The Global Economic Burden of Youth Self-Harm: A Systematic Analysis of 204 Countries and Territories for 2019

By Siddhesh Zadey BSMS, MScGH

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Zadey S. The global economic burden of youth self-harm: A systematic analysis of 204 countries and territories for 2019. HPHR. 2023;71. https://doi.org/10.54111/0001/SSS1

The Global Economic Burden of Youth Self-Harm: A Systematic Analysis of 204 Countries and Territories for 2019

Abstract

Introduction

Globally, young people (<24 years of age) contribute to about a quarter of the total disease burden of self-harm. However, national strategic plans have been found to have no specific recommendations for managing children and young people suffering from suicidality or preventing youth self-harm. Limited policy attention and allocation of funds can be partially attributed to limited evidence on the economic burden of self-harm. Beyond ethical and health arguments, a high economic burden could persuade policy action. Hence, understanding the global economic burden of youth self-harm including that in low- and middle-income countries (LMICs) is crucial.

Methods

We analyzed the economic burden of self-harm among people up to 24 years of age for 204 countries and territories included in the Global Burden of Disease (GBD) study. We extracted self-harm DALYs in the <20, 20-24 age groups for both sexes for 2019 using the GBD Results tool.4 The mean estimates for the gross domestic product (GDP) per capita in 2020 purchasing power parity (PPP) adjusted dollars and projected population for 2019 were taken from GHDx. We used the value-of-life-year (VLY) or full-income approach for economic burden as outlined in ‘Global Health 2035’. Different World Bank regions are considered to have had different levels of impact of mortality reduction on full income in the past decades. We chose the region-based factors at a 3% discount rate. Economic burden or VLYs lost to youth self-harm were calculated as the product of DALYs, GDP per capita (in $ PPP (2020)), and the factor. Uncertainty was propagated for VLYs lost using the 95% uncertainty interval (UI) of DALYs.

Results

The global economic burden of youth self-harm in 2019 was $251,779,943,868 (95% UI: 208,845,558,648 – 303,222,010,830). Of the 204 countries, India had the largest economic burden of youth self-harm of $71,098,857,448 (60,118,492,219 – 83,332,732,126) while Bermuda had the smallest burden of $1440346 (1,074,392 – 1,913,681). Among the World Bank Income Groups, the LMIC group had the largest economic burden followed by high-income, upper-middle-income, and low-income countries. Among WHO regions, Southeast Asia had the largest economic burden. 

Discussion & Conclusion

To our knowledge, these are the first such comprehensive estimates. Self-harm in youth massively burdens economies around the world. This necessitates urgent policy attention from the finance, youth empowerment, and family welfare ministries beyond health ministries for planning and implementing effective suicide prevention strategies. 

 

Introduction

Globally, young people (<24 years of age) contribute to about a quarter of the total burden of self-harm as measured by disability-adjusted life-years (DALYs). Attending to self-harm and suicide deaths among young people should be prioritized. Several adaptations are needed in clinical practice including increased focus on therapeutic alliance, use of interventions based on digital technology, establishment of care networks, and delivery of culturally sensitive care among others.1 However, these changes can be made possible only if self-harm in youth is gets the deserved policy attention and necessary financing. Previously, policy documents and national plans have been found to have no specific recommendations for managing children and young people suffering from suicidality or preventing youth self-harm.2

 

Among several other contributors, lack of policy focus can be due to the limited evidence on cost-effective interventions. However, another perspective towards to counter the inaction can be to look at the economic losses due to self-harm disease burden. Previously, it has been shown that the economic burden of preventable deaths due to self-harm was over $5 billion in 2014 for ten countries with the highest human development index (HDI).3 In addition to the ethical and health arguments, such high economic burden warranties policy action. However, these ten countries contribute to only a small fraction of the global youth self-harm DALYs. Hence, it is crucial to understand the global economic burden of youth self-harm including that in low- and middle-income countries.

Methods

We analyzed the economic burden of self-harm among people upto 24 years of age for 204 countries and territories included in the Global Burden of Disease (GBD) study. We extracted self-harm DALYs in the <20, 20-24 age groups for both sexes for 2019 using the GBD Results tool.4 To maintain source data homogeneity, the mean estimates for gross domestic product (GDP) per capita in 2020 purchasing power parity (PPP) adjusted dollars and projected population for 2019 were taken from the GHDx.5,6 For estimating the economic burden, we used the value-of-life-year (VLY) or full-income approach as outlined in the Global Health 2035 report.7 Going beyond the traditional human capital approach where an individual’s economic productivity if tied to healthy years of adult life, VLY assumes an intrinsic value to all lives.8 Hence, it is more suitable to understand the economic burden of health losses among the youth, who may not be actively or immediately contributing a country’s economy. Under full-income approach, different World Bank regions are considered to have different levels of impact of mortality reduction on full income in the past decades. We chose the region-based factors at 3% discount rate as presented in Table 1. Economic burden or VLYs lost to youth self-harm were calculated as the product of DALYs, GDP per capita (in $ PPP (2020)), and the factor. We also present the economic burden as percentage of country’s GDP. Uncertainty was propagated for VLYs lost and %GDP using the 95% uncertainty interval (UI) of the DALY estimates. Since this was a secondary analysis of publicly available data, no IRB review was considered necessary.

