Mental health
Mental illness burden of disease: First Nations
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Key points What is burden of disease? Spotlight data Where can I find more information?Key points
The leading cause of total disease burden among First Nations people was mental health conditions and substance use disorders (23%).
The total burden due to mental health conditions and substance use disorders for First Nations people increased by 21% between 2003 and 2018.
First Nations males experienced a higher burden from alcohol use disorders while First Nations females experienced a higher burden from anxiety disorders.
What is burden of disease?
The concept of burden of disease has been developed as a way of measuring the impact of diseases and injuries on a population. It is the difference between a population’s actual health and its ideal health, where ideal health is living to old age in good health (without disease or disability). Burden of diseaseis measured using the summary measure of disability-adjusted life years (DALY, also known as the total burden in this report). One DALY is one year of healthy life lost to disease and injury. DALY caused by living in poor health (non-fatal burden) are the ‘years lived with disability’ (YLD). DALY caused by premature death (fatal burden) are the ‘years of life lost’ (YLL) and are measured against an ideal life expectancy. The use of DALY allows the impact of premature deaths and living with health impacts from disease or injury to be compared and reported in a consistent manner. This report also presents the total burden or DALY as an ‘age-standardised’ rate (per 1,000 population).
This report provides comparable estimates of burden of disease for Aboriginal and Torres Strait Islander (First Nations) people and non-Indigenous Australians in 2018. It should be noted that 2018 is the most recent year that Australian burden of disease estimates are available for First Nations people, so comparisons should not be made with the Australian burden of disease study 2024.
What are mental health conditions and substance use disorders?
This report outlines the burden of disease experienced by First Nations people due to mental and substance use disorders as estimated in the Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018. Mental and substance use disorders encompass a broad range of conditions including affective disorders (major depressive disorder, dysthymia and bipolar disorder), anxiety disorders, alcohol & drug use disorders, child behavioural & developmental disorders, schizophrenia, and intellectual disability. It excludes suicidal behaviour, self-harm, drug poisoning and drug overdose (which are included in injuries) and dementia, a condition affecting the nervous system (which is included in neurological conditions). For brevity, the label for this group is shortened to ‘mental & substance use disorders’ for this report.
Spotlight data
What is the burden of mental and substance use disorders for First Nations people?
DALY (per 1,000 population, age-standardised) attributed to specific causes from the mental and substance use disorders group
The specific cause with the highest DALY per 1,000 population was anxiety disorders (16.5) followed by alcohol use disorders (14.2), depressive disorders (13.9) drug use disorders (excl. alcohol) (6.4) and schizophrenia (5.2). The age-standardised DALY rate for all mental and substance use disorders was 69.6 per 1,000 population, which includes the aforementioned specific causes as well as bipolar disorder and conduct disorder, intellectual disability, eating disorders, autism spectrum disorder, ADHD and other mental and substance use disorders.
| specific causes | Data |
|---|---|
| Anxiety disorders | 16.5 |
| Alcohol use disorders | 14.2 |
| Depressive disorders | 13.9 |
| Drug use disorders (excl. alcohol) | 6.4 |
| Schizophrenia | 5.2 |
| All mental & substance use disorders* | 69.6 |
* Total includes all causes listed in table as well as bipolar disorder, conduct disorder, intellectual disability, eating disorders, autism spectrum disorder, ADHD and other mental & substance use disorders.
Note: Rates have been age-standardised to the 2001 Australian population.
Source:
Data taken from table 9.1, available at:
|
Data source overview
The Australia Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018 found that mental and substance use disorders was leading cause of total burden for First Nations people in 2018, responsible for 23% of the burden.
In 2018, the specific causes which contributed the largest age-standardised total burden for First Nations people from the mental and substance use disorders group were:
- anxiety disorders (23%)
- alcohol use disorders (19%)
- depressive disorders (19%).
After adjusting for differences in age structure between the two populations, it is estimated that First Nations people experienced an overall burden from disease and injury at 2.3 times the rate of non-Indigenous Australians in 2018. Mental and substance use disorders were the largest contributor to the gap in disease burden (based on age-standardised disease burden rate differences), contributing 20% of the gap (AIHW 2022).
How does the mental and substance use disorder total burden vary by sex?
First Nations males experienced more burden due to mental and substance use disorders (54% of disease burden) than First Nations females (46%). However, First Nations females and males experienced different total disease burden for specific causes.
Of the 219 specific causes analysed, anxiety disorders and depressive disorders were ranked in the top 5 diseases for both sexes. However, the proportion of burden that each cause contributed was different. For First Nations females, anxiety disorders and depressive disorders were the leading causes of total burden and contributed 6.7% and 5.5% respectively. For First Nations males, alcohol use disorders were the third leading cause of total burden, contributing 6.2% of the total burden, followed by anxiety disorders and depressive disorders contributing 4% and 3.2% respectively.
From the mental and substance use disorders group, the specific causes that contributed the most to the gap in burden between First Nations people and non-Indigenous Australians in 2018 were alcohol use disorders (7.4% of the gap) for males and anxiety disorders (5.9%) for females (AIHW 2022).
What is the fatal and non-fatal burden for mental and substance use disorders?
Mental and substance use disorders was the leading cause of non-fatal burden (YLD) in First Nations people in 2018 (42% of total non-fatal burden). For First Nations people aged 5 to 54, mental and substance use disorders accounted for one-third to two-thirds of the total non-fatal burden across the age groups. Mental and substance use disorders for First Nations people only contributed 1.9% of the fatal burden in 2018 (AIHW 2022).
How has the mental and substance use disorder total burden changed over time?
After adjusting for the impact of the increasing age and size of the First Nations population (by using age-standardised rates), the burden from mental and substance use disorders among First Nations people increased by 21% (as measured by the DALY rate difference) from 2003 to 2018.
How does the mental and substance use disorder total burden vary by location?
In 2018, First Nations burden of disease estimates was reported for the four jurisdictions of New South Wales, Queensland, Western Australia and the Northern Territory. Across all four jurisdictions, the leading cause of total burden for First Nations people was mental and substance use disorders, contributing 24% for Queensland, 23% for New South Wales, 19% for Western Australia and 16% for the Northern Territory.
Where can I find more information?
An overview of the methods can be found in Appendix A of the Australian Burden of Disease: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018.
Details on the disease specific methods – particularly for Mental and substance use disorders can be found in Australian Burden of Disease Study: Methods and supplementary material 2018.
Australian Institute of Health and Welfare (2022) Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018, AIHW, Australian Government, accessed 06 March 2025.