The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990–2019: Findings from the Global Burden of Disease Study 2019

Background Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease (GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time. Methods Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated. Findings In 2019, rates per 100,000 population were 16,983 (95% UI 12,823 – 21,630) for MDs, 3,891 (3,020 - 4,905) for SUDs, and 89·1 (63·8 - 123·1) for self-harm. In terms of disability, anxiety contributed to 647·3 (432–912·3) YLDs, while in terms of premature death, self-harm contributed to 319·6 (248·9–412·8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14·9%;9·4-20·1) and drug use disorders (16·9%;8·9-26·3), and decreased in idiopathic developmental intellectual disability (–29·1%;23·8-38·5). YLLs decreased in self-harm (–27·9%;38·3-18·7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs. Interpretation Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people

Met and unmet need for mental health care before and during the COVID-19 pandemic

There is a concern that the coronavirus disease 2019 (COVID-19) pandemic will generate large unmet needs for mental health care. Using data from an epidemiological psychiatric diagnostic interview survey (n = 2159) conducted on a probability sample from the general population, the proportions of met and unmet need for mental health care among individuals with and without mental disorders were compared before and during the COVID-19 pandemic. The results showed no statistical difference in met and unmet need for mental health care, but point estimates were suggestive of a higher unmet need for care among those with a current mental disorder after the lock-down period.publishedVersio

Educational gradients in the quality of mortality data: a nationwide, registry-based study on heart failure listed incorrectly as underlying cause of death in Norway

Aim: In the context of mortality, heart failure (HF) represents an intermediate factor and should not be used to describe underlying cause of death (UCoD). We explored the potential educational gradients in use of HF to describe UCoD using national data spanning more than 30 years from Norway. Methods: Using a cross-sectional design, we linked data from the Cause of Death Registry and the National Education Database. Logistic regression models were used to analyze the association between highest attained education and the odds of HF being listed as the UCoD: odds ratios (ORs) and corresponding 95% confidence intervals (CIs) are reported. Results: HF was listed as UCoD in 46,331 (3.7%) of 1,254,249 deaths analyzed. Compared to primary education, secondary and tertiary education were associated with 10% (OR = 0.90, 95% CI: 0.88–0.92) and 17% (OR = 0.83, 95% CI: 0.80-0.86) lower odds of HF incorrectly listed as UCoD, respectively. We observed no significant differences for the association between education and study outcomes between men and women and across place of death categories. However, educational gradients were greater among younger compared to older individuals (pinteraction, = 0.002). Similar educational gradients were observed in the analyses restricted to cardiovascular deaths (OR = 0.93; 95% CI: 0.91–0.94 for secondary vs. primary education, and OR = 0.91; 95% CI: 0.88–0.95 for tertiary vs. primary education). Conclusions: Education was inversely associated with the use of HF to incorrectly describe UCoD. Addressing the observed educational gradients, would improve the quality of mortality data and allow for less biased descriptions of cause-specific mortality.publishedVersio

Screening student drinking behaviors: examining AUDIT criterion validity using CIDI-based alcohol use disorder as the ‘gold standard’

INTRODUCTION: High levels of alcohol consumption among college students have been observed across countries. Heavy drinking episodes are particularly prevalent in this population, making early identification of potentially harmful drinking critical from a public health perspective. Short screening instruments such as the Alcohol Use Disorders Identification Test (AUDIT) are serviceable in this regard. However, there is a need for studies investigating the criterion validity of AUDIT in the student population. The aim was to examine the criterion validity of the full AUDIT and AUDIT-C (the first three items directly gauging consumption patterns) in a sample of college and university students using 12-month prevalence of alcohol use disorder derived from an electronic, self-administered version of the World Health Organization (WHO) Composite International Diagnostic Interview, fifth version (CIDI 5.0), which serves as the 'gold standard'. METHODS: The study population of the current study is derived from thepublishedVersio

Prevalence of mental disorders, suicidal ideation and suicides in the general population before and during the COVID-19 pandemic in Norway: A population-based repeated cross-sectional analysis

