The global burden of disease studies: tracking the progress of a moving train

摘要

Estimating the impact or consequences of health conditions on populations has understandable policy appeal. Using mortality as an index of that impact has implicit attraction: it is a final and irrevocable outcome and its definitiveness as a measure is not open to question. Once we go beyond mortality as an index of disease outcome, several opportunities present themselves. But so do several challenges. The Global Burden of Disease studies have embodied both these opportunities as well as the challenges. Estimating the impact of mental disorders, especially in the context of comparisons with physical diseases, poses an added challenge. The subjective nature of many of the features of mental illness, the imprecision of their measurement and the spectrum pattern of the distribution of many of the symptoms make mental disorders open to either problem deflation or inflation. The reliability of the various tools for assessing and classifying mental health conditions gives some assurance about the fact that these are real entities, albeit often defined in abstract terms, but the rather poor validity for many of these disorders leads not only to frequent shifts in their boundaries but also to the fact that a sizeable section of the community will remain sceptical about their nature (Jablensky, ).