Neuropsychiatric Diseases Cause Disproportionate Suffering

I've been poring over disability adjusted life-year statistics for the U.S. One of the things that made me choose psychiatry was that there are a lot of diseases that cause horrendous suffering, and one of the horrendous things about it is that this is suffering that can last a lifetime; they're not directly fatal illnesses in the same way that cancer or heart disease are. This highlights the conflict in medicine between decreasing suffering, and decreasing death. It's underappreciated by many people (including, in my experience, physicians) that these are not the same thing; that in fact there are many times when avoiding one can lead to the other, and vice versa. (One way to think of the job of a physician is to protect and extend the possibility of positive future experience.)

Disability-adjusted life years is the sum of years lived with disability (YLWD) and years of life lost (YLL) due to the disease. Granted, living with disease A for 10 years is likely to cause different suffering than disease B over the same time, but this gives us an idea. And the statistics are given in time per person across the population. Consequently if a disease causes lots of disability but is rare, it will have a lower number than another which causes less disability but is very common.

Some points that emerge from inspecting the data:

1) If you look at the ratio of YLWD to YLL, you can see which diseases kill quickly without much suffering (i.e. lots of people die from it but not many years lived with disability). On the other hand, if you want to focus on diseases that cause disproportionate suffering, you look for diseases with a high disability years to life lost ratio. In decreasing order, the diseases out of the top 50 that have the highest disability years:life lost ratio are: major depressive disorder, bipolar disorder, back pain, anxiety disorders, schizophrenia, alcohol use disorder, and drug abuse, COPD. One quirk is that suicide is listed separately and depression, bipolar and a few others have no stats for years lost, and suicide is how people die from depression and bipolar. So, if you make the simplifying assumption that suicide and MDD have a 1:1 correlation, i.e. everyone who dies from depression dies from suicide and everyone who commits suicide does so out of depression, the list doesn't change that much (now, bipolar disorder, back pain, anxiety disorder, schizophrenia, MDD, alcohol, drugs, COPD.)

The trend here toward neuropsychiatric disorders is clear.

2) Comparing the genders, it's unsurprising to see that women fare better than men. What's more, women's outcomes have improved more over the period 1990-2010, in conditions relating to behavioral risk-taking and impulse control - e.g., road injuries and drug use.

3) Embarrassingly, years per population lived with disability for schizophrenia, dysthymia nad bipolar are all essentially flat for this 20 year period. That's bad. That is not the case for most other major diseases.

4) The rise in death and disability over this period from addiction remains staggering. For added irony, a huge proportion (possibly the majority?) of this represents prescription drug abuse. This represents a major, major policy failure on the part of drug enforcement agencies - you know, the ones that have marijuana scheduled as more dangerous than synthetic opioids. The agencys' position must be: hey, people are suffering and dying, but it's a-okay as long as it's not from street drugs!