 

Table 1: Country-wise disease and economic burden of youth (up to 24 years of age) self-harm in 2019.

Country

World Bank Income Group

WHO Region

World Bank Region

Population (2019)

Value of a Life-Year (as % GDP per capita)

Youth Self-harm DALYs (95% UI)

Value of Life-Years lost to Youth Self-harm in $ PPP (2020) (95% UI)

Value of Life-Years lost to Youth Self-harm as % GDP

China (CHN)

Upper-Middle Income Country

Western Pacific Region

East Asia and Pacific

1422350422

2.2

505468 (424148, 608625)

17392802302 (14594662506, 20942384091)

0.08 (0.07, 0.09)

Democratic People’s Republic of Korea (PRK)

Low Income Country

South-East Asian Region

East Asia and Pacific

26232861

2.2

22854 (15344, 32897)

91313580 (61306011, 131441658)

0.19 (0.13, 0.28)

Taiwan (Province of China) (TWN)

High Income Country

Western Pacific Region

East Asia and Pacific

23620243

2.2

14341 (10722, 19006)

1680971686 (1256836620, 2227777710)

0.13 (0.1, 0.18)

Cambodia (KHM)

Lower-Middle Income Country

Western Pacific Region

East Asia and Pacific

16603118

2.2

11746 (7727, 16456)

117732967 (77452461, 164944562)

0.16 (0.1, 0.22)

Indonesia (IDN)

Upper-Middle Income Country

South-East Asian Region

East Asia and Pacific

259465835

2.2

114690 (86424, 148802)

3121905489 (2352500712, 4050467512)

0.1 (0.07, 0.13)

Lao People’s Democratic Republic (LAO)

Lower-Middle Income Country

Western Pacific Region

East Asia and Pacific

7158250

2.2

8764 (5527, 12543)

164929009 (104016610, 236054049)

0.27 (0.17, 0.39)

Malaysia (MYS)

Upper-Middle Income Country

Western Pacific Region

East Asia and Pacific

31301402

2.2

16787 (10386, 29570)

1052159056 (650997554, 1853401240)

0.12 (0.07, 0.21)

Maldives (MDV)

Upper-Middle Income Country

South-East Asian Region

South Asia

498414

2.8

165 (108, 241)

11287092 (7356714, 16451004)

0.09 (0.06, 0.14)

Myanmar (MMR)

Lower-Middle Income Country

South-East Asian Region

East Asia and Pacific

54676901

2.2

32780 (20564, 47945)

401071012 (251612927, 586622241)

0.13 (0.08, 0.19)

Philippines (PHL)

Lower-Middle Income Country

Western Pacific Region

East Asia and Pacific

112142764

2.2

78585 (55534, 97105)

1613455212 (1140178307, 1993700496)

0.15 (0.11, 0.19)

Sri Lanka (LKA)

Lower-Middle Income Country

South-East Asian Region

South Asia

21854452

2.8

50471 (36222, 68468)

1998193698 (1434048397, 2710688019)

0.65 (0.46, 0.88)

Thailand (THA)

Upper-Middle Income Country

South-East Asian Region

East Asia and Pacific

70111586

2.2

54897 (36360, 80270)

2369608733 (1569458228, 3464867785)

0.17 (0.11, 0.25)

Timor-Leste (TLS)

Lower-Middle Income Country

South-East Asian Region

East Asia and Pacific

1334823

2.2

1537 (837, 2229)

11921704 (6491062, 17294604)

0.25 (0.14, 0.37)

Vietnam (VNM)

Lower-Middle Income Country

Western Pacific Region

East Asia and Pacific

96372928

2.2

68978 (46508, 97559)

1385524142 (934175975, 1959607569)

0.16 (0.11, 0.22)

Fiji (FJI)

Upper-Middle Income Country

Western Pacific Region

East Asia and Pacific

911248

2.2

1803 (1266, 2485)

51344671 (36047907, 70735380)

0.44 (0.31, 0.6)

Kiribati (KIR)

Lower-Middle Income Country

Western Pacific Region

East Asia and Pacific

118621

2.2

723 (499, 986)

3645622 (2515917, 4973714)

1.34 (0.93, 1.83)

Marshall Islands (MHL)

Upper-Middle Income Country

Western Pacific Region

East Asia and Pacific

56842

2.2

247 (163, 340)

2249319 (1479665, 3096897)

0.96 (0.63, 1.32)

Micronesia (Federated States of) (FSM)

Lower-Middle Income Country

Western Pacific Region

East Asia and Pacific

102116

2.2

545 (352, 749)

4367567 (2826392, 6003068)

1.17 (0.76, 1.61)

Papua New Guinea (PNG)

Lower-Middle Income Country

Western Pacific Region

East Asia and Pacific

9866614

2.2

5351 (3046, 12238)

