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      The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990–2019: Findings from the Global Burden of Disease Study 2019

      research-article
      1 , * , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 161 , 17 , 162 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 118 , 159 , 158 , 160 , 130
      The Lancet Regional Health - Europe
      Elsevier
      Young people, Mental health, Mental disorders, Self-harm, Substance use, Europe

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          Summary

          Background

          Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease (GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time.

          Methods

          Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated.

          Findings

          In 2019, rates per 100,000 population were 16,983 (95% UI 12,823 – 21,630) for MDs, 3,891 (3,020 - 4,905) for SUDs, and 89·1 (63·8 - 123·1) for self-harm. In terms of disability, anxiety contributed to 647·3 (432–912·3) YLDs, while in terms of premature death, self-harm contributed to 319·6 (248·9–412·8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14·9%;9·4-20·1) and drug use disorders (16·9%;8·9-26·3), and decreased in idiopathic developmental intellectual disability (–29·1%;23·8-38·5). YLLs decreased in self-harm (–27·9%;38·3-18·7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs.

          Interpretation

          Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people.

          Funding

          The Bill and Melinda Gates Foundation

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          Most cited references42

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          Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

          Summary Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding Bill & Melinda Gates Foundation.
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            Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic

            (2021)
            Background Before 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative. In this study, we aimed to quantify the impact of the COVID-19 pandemic on the prevalence and burden of major depressive disorder and anxiety disorders globally in 2020. Methods We conducted a systematic review of data reporting the prevalence of major depressive disorder and anxiety disorders during the COVID-19 pandemic and published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google Scholar, preprint servers, grey literature sources, and consulted experts. Eligible studies reported prevalence of depressive or anxiety disorders that were representative of the general population during the COVID-19 pandemic and had a pre-pandemic baseline. We used the assembled data in a meta-regression to estimate change in the prevalence of major depressive disorder and anxiety disorders between pre-pandemic and mid-pandemic (using periods as defined by each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2 infection rate, and daily excess mortality rate). We then used this model to estimate the change from pre-pandemic prevalence (estimated using Disease Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and location. We used final prevalence estimates and disability weights to estimate years lived with disability and disability-adjusted life-years (DALYs) for major depressive disorder and anxiety disorders. Findings We identified 5683 unique data sources, of which 48 met inclusion criteria (46 studies met criteria for major depressive disorder and 27 for anxiety disorders). Two COVID-19 impact indicators, specifically daily SARS-CoV-2 infection rates and reductions in human mobility, were associated with increased prevalence of major depressive disorder (regression coefficient [ B ] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1 [7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders (0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p<0·0001]. Females were affected more by the pandemic than males ( B 0·1 [0·1 to 0·2; p=0·0001] for major depressive disorder, 0·1 [0·1 to 0·2; p=0·0001] for anxiety disorders) and younger age groups were more affected than older age groups (−0·007 [–0·009 to −0·006; p=0·0001] for major depressive disorder, −0·003 [–0·005 to −0·002; p=0·0001] for anxiety disorders). We estimated that the locations hit hardest by the pandemic in 2020, as measured with decreased human mobility and daily SARS-CoV-2 infection rate, had the greatest increases in prevalence of major depressive disorder and anxiety disorders. We estimated an additional 53·2 million (44·8 to 62·9) cases of major depressive disorder globally (an increase of 27·6% [25·1 to 30·3]) due to the COVID-19 pandemic, such that the total prevalence was 3152·9 cases (2722·5 to 3654·5) per 100 000 population. We also estimated an additional 76·2 million (64·3 to 90·6) cases of anxiety disorders globally (an increase of 25·6% [23·2 to 28·0]), such that the total prevalence was 4802·4 cases (4108·2 to 5588·6) per 100 000 population. Altogether, major depressive disorder caused 49·4 million (33·6 to 68·7) DALYs and anxiety disorders caused 44·5 million (30·2 to 62·5) DALYs globally in 2020. Interpretation This pandemic has created an increased urgency to strengthen mental health systems in most countries. Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option. Funding Queensland Health, National Health and Medical Research Council, and the Bill and Melinda Gates Foundation.
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              Global burden of disease in young people aged 10-24 years: a systematic analysis.

