Mental health conditions and substance use disorders
Key points
- Mental health conditions & substance use disorders made up 20% (64,147 DALY) of total burden, 40% (62,846 YLD) of non-fatal burden and 0.8% (1,301 YLL) of fatal burden for First Nations people in 2022.
- Mental health conditions & substance use disorders were the leading cause of total and non-fatal burden and the 12th leading cause of fatal burden for First Nations people in 2022.
- The main causes of mental health conditions & substance use disorders burden were anxiety disorders (25% of total burden in this disease group), depressive disorders (17%) and alcohol use disorders (15%).
- Most of the burden for mental health conditions & substance use disorders was non-fatal (98%).
- A slightly larger proportion of the total burden due to mental health conditions & substance use disorders was experienced by First Nations males (52% of DALY) than by First Nations females (48%).
- Between 2011 and 2022, the age-standardised rate of total burden due to mental health conditions & substance use disorders for First Nations people increased by 11%.
- In 2022, the age-standardised rate of burden due to mental health conditions & substance use disorders for First Nations people was 2.1 times the rate for non-Indigenous Australians.
The mental health conditions & substance use disorders disease group encompasses 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.
This disease group 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 more information, see Australian Burden of Disease Study: methods and supplementary material 2018.
How much burden do mental health conditions and substance use disorders contribute?
Mental health conditions & substance use disorders was the leading cause of total burden and non-fatal burden among First Nations people and the 12th leading cause of fatal burden in 2022.
In 2022, mental health conditions & substance use disorders made up 20% (64,147 DALY) of total burden, 40% (62,846 YLD) of non-fatal burden and 0.8% (1,301 YLL) of fatal burden.
The main causes of burden in this disease group were anxiety disorders (25%), depressive disorders (17%) and alcohol use disorders (15%) (Figure 1).
Figure 1: Contribution of individual causes to mental health conditions & substance use disorders total burden (DALY)
Notes
- Percentage labels are not shown for disease groups contributing less than 4.5% of burden.
- Estimates in relation to conduct disorder and autism should be interpreted with caution as they are subject to data quality issues.
- The residual cause ‘Other mental health conditions & substance use disorders’ includes delirium, personality disorders and any remaining child disorders such as specific learning disorders, developmental disorders and sleep disorders. See the Australian Burden of Disease Study: methods and supplementary material 2018 for a full list of ICD-10 codes.
Source: AIHW First Nations Burden of Disease Database
To explore the contribution of total, non-fatal and fatal burden for each disease group, see the interactive data visualisation: Dashboard 1: Burden of disease in Australia.
Most of the burden is non-fatal
Nearly all (98%) of the burden due to mental health conditions & substance use disorders was non-fatal (Figure 2a), the leading causes of which were anxiety disorders (25% of non-fatal burden for mental health conditions & substance use disorders), depressive disorders (17%) and alcohol use disorders (14%).
Only a very small proportion (2.0%) of the burden in this disease group was fatal (Figure 2a), the large majority of which was due to alcohol use disorders (67% of fatal burden for mental health conditions & substance use disorders) and drug use disorders (21%).
Figure 2a: Mental health conditions and substance use disorders burden (DALY), diseases by burden type, First Nations people, 2022
Source: AIHW First Nations Burden of Disease Database
How does burden differ by sex?
There were differences in burden due to mental health conditions & substance use disorders between First Nations males and females, with DALY, YLD and YLL rates higher among males than females (Table 1).
Sex | DALY | YLD | YLL |
|---|---|---|---|
Males | 64.6 | 62.9 | 1.7 |
Females | 61.1 | 60.2 | 0.9 |
Persons | 62.8 | 61.6 | 1.3 |
Source: AIHW First Nations Burden of Disease Database
Overall, a slightly larger proportion of the total burden due to mental health conditions & substance use disorders was experienced by First Nations males (52% of DALY) than by First Nations females (48%) (Figure 2b).
This proportion differed by the type of mental health condition & substance use disorder. For example, males experienced more of the burden due to autism spectrum disorders, schizophrenia and ADHD, while females experienced more of the burden due to bipolar affective disorder and eating disorders.
Figure 2b: Mental health conditions and substance use disorders burden (DALY), diseases by sex, First Nations people, 2022
Source: AIHW First Nations Burden of Disease Database
How does burden differ by age?
The number of DALY and age-specific DALY rates due to mental health conditions & substance use disorders were highest among those aged 15–44 and lowest for those aged under 5 and 75 and over. A similar pattern was evident for age-specific YLD rates, while age-specific YLL rates were highest for those aged 45–64 (Table 2).
