Published on 15 September 2026
Mental disorders: 1.17 billion cases, the leading cause of disability worldwide
In brief
The 2023 update of the Global Burden of Disease devoted to mental disorders covers twelve disorders, 204 countries and the period 1990 to 2023. It estimates 1.17 billion prevalent cases in 2023, a 95.5% rise in the number of cases and a 24.2% rise in the age-standardised rate since 1990. Mental disorders account for 6.1% of disability-adjusted life-years, which places them fifth worldwide against twelfth in 1990, and they have become the leading cause of years lived with disability, ahead of every other disease. The burden peaks between 15 and 19 years. These figures describe the burden soundly. They do not explain why it is growing.
The context
The Global Burden of Disease is the most systematic exercise in health accounting that medicine has. It does not measure patients, it models populations from the epidemiological sources available, in order to produce estimates that can be compared between countries and over time. That is what makes it a formidable advocacy instrument, and it is also why it has to be read with method.
For psychiatry the stakes are twofold: quantifying a burden that stayed invisible in budget decisions for a long time, and knowing what the figures quoted afterwards in meetings are actually worth.
The study at a glance
| Question (PICO) | |
|---|---|
| Population | |
| World population, 204 countries and territories, 21 regions, all ages and both sexes, from 1990 to 2023, with analysis by Socio-demographic Index quintile | |
| Object | |
| Twelve mental disorders: anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category | |
| Method | |
| Review of the epidemiological literature, then Bayesian meta-regression estimating prevalence by disorder, sex, age, location and year. Prevalence multiplied by disability weights to obtain years lived with disability | |
| Outcomes | |
| Prevalence, deaths, years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), as counts and as age-standardised rates | |
| Design | |
| Global systematic analysis with Bayesian modelling · CEBM 2a |
One technical point matters for interpretation: anorexia nervosa is, in the authors’ own words, “the only mental disorder considered as an underlying cause of death in GBD”. For every other disorder, disability-adjusted life-years coincide with years lived with disability. For all disorders other than anorexia nervosa, no death is attributed within this framework, which has to be kept in mind when these figures are set against those of lethal diseases.
The findings
| Indicator | Result |
|---|---|
| Prevalent cases since 1990 | +95.5% (75.0 to 121.2) |
| PEB readingLargely demographic population growth and ageing | |
| Age-standardised rate | +24.2% (11.4 to 41.4) |
| PEB readingA rise beyond demography the share attributable to case finding remains undetermined | |
| Total burden | 171 million DALYs (127 to 228), that is 6.1% of the global burden (4.8 to 7.6) |
| PEB reading5th leading cause worldwide, up from 12th in 1990 | |
| Years lived with disability | Ranked 1st worldwide, 17.3% of the total (14.8 to 20.6) |
| PEB readingLeading cause of disability, all diseases combined | |
| Heaviest disorders | Anxiety disorders 11th among the 304 detailed causes, depression 15th, schizophrenia 41st |
| PEB readingAnxiety ahead of depression, which often surprises | |
| Sex | Age-standardised DALY rate higher in females, 2,240 (1,644 to 3,014) against 1,900 (1,400 to 2,511) per 100,000 |
| PEB readingGap asserted by the authors intervals widely overlapping, causes unsettled | |
| Age | Peak between 15 and 19 years, 2,617 per 100,000 |
| PEB readingStrong argument for early detection | |
| Differences between countries | From 1,302 per 100,000 in Viet Nam to 3,556 in the Netherlands |
| PEB readingA ratio of one to almost three, hard to attribute | |
| Level of development | DALY rate of 1,853 per 100,000 in the middle Socio-demographic Index quintile, against 2,184 in the high quintile |
| PEB readingThe estimated burden is higher in the most developed countries a counterintuitive result | |
What is demonstrated, what is suggested
Demonstrated, in the sense of the data available: the number of cases and the relative rank of mental disorders in the global burden have both risen, and that rise goes beyond what demography alone would explain. The first place in years lived with disability is coherent with the chronic nature of these conditions and with the fact that the GBD attributes almost no death to them.
Suggested, without being established: that the rise in the age-standardised rate reflects a real increase in the frequency of the disorders. Better case finding, changing criteria and the cross-cultural variability of the instruments all contribute to that slope, in proportions no one can measure. A country that starts diagnosing sees its prevalence climb without a single one of its inhabitants having changed.
