, factors unrelated to war also contribute to mental disorders in The Arab World. For instance, polygamy is more common in Muslim communities, and women in polygamous marriages report a higher rate of depression and psychoticism than women in monogamous marriages. This is in addition to the “first wife syndrome” seen in polygamous marriages, in which the first wife reports more anxiety, paranoid ideation, and psychoticism compared to the second and third wives. Moreover, health and social inequalities for refugees across the Arab World result in deprivation-related multi-morbidity including mental illness. Intimate partner violence is also prevalent across much of the Arab World.
Among the mental disorders both globally and in the Arab World, depressive disorders appear to be the highest contributors to nonfatal burden. Low mood, loss of motivation, and anhedonia–features typical of major depressive disorder–impact one’s ability to function in the community. The prevalence of major depressive disorder in various Muslim countries has been previously described.
Females contribute more to the burden of mental disorders across all age groups over 14 years in the Arab World. Females in general are more likely to suffer from mental disorders compared to males. Several studies have shed light on women’s increased risk of mental disorders in Muslim countries and Middle East . Conduct disorder and ADHD on the other hands are more common in males aged under 14 years in both the Arab World and globally.
Our findings show that the burden of mental disorders is highest in the high-income Arab World countries. This trend of increased mental illness with increased living standards has been described in developed countries.
Our study clearly shows that mental health is a pressing priority in the Arab Muslim World.