Background Self-report data on mental distress indicate a deterioration of population mental health in many countries during the COVID-19 pandemic. A Norwegian epidemiological diagnostic psychiatric interview survey was conducted from January to September 2020, allowing for comparison of mental disorder and suicidal ideation prevalence from before through different pandemic periods. Prevalence of suicide deaths were compared between 2020 and 2014–2018. Methods Participants from the Trøndelag Health Study (HUNT) in Trondheim were recruited through repeated probability sampling. Using the Composite International Diagnostic Interview (CIDI 5.0) (n = 2154), current prevalence of mental disorders and suicidal ideation was examined in repeated cross-sectional analyzes. Data on suicide deaths was retrieved from the Norwegian Cause of Death Registry and compared for the months March to May in 2014–2018 and 2020. Findings Prevalence of current mental disorders decreased significantly from the pre-pandemic period (January 28th to March 11th 2020; 15•3% (95% CI 12•4–18•8)) to the first pandemic period (March 12th – May 31st; 8•7% (6•8–11•0)). Prevalences were similar between the pre-pandemic period and the interim (June 1st July 31st; 14•2% (11•4–17•5)) and second periods (August 1st-September 18th; 11•9% (9•0–15•6)). No significant differences were observed in suicidal ideation or in suicide deaths. Interpretation Except for a decrease in mental disorders in the first pandemic period, the findings suggest stable levels of mental disorders, suicidal ideation and suicide deaths during the first six months of the COVID-19 pandemic compared to pre-pandemic levels. Potential methodological and contextual explanations of these findings compared with findings from other studies are discussed.publishedVersio

Prevalence of mental disorders, suicidal ideation and suicides in the general population before and during the COVID-19 pandemic in Norway: A population-based repeated cross-sectional analysis

Background Self-report data on mental distress indicate a deterioration of population mental health in many countries during the COVID-19 pandemic. A Norwegian epidemiological diagnostic psychiatric interview survey was conducted from January to September 2020, allowing for comparison of mental disorder and suicidal ideation prevalence from before through different pandemic periods. Prevalence of suicide deaths were compared between 2020 and 2014–2018. Methods Participants from the Trøndelag Health Study (HUNT) in Trondheim were recruited through repeated probability sampling. Using the Composite International Diagnostic Interview (CIDI 5.0) (n = 2154), current prevalence of mental disorders and suicidal ideation was examined in repeated cross-sectional analyzes. Data on suicide deaths was retrieved from the Norwegian Cause of Death Registry and compared for the months March to May in 2014–2018 and 2020. Findings Prevalence of current mental disorders decreased significantly from the pre-pandemic period (January 28th to March 11th 2020; 15•3% (95% CI 12•4–18•8)) to the first pandemic period (March 12th – May 31st; 8•7% (6•8–11•0)). Prevalences were similar between the pre-pandemic period and the interim (June 1st July 31st; 14•2% (11•4–17•5)) and second periods (August 1st-September 18th; 11•9% (9•0–15•6)). No significant differences were observed in suicidal ideation or in suicide deaths. Interpretation Except for a decrease in mental disorders in the first pandemic period, the findings suggest stable levels of mental disorders, suicidal ideation and suicide deaths during the first six months of the COVID-19 pandemic compared to pre-pandemic levels. Potential methodological and contextual explanations of these findings compared with findings from other studies are discussed.publishedVersio

Agreement between survey- and register-based measures of depression in Denmark

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Prevalence of mental disorders among Norwegian college and university students: a population-based cross-sectional analysis

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Folkehelserapporten - kortversjon. Helsetilstanden i Norge 2018

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Sykdomsbyrde i Norge 2015. Resultater fra Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015)