              Young people aged 10-24 years represent 27% of the world's population. Although important health problems and risk factors for disease in later life emerge in these years, the contribution to the global burden of disease is unknown. We describe the global burden of disease arising in young people and the contribution of risk factors to that burden. We used data from WHO's 2004 Global Burden of Disease study. Cause-specific disability-adjusted life-years (DALYs) for young people aged 10-24 years were estimated by WHO region on the basis of available data for incidence, prevalence, severity, and mortality. WHO member states were classified into low-income, middle-income, and high-income countries, and into WHO regions. We estimated DALYs attributable to specific global health risk factors using the comparative risk assessment method. DALYs were divided into years of life lost because of premature mortality (YLLs) and years lost because of disability (YLDs), and are presented for regions by sex and by 5-year age groups. The total number of incident DALYs in those aged 10-24 years was about 236 million, representing 15·5% of total DALYs for all age groups. Africa had the highest rate of DALYs for this age group, which was 2·5 times greater than in high-income countries (208 vs 82 DALYs per 1000 population). Across regions, DALY rates were 12% higher in girls than in boys between 15 and 19 years (137 vs 153). Worldwide, the three main causes of YLDs for 10-24-year-olds were neuropsychiatric disorders (45%), unintentional injuries (12%), and infectious and parasitic diseases (10%). The main risk factors for incident DALYs in 10-24-year-olds were alcohol (7% of DALYs), unsafe sex (4%), iron deficiency (3%), lack of contraception (2%), and illicit drug use (2%). The health of young people has been largely neglected in global public health because this age group is perceived as healthy. However, opportunities for prevention of disease and injury in this age group are not fully exploited. The findings from this study suggest that adolescent health would benefit from increased public health attention. None. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Journal
                Lancet Reg Health Eur
                Lancet Reg Health Eur
                The Lancet Regional Health - Europe
                Elsevier
                2666-7762
                01 April 2022
                May 2022
                01 April 2022
                : 16
                : 100341
                Affiliations
                [1 ]Outpatient and Inpatient Care Service, Central Health Directorate, Region Friuli Venezia Giulia, Italy
                [2 ]Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
                [3 ]Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
                [4 ]Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Institute of Health, Rome, Italy
                [5 ]Department of Mental Health, AUSL Romagna, Ravenna, Italy
                [6 ]Department of Public Health, Aarhus University, Aarhus, Denmark
                [7 ]Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
                [8 ]Department of Clinical Research in Neurology, Fondazione Cardinale Giovanni Panico Hospital, Tricase, Italy
                [9 ]Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
                [10 ]Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
                [11 ]Department of Primary Care and Public Health, University of East Anglia, Norwich, UK
                [12 ]Public Health England, London, UK
                [13 ]Department of Internal Medicine, Catholic University of Rome, Rome, Italy
                [14 ]Cardiology Department Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
                [15 ]Department of Statistics and Econometrics Bucharest Carol Davila University of Economic Studies, Bucharest, Romania
                [16 ]CIBERSAM, Institute of Health Carlos III, Madrid, Spain
                [17 ]Department of Hypertension, Medical University of Lodz, Lodz, Poland
                [18 ]Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
                [19 ]T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
                [20 ]Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
                [21 ]Department of Social and Clinical Pharmacy, Charles University, Hradec Kralova, Czech Republic
                [22 ]Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
                [23 ]Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
                [24 ]Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
                [25 ]Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
                [26 ]Institute of Applied Health Research, University of Birmingham, Birmingham, UK
                [27 ]Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
                [28 ]Independent Consultant, Athens, Greece
                [29 ]Department of Chemical Sciences, University of Porto, Porto, Portugal
                [30 ]Department of Medicine (Prof N Cruz-Martins PhD), University of Porto, Porto, Portugal
                [31 ]Department of Health Sciences Institute of Research and Advanced Training in Health Sciences and Technologies (CESPU), Famalicão, Portugal
                [32 ]Faculty of Life Sciences and Medicine, King's College London, London, UK
                [33 ]Department of Clinical Toxicology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
                [34 ]National Centre for AIDS and STD Control, Save the Children, Kathmandu, Nepal
                [35 ]Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
                [36 ]Laboratory of Toxicology, University of Porto, Porto, Portugal
                [37 ]Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
                [38 ]Population and Behavioural Sciences, University of St Andrews, St Andrews, UK
                [39 ]Associated Laboratory for Green Chemistry (LAQV), University of Porto, Porto, Portugal