Age group | Number of DALY | DALY rate | YLD rate | YLL rate |
|---|---|---|---|---|
Under 5 | 780 | 7.2 | 7.2 | — |
5–14 | 6,867 | 30.1 | 30.1 | — |
15–24 | 16,608 | 88.3 | 88.0 | 0.4 |
25–44 | 28,669 | 109.6 | 108.1 | 1.5 |
45–64 | 9,841 | 55.4 | 51.4 | 4.0 |
65–74 | 1,069 | 26.2 | 23.7 | 2.5 |
75 and over | 313 | 19.1 | 17.0 | 2.2 |
Total | 64,147 | 62.8 | 61.6 | 1.3 |
— Zero or rounded to zero
Source: AIHW First Nations Burden of Disease Database
The contribution of individual conditions to mental health conditions & substance use burden varied across the life course (Figure 3):
- For infants and children aged under 5, autism spectrum disorders (24%), anxiety disorders (22%), conduct disorders (21%) and intellectual disability (20%) were the leading causes of the burden, accounting for 87% of total burden in this age group. (Note these proportions are based on a small number of DALY, some of which relate only to children aged 4, and should be interpreted with caution.)
- For children aged 5–14, about half the burden was due to conduct disorder (25%) and anxiety disorders (25%).
- For people aged 15–64, anxiety disorders (25%), depressive disorders (18%) and alcohol use disorders (17%) were the leading causes of burden.
- For those aged 65 and over, anxiety disorders (24%) and depressive disorders (19%) were the leading causes of burden.
Figure 3: Contribution of individual causes to mental health conditions & substance use disorders total burden (DALY), by age group, First Nations people, 2022
Notes
- The residual cause ‘Other mental health conditions & substance use disorders’ includes delirium, personality disorders and any remaining child disorders such as specific learning disorders, developmental disorders and sleep disorders. See the Australian Burden of Disease Study: methods and supplementary material 2018 for a full list of ICD-10 codes.
- Estimates for anxiety disorders and conduct disorder in children under 5 relate to children aged 4 years only.
- First Nations estimates for autism spectrum disorders should be interpreted with caution as they are based on indirect modelling methods that are less reliable than for some other causes.
- Proportions in the under 5 and 75 and over age groups should be treated with caution, due to underlying small numbers.
Source: AIHW First Nations Burden of Disease Database
To explore the contribution of fatal and non-fatal burden to the leading causes of the top 5 disease groups see the interactive data visualisation: Dashboard 7: Top disease groups across the stages of life.
How has the burden changed over time?
Between 2011 and 2022, the age-standardised rate of total burden due to mental health conditions & substance use disorders for First Nations people increased from 59 to 66 DALY per 1,000 people, an increase of 11%. This was driven by an increase in the non-fatal burden (14%). Rates of fatal burden due to mental health conditions & substance use disorders decreased between 2011 and 2022 (from 3.2 to 1.8 YLL per 1,000; decrease of 45%) (Figure 4).
Figure 4: Change between 2011 and 2022 in the age-standardised total (DALY), fatal (YLL), and non-fatal (YLD) burden rate (per 1,000 people), mental health conditions & substance use disorders, First Nations people
Source: AIHW First Nations Burden of Disease Database
For non-Indigenous people the age-standardised rate of total burden due to mental health conditions & substance use disorders increased by 22% between 2011 and 2022 (from 26 to 32 DALY per 1,000 people). This was driven by an increase of 23% in the age-standardised non-fatal burden rate over the same period (from 25 to 31 YLD per 1,000 people). The age-standardised fatal burden rate for non-Indigenous people was less than 1 per 1,000 people in 2011 and 2022 (see Figure 7 in Gap in disease burden section).
To explore the changes over time in the DALY, YLD, and YLL for First Nations people in each disease group, see the interactive data visualisation: Dashboard 3: Comparisons over time.
Comparisons with non-Indigenous Australians
In 2022, the age-standardised rate of burden due to mental health conditions & substance use disorders for First Nations people was 2.1 times the rate for non-Indigenous Australians (age-standardised rates of 65.6 and 31.5 DALY per 1,000 people, respectively).
The largest absolute differences in DALY rates between First Nations people and non-Indigenous Australians were observed for alcohol use disorders (rate difference of 8.2 DALY per 1,000 people), anxiety disorders (rate difference of 7.3 DALY per 1,000) and depressive disorders (rate difference of 4.5 DALY per 1,000) (Figure 5).
The largest relative differences in DALY rates between First Nations people and non-Indigenous Australians (based on age-standardised rate ratios) were observed for alcohol use disorders (rate ratio of 3.9), schizophrenia (3.6), intellectual disability (3.5), and conduct disorder (3.5).
Figure 5: Mental health conditions & substance use disorders age-standardised total burden rates (DALY per 1,000 people) and rate ratios, First Nations people and non-Indigenous Australians, by disease, 2022
Notes
- Data for autism spectrum disorders and eating disorders are not reported due to data quality issues. Estimates for conduct disorder should be interpreted with caution as they are also subject to data quality issues.
- ‘Other’ refers to the residual cause ‘Other mental health conditions & substance use disorders’, which includes delirium, personality disorders and any remaining child disorders such as specific learning disorders, developmental disorders and sleep disorders. See the Australian Burden of Disease Study: methods and supplementary material 2018 for a full list of ICD-10 codes.
Source: AIHW First Nations Burden of Disease Database
To explore the gap in disease burden between First Nations people and non-Indigenous Australians, see the interactive data visualisation: Dashboards 6a and 6b: Gap in health outcomes.