Unsettled: the gap between countries, close to a factor of three. Better detection, different exposure to risk factors, unequal availability of primary data: the design cannot separate these explanations, and the authors themselves write that “stronger surveillance systems, particularly in low-income and middle-income countries, are required”.
Critical appraisal
| Domain | Finding |
|---|---|
| Nature of the estimates | |
| This is a model, not a census. The uncertainty intervals are wide, in particular on the total burden, from 127 to 228 million DALYs | |
| Recognition bias | |
| The rise in the age-standardised rate may partly reflect better detection. A structural limitation, one the model cannot correct | |
| Data coverage | |
| The authors call explicitly for stronger surveillance in low-income and middle-income countries, which says enough about how fragile the estimates are in those regions | |
| Scope | |
| Twelve disorders, listed in the publication. Substance use disorders and neurocognitive disorders are not among them, which rules out presenting this figure as the total burden of psychiatry | |
| Mortality | |
| Anorexia nervosa alone is treated as an underlying cause of death. The years of life lost of the other disorders therefore do not enter the total | |
| Funding | |
| Gates Foundation, Queensland Health and University of Queensland | |
Level of evidence
PEB appraisal: high confidence on orders of magnitude and on ranks, moderate confidence on fine-grained trends. The scientific score of 82 does not penalise a lack of rigour, it reflects the constraints of any global epidemiology, starting with the unequal availability of primary data. The Premium decision is an editorial judgement, taken deliberately, and motivated by the reach of the article.
The colleague test
What an experienced colleague would say if you put this study to them in two minutes, between two consultations.
“ Leading cause of disability worldwide, that is the figure I have been waiting twenty years for in budget meetings. But I stop short of saying that mental disorders are exploding: we count better, we diagnose more, and the model cannot separate the two. I quote the rank, not the slope. ”
What this means in practice: first place in years lived with disability is solid and can be quoted without reservation. The rise in the age-standardised rate calls for care in the wording.
What you can do with this on Monday morning. Nothing in prescribing, a great deal in positioning.
- Quote first place worldwide in years lived with disability in any discussion about resources, posts or waiting times. It is a fact, not an opinion.
- Strengthen case finding between 15 and 19 years, where the burden peaks, including at the first consultations of young adults. What such an effort produces is itself a matter for evidence, as the STADIA trial of a standardised diagnostic tool in the child mental health pathway shows.
- Do not underestimate anxiety disorders, which weigh more heavily than depression in this ranking, while they are often handled as a secondary complaint.
- Keep one methodological point in reserve for discussion: within this framework only anorexia nervosa is credited with deaths, so a comparison with a lethal disease is not a comparison between equals.
- The course of action is set out in the NICE decision tree for generalised anxiety and panic disorder.
Frequently asked questions
Are mental disorders really becoming more common, or are we simply diagnosing them better?
Both hypotheses remain compatible with these data. The rise in the age-standardised rate is real as a measurement, but its cause is not established. Presenting this figure as proof of an epidemic would be an over-interpretation.
Why first for disability and only fifth for the overall burden?
Because the overall burden adds the years lost to premature death to the years lived with disability. Within this framework the GBD attributes deaths to anorexia nervosa alone, which flattens the first component for every other disorder.
Does 1.17 billion cases mean 1.17 billion people?
No. The GBD counts prevalent cases, disorder by disorder. One person with two disorders is counted twice. The number of people affected is necessarily lower.
Can these data be used for one country in particular?
With caution. Each of the 204 countries is modelled, but an estimate produced by a global model does not replace dedicated national surveys. For a local argument, cross the two.
How is the gap between Viet Nam and the Netherlands to be explained?
The study does not explain it. Diagnostic recognition, exposure to risk factors and the quality of the source data probably all play a part, in proportions this design cannot estimate.
Annotated bibliography
GBD 2023 Mental Disorder Collaborators (2026). Updated trends in the global prevalence and burden of mental disorders, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet, 407(10543), 2040-2064. DOI 10.1016/S0140-6736(26)00519-2 · PMID 42167272. Source study analysed here. Funded by the Gates Foundation, Queensland Health and the University of Queensland.
GBD 2019 Mental Disorders Collaborators (2022). Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Psychiatry, 9(2), 137-150. DOI 10.1016/S2215-0366(21)00395-3 · PMID 35026139. The previous iteration, useful for placing how the estimates move from one wave to the next.