In May 2024, The Lancet published the latest findings from the Global Burden of Disease Study (GBD). These papers summarise the global trends for a wide range of illnesses and causes of injury across groups based on age, sex, location, and sociodemographic index. The papers include data up to 2021 and are the first GBD reports to cover the effects of the COVID-19 pandemic, which features strongly. Less obvious are the implications for mental health. In one respect, the mental health field is ahead of GBD: it is well established that the COVID-19 pandemic had a major adverse effect on the mental health of young people, through the associated social restrictions and disruption to education, more than direct effects of viral infection. GBD is described as a rules-based evidence synthesis of global health data. 12 000 collaborators in 163 countries collect data from a wide range of sources for 1075 locations (in 21 countries, analysis goes to sub-national level) across 25 age groups, disaggregated by sex, if possible. Each iteration features new developments and supercedes previous versions. The data are freely available via the GBD Exchange for anyone to prepare reports relevant to disease(s) and geographical areas of interest. Thus, for The Lancet Psychiatry, the interest in GBD papers lies in novel insights, rather than descriptive summaries. So, what are the key messages for the mental health field? The GBD paper on mortality and life expectancy shows the ongoing shift in the age structure of populations from younger to older individuals. Youth mental health receives far more attention than mental disorders in older adults, apart from dementia: should more consideration be given to old age psychiatry, to manage both existing and new-onset disorders in this growing population? Many trials exclude adults over 65 years and drug trials often exclude people with comorbidities, meaning that evidence on how best to manage symptoms in these patients is scarce, whereas polypharmacy is common. Few psychiatric disorders are recorded as the cause of death, so the main burden of mental illness is measured in years lived with disability (YLDs) and disability-adjusted life-years (DALYs) rather than years of life lost. Depressive disorders were the second highest cause of YLDs in 2021 (56·3 million [95% CI 39·3–76·5] YLDs), showing an increase of 36·5% (31·7 to 41·7) from 2010, and anxiety disorders were sixth (42·5 million [29·4 to 57·7] YLDs). Other mental disorders among the 25 leading causes of global YLDs were schizophrenia, Alzheimer's disease and other dementias, autism spectrum disorders, alcohol use disorders, drug use disorders, and other mental disorders (67·1 million YLDs combined). ....
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