                [40 ]Research Center on Public Health, University of Milan Bicocca, Monza, Italy
                [41 ]Institute of Public Health, Charité Universitätsmedizin Berlin (Charité Medical University Berlin), Berlin, Germany
                [42 ]Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
                [43 ]Department of Applied Social Sciences, Sapientia Hungarian University of Transylvania, Târgu-Mureş, Romania
                [44 ]Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
                [45 ]Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
                [46 ]Research Unit, University of Barcelona, Barcelona, Spain
                [47 ]Biomedical Research Networking Center for Mental Health Network (CiberSAM), Barcelona, Spain
                [48 ]Department of Pharmacy, University of Huddersfield, Huddersfield, UK
                [49 ]School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
                [50 ]Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
                [51 ]Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
                [52 ]Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
                [53 ]Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
                [54 ]Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
                [55 ]Department of Public Health, University of Naples Federico II, Naples, Italy
                [56 ]Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehram, Iran
                [57 ]Division of Pulmonary Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
                [58 ]Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
                [59 ]Department of Ophthalmology, Heidelberg University, Mannheim, Germany
                [60 ]Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
                [61 ]Department of Family Medicine and Public Health, University of Opole, Opole, Poland
                [62 ]MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
                [63 ]Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
                [64 ]Surgery Research Unit, University of Oulu, Oulu, Finland
                [65 ]Family Medicine Department, United Arab Emirates University, Al Ain, United Arab Emirates
                [66 ]Primary Care Department, NHS North West London, London, UK
                [67 ]School of Health Sciences, Kristiania University College, Oslo, Norway;
                [68 ]Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, USA
                [69 ]Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
                [70 ]Department of Epidemiology and Public Health University College London, London, UK
                [71 ]Department of Public Health, University of Helsinki, Helsinki, Finland
                [72 ]Health System and Population Studies Divisions, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
                [73 ]Center for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
                [74 ]Biomedical Research Networking Center for Mental Health Network (CIBERSAM), San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
                [75 ]Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
                [76 ]Division of Psychology and Language Sciences, University College London, London, UK
                [77 ]Department of Psychiatry, University of Nairobi, Nairobi, Kenya
                [78 ]Department of Public Health, University of Helsinki, Helsinki, Finland
                [79 ]Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
                [80 ]Clinical and Experimental Medicine, University of Catania, Catania, Italy
                [81 ]Department of Health Sciences, University of Leicester, Leicester, UK
                [82 ]National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Insitute of Health, Rome, Italy
                [83 ]UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
                [84 ]Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE) University of Porto, Porto, Portugal
                [85 ]School of Health, Polytechnic Institute of Porto, Portugal;
                [86 ]Associated Laboratory for Green Chemistry (LAQV), University of Porto, Porto, Portugal
                [87 ]Institute for Research and Advanced Training in Health Sciences and Technologies, Instituto Universitário de Ciências da Saúde (University Institute of Health Sciences), Gandra, Portugal
                [88 ]Psychiatry Department, Hospital Universitario Doctor Peset, Valencia, Spain
                [89 ]Department of Medicine, University of Valencia, Valencia, Spain
                [90 ]Health Policy Research Public Health Foundation of India, Gurugram, India
                [91 ]Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
                [92 ]Queensland Brain Institute, School of Public Health, The University of Queensland, Brisbane, QLD, Australia
                [93 ]National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
                [94 ]Department of Healthcare, University of Vlora, Vlora city, Albania
                [95 ]Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece
                [96 ]University Research Institute, National and Kapodistrian University of Athens, Athens, Greece
                [97 ]Clinical Microbiology and Parasitology Unit, Dr. Zora Profozic Polyclinic, Zagreb, Croatia
                [98 ]University Centre Varazdin, University North, Varazdin, Croatia
                [99 ]Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
                [100 ]Department of Statistics and Econometrics Bucharest University of Economic Studies, Bucharest, Romania
                [101 ]Department of Medical Sciences IRCCS Casa Sollievo della Sofferenza General Hospital, San Giovanni Rotondo, Italy
                [102 ]Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
                [103 ]Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany
