Materials and methods the global burden of disease

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MATERIALS AND METHODS The Global Burden of Disease Study 2016 (GBD 2016) was used to estimate the proportion of disease burden that came from mental and substance use dis- orders (18). Data from the Institute of Health Metrics and Evaluation (19) was obtained for each country in the Ameri- cas by specific disorder, age, and gender. GBD 2016 estimates for Disability Ad- justed Life Year (DALY) and Years Lived with Disability (YLD) were determined for the Region of the Americas as a whole (including the Caribbean, Latin America, and North America). These were com- pared to global estimates. In addition, estimates were made by subregion: North America (Canada and the United States); Mesoamerica (Costa Rica, El Sal- vador, Guatemala, Honduras, Mexico, Nicaragua, and Panama); the Latin Ca- ribbean (Cuba, Dominican Republic, Haiti, and Puerto Rico); South America (Argentina, Bolivia, Brazil, Chile, Colom- bia, Ecuador, Paraguay, Peru, Uruguay, and Venezuela); and the non-Latin Caribbean (Antigua and Barbuda, Baha- mas, Barbados, Belize, Bermuda, Domin- ica, Jamaica, Saint Lucia, Saint Vincent and the Grenadines, Grenada, Guyana, Suriname, Trinidad and Tobago, United States Virgin Islands). Studies on a 12-month prevalence of mental disorders were selected based on being the most representative communi- ty-based survey of a country—using the Composite International Diagnos- tic Interview (CIDI; 20), the Diagnostic Interview Schedule for Children (DISC; 21), or a latter equivalent inter- view schedule—and having available service utilization data to permit calcula- tion of the treatment gap. The studies, therefore, were not necessarily a coun- try’s most recent mental health preva- lence survey. Data from studies that were part of the World Mental Health Survey (WMHS) were obtained from published reports: Argentina (22), n = 3 927, age 18 years, was based on a nationally rep- resentative sample; Brazil (23), n = 5 037, age 18 years, collected data from met- ropolitan São Paulo; Colombia (24), n = 4 426, age 18 – 65 years, included all urban areas; Mexico (25), n = 5 782, age 18 – 65 years, included all urban areas; Peru (26), n = 3 930, age 18 – 56 years, was based on five urban areas; and the United States (27), n = 9 282, age 18 years, was a nationally representative sample from its National Comorbidity Survey Repli- cation. The study selected for Canada (28), n = 38 492, age 15 years, was repre- sentative of much of the country and used the WMHS CIDI. For Chile (29), n = 2 978, age 15 years, a CIDI 1.1 survey of four provinces represented the major geographic areas and used the Diagnos- tic and Statistical Manual of Mental Dis- orders, 3rd edition, revised (DSM-III_R) rather than DSM-IV. For Guatemala (30), n = 1 452, age 18 – 65 years, a nationally representative survey used the CIDI 2.1 and sampled all the ethnic groups in the country, including the Ladino (mixed in- digenous and European heritage, but identifying as non-indigenous) and the Maya (encompassing 21 different ethnic- ities) populations.
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