Over Three Decades of Mental Health in Sub-Saharan Africa: An Analysis of GBD Data From 1990 to 2023

Mental disorders are leading causes of disability worldwide but remain underprioritized in many low- and middle-income countries, including sub-Saharan Africa (SSA), where access to care, workforce capacity, and mental health infrastructure remain limited.

This study quantified the burden of mental and substance use disorders (SUDs) in SSA from 1990 to 2023 using Global Burden of Disease (GBD) 2023 estimates, with attention to long-term trends, late-period changes, country-level heterogeneity, sex differences, and risk-factor attribution.

We analyzed GBD 2023 estimates for 46 SSA countries from 1990 to 2023, including prevalence, disability-adjusted life years (DALYs), age-standardized rates, sex-specific estimates, country-level burden, and selected risk factors. Percentage changes were calculated for 1990-2023, with sensitivity analyses for 1990-2019 and 2019-2023 and segmented log-linear trend models using 2019 as the breakpoint.

From 1990 to 2023, the age-standardized prevalence rate of mental disorders increased from 11,138.8 to 14,841.0 per 100,000 (+33.24%), while the age-standardized DALY rate increased from 1634.9 to 2218.9 per 100,000 (+35.73%). Anxiety disorders showed the largest relative increases in age-standardized prevalence (+90.99%) and DALY rates (+92.11%). Depressive disorders also increased, while ADHD age-standardized rates remained largely stable. SUDs showed rising absolute burden despite declining age-standardized prevalence and DALY rates. Late-period analyses showed larger increases after 2019, particularly for anxiety disorders. Females had higher age-standardized rates and larger relative increases for anxiety and depressive disorders, whereas males had higher rates of ADHD and SUDs. Among selected risk factors, sexual violence against children had the highest age-standardized attributable DALY rate in 2023, while bullying victimization and intimate partner violence showed the largest relative increases.

Mental and SUDs represent a growing public health challenge in SSA. Strengthening mental health systems, integrating services into primary and general healthcare platforms, expanding SUD prevention and treatment, addressing violence-related risk factors, and reducing stigma are essential to improving mental health outcomes across the region.