Introduction Disease burden estimates describe how diseases, injuries and risk factors affect the mortality and disability in a population. The comparison of the disease burden in different groups of the population is central in the estimations. The Global Burden of Disease project (GBD) is a large epidemiological project aimed at identifying and describing the main drivers of fatal and non-fatal health loss at global, regional, national, and, in some cases, subnational levels. The project is coordinated from the Institute for Health Metrics and Evaluations (IHME) in Seattle, United States. GBD describes the development in disease burden for more than 300 health conditions and almost 80 risk factors for 195 countries. In the autumn 2016 GBD published new global, regional and national estimates of disease burden (GBD 2015), including detailed measures of disease burden in Norway. The present report gives a summary of the Norwegian results. Methods The GBD project employs four main measures of disease burden: number of deaths, years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life-years (DALY). Life expectancy and healthy life expectancy are also estimated. YLLs are estimated based on life expectancy at the age of death. Non-fatal health loss (YLD) is estimated by multiplying the prevalence of disease and injuries with their associated health loss, quantified through disability weights. DALY is a summary measure of fatal and non-fatal health loss, and is estimated by summarising the YLLs and YLDs for different health conditions. The data sources used in GBD are collected through systematic searches and literature reviews of health data from sources such as health registries, health surveys and published articles around the world. When data are sparse or missing in a geographical area, the global model in GBD provides estimates from that area based on data from other similar areas. Norwegian estimates are most heavily influenced by data from other Western-European countries. Results The GBD 2015 results for Norway show that both life expectancy and healthy life expectancy have increased since 2005. The disease burden in Norway is dominated by non-communicable diseases, both in terms of fatal and non-fatal health loss. The most important causes of death are diseases common in the population 70 years and older, in particular cardiovascular diseases and dementias. Neoplasms (cancer) is the second largest cause of death in the population, and the most important cause of death before age 70. Despite decreasing since 2005, ischemic heart disease (myocardial infarction) is still the largest cause of both number of deaths and YLLs in Norway. Other important contributors to number of deaths and YLLs are cerebrovascular disease (stroke), dementia, lung cancer, colorectal cancer, lower respiratory infection (pneumonia) and chronic obstructive pulmonary disease (copd). Suicide and overdoses are the most common causes of death in the age group 15 to 49 years, and are therefore among the ten largest causes of premature mortality (YLLs). Musculoskeletal and mental disorders are the largest causes of non-fatal health loss (YLDs). Mental disorders cause substantial non-fatal health loss in almost all age-groups, and depressive and anxiety disorders are the most important causes within this group. Low back and neck pain is the largest single cause of disease burden measured as DALYs in the Norwegian population. High blood pressure, unhealthy diet and smoking are the modifiable risk factors that cause the most deaths. Smoking is the most important risk factor for death before the age of 70. The risk factors in GBD explain around half of the deaths, but only 20 % of the non-fatal health loss in Norway. Discussion The extensive collection of data sources from all over the world, the quantification of uncertainty and the effort to maximize comparability over time, geographical area and across different health conditions are the main strengths of the GBD project. GBD also contributes to identifying areas with sparse or missing information. For instance, there are large differences in the amount of disease burden that is explained by the included risk factors in GBD. While 85 % of the disease burden due to cardiovascular diseases is attributed to the GBD risk factors, they only explain about 20 % of the disease burden due to musculoskeletal and mental disorders. Missing and sparse data, and varying quality of the data are the major challenges for the validity of the GBD results. This also applies to data from high income countries such as Norway. There is little tradition for systematic data-collection on many non-fatal health conditions, such as mental and drug use disorders, and the prevalence and distribution of these in the Norwegian population are not known. Norway also lacks a system for regular collection of national representative data on prevalence of important risk factors, such as alcohol use, diet, high cholesterol, high blood pressure and low physical activity. To improve the quality of the Norwegian estimates, it is essential that health conditions and risk factors that are important for the Norwegian disease burden are regularly assessed in the Norwegian population. Conclusion The results from the GBD-project provide a comprehensive and comparative overview of fatal and non-fatal disease burden over time and across sex and age groups in the Norwegian population. The project also estimates the contribution from important risk factors on public health. The results may inform the knowledgebase and discussions on public health issues in Norway.publishedVersio