                [104 ]Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
                [105 ]Department of Health Care Management, Technical University of Berlin, Berlin, Germany
                [106 ]Department of Surgery, General University Hospital of Patras, Patras, Greece
                [107 ]Medical School, University of Thessaly, Larissa, Greece
                [108 ]Institute of Epidemiology and Medical Biometry Ulm University, Ulm, Germany
                [109 ]Department of General Surgery Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
                [110 ]Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
                [111 ]Department of Anatomy and Embryology Romania, Bucharest, Romania
                [112 ]Cardio-Aid, Bucharest, Romania
                [113 ]Department of Pediatrics, National Hospital, Abuja, Nigeria
                [114 ]Department of International Public Health, University of Liverpool, Liverpool, UK
                [115 ]National School of Public Health Institute of Health Carlos III, Madrid, Spain
                [116 ]Privatpraxis, Heidelberg, Germany
                [117 ]Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
                [118 ]Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
                [119 ]Global Health Governance Programme, University of Edinburgh, Edinburgh, UK
                [120 ]School of Dentistry, University of Leeds, Leeds, UK
                [121 ]Department of Statistics and Econometrics Bucharest University of Economic Studies, Bucharest, Romania
                [122 ]Department of Chemistry, University of Porto, Porto, Portugal
                [123 ]Institute of Infection and Immunity, St George's University of London, London, UK
                [124 ]University Medical Center Groningen, School of Economics and Business University of Groningen, Groningen, Netherlands
                [125 ]WHO Collaborating Centre for Public Health Education and Training Imperial College London, London, UK
                [126 ]Department of Primary Care and Public Health, Imperial College London, London, UK
                [127 ]University College London Hospitals, London, UK
                [128 ]Academic Public Health England, London, UK
                [129 ]Clinical and Epidemiological Research in Primary Care (GICEAP), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
                [130 ]Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
                [131 ]Department of Psychosocial Science University of Bergen, Bergen, Norway
                [132 ]Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
                [133 ]Swiss Research Institute for Public Health and Addiction University of Zürich, Zurich, Switzerland
                [134 ]Interdisciplinary Centre Psychopathology and Emotion regulation (ICPE) University of Groningen, Groningen, Netherlands
                [135 ]Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia
                [136 ]Finnish Institute of Occupational Health, Helsinki, Finland
                [137 ]London Institute for Healthcare Engineering, King's College London, London, UK
                [138 ]Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
                [139 ]Department of Psychology, Reykjavik University, Reykjavik, Iceland
                [140 ]Department of Health and Behavior Studies, Columbia University, New York, NY, USA
                [141 ]Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
                [142 ]Department of Biological Sciences, University of Porto, Porto, Portugal
                [143 ]Surgery, "Sf. Pantelimon" Emergency Clinical Hospital Bucharest, Bucharest, Romania
                [144 ]Faculty of Health and Public Administration, Semmelweis University, Budapest, Hungary
                [145 ]Department of Medicine, University of Valencia, Valencia, Spain
                [146 ]Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
                [147 ]Psychiatry and Medical Psychology Department, University of Lisbon, Lisbon, Portugal
                [148 ]Child and Adolescent Mental Health Services (CAMHS), Hospital Garcia de Orta, Almada, Portugal
                [149 ]Department of Pathology and Legal Medicine, University of São Paulo, Ribeirão Preto, Brazil
                [150 ]Modestum LTD, London, UK
                [151 ]UKK Institute, Tampere, Finland
                [152 ]Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
                [153 ]Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
                [154 ]UCL Great Ormond Street Institute of Child Health, University College London, London, UK
                [155 ]Demographic Change and Aging Research Area, Federal Institute for Population Research, Wiesbaden, Germany
                [156 ]Institute of Health and Society, University of Oslo, Oslo, Norway
                [157 ]Department of Neurology, Technical University of Munich, Munich, Germany
                [158 ]Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
                [159 ]School of Public Health (A J Ferrari PhD), The University of Queensland, Brisbane, QLD, Australia
                [160 ]Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
                [161 ]Department of Psychiatry, Universidad Autónoma de Madrid (Autonomous University of Madrid), Madrid, Spain
                [162 ]Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
                Author notes
                [* ]Corresponding author at: Outpatient and Inpatient Care Service, Central Health Directorate, Region Friuli Venezia Giulia, Trieste 34100, Italy. giulio.castelpietra@ 123456regione.fvg.it
                Article
                S2666-7762(22)00034-5 100341
                10.1016/j.lanepe.2022.100341
                8980870
                35392452
                82bc44a5-2f1e-4826-af06-a32120af4bae
                © 2022 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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