51067700 (29068944, 116791045)

0.12 (0.07, 0.27)

Samoa (WSM)

Upper-Middle Income Country

Western Pacific Region

East Asia and Pacific

211354

2.2

642 (406, 907)

9022263 (5707344, 12753660)

0.67 (0.42, 0.94)

Solomon Islands (SLB)

Lower-Middle Income Country

Western Pacific Region

East Asia and Pacific

655632

2.2

3329 (1656, 4907)

19917798 (9908611, 29356053)

1.12 (0.56, 1.65)

Tonga (TON)

Upper-Middle Income Country

Western Pacific Region

East Asia and Pacific

102350

2.2

112 (76, 166)

1600663 (1077596, 2374003)

0.24 (0.16, 0.36)

Vanuatu (VUT)

Lower-Middle Income Country

Western Pacific Region

East Asia and Pacific

294550

2.2

1235 (771, 1725)

8547546 (5333485, 11939999)

0.92 (0.58, 1.29)

Armenia (ARM)

Upper-Middle Income Country

European Region

Europe and Central Asia

3019674

1.9

1464 (1127, 1889)

39841712 (30670277, 51400203)

0.09 (0.07, 0.12)

Azerbaijan (AZE)

Upper-Middle Income Country

European Region

Europe and Central Asia

10278674

1.9

4051 (2647, 5946)

121130700 (79163128, 177792058)

0.07 (0.05, 0.11)

Georgia (GEO)

Upper-Middle Income Country

European Region

Europe and Central Asia

3664752

1.9

1741 (1259, 2353)

52732312 (38119316, 71266457)

0.09 (0.07, 0.12)

Kazakhstan (KAZ)

Upper-Middle Income Country

European Region

Europe and Central Asia

18392068

1.9

38259 (31926, 46705)

2014113393 (1680723671, 2458696757)

0.4 (0.33, 0.48)

Kyrgyzstan (KGZ)

Lower-Middle Income Country

European Region

Europe and Central Asia

6535459

1.9

8301 (6853, 9993)

94906050 (78356614, 114252222)

0.24 (0.2, 0.29)

Mongolia (MNG)

Lower-Middle Income Country

Western Pacific Region

East Asia and Pacific

3387589

2.2

8052 (5150, 11060)

236049469 (150971855, 324251211)

0.52 (0.33, 0.72)

Tajikistan (TJK)

Low Income Country

European Region

Europe and Central Asia

9492414

1.9

7152 (5236, 9751)

51712972 (37860728, 70510211)

0.14 (0.1, 0.2)

Turkmenistan (TKM)

Upper-Middle Income Country

European Region

Europe and Central Asia

5083080

1.9

7895 (5965, 10155)

299821956 (226531652, 385645829)

0.3 (0.22, 0.38)

Uzbekistan (UZB)

Lower-Middle Income Country

European Region

Europe and Central Asia

33677096

1.9

78241 (61849, 96430)

1296137997 (1024588075, 1597453750)

0.44 (0.35, 0.54)

Albania (ALB)

Upper-Middle Income Country

European Region

Europe and Central Asia

2720353

1.9

2100 (1298, 3045)

57456303 (35516377, 83288786)

0.15 (0.09, 0.21)

Bosnia and Herzegovina (BIH)

Upper-Middle Income Country

European Region

Europe and Central Asia

3299982

1.9

2259 (1548, 3107)

64661572 (44288581, 88922198)

0.13 (0.09, 0.18)

Bulgaria (BGR)

Upper-Middle Income Country

European Region

Europe and Central Asia

6934625

1.9

3516 (2610, 4612)

165532276 (122875988, 217120321)

0.1 (0.07, 0.13)

Croatia (HRV)

High Income Country

European Region

Europe and Central Asia

4247902

1.9

2491 (1878, 3238)

143484629 (108201847, 186535212)

0.11 (0.08, 0.14)

Czechia (CZE)

High Income Country

European Region

Europe and Central Asia

10643487

1.9

5758 (4498, 7216)

473496509 (369942073, 593419172)

0.1 (0.08, 0.13)

Hungary (HUN)

High Income Country

European Region

Europe and Central Asia

9674413

1.9

5004 (3901, 6282)

321864529 (250942832, 404094622)

0.1 (0.08, 0.12)

North Macedonia (MKD)

Upper-Middle Income Country

European Region

Europe and Central Asia

2152731

1.9

933 (660, 1271)

31284560 (22112258, 42608622)

0.08 (0.06, 0.11)

Montenegro (MNE)

Upper-Middle Income Country

European Region

Europe and Central Asia

620340

1.9

524 (382, 727)

23573159 (17186234, 32692360)

0.16 (0.12, 0.22)

Poland (POL)

High Income Country

European Region

Europe and Central Asia

38434445

1.9

33185 (27418, 40256)

2206112701 (1822705573, 2676195008)

0.16 (0.14, 0.2)

Romania (ROU)

High Income Country

European Region

Europe and Central Asia

19237066

1.9

9472 (7417, 11896)

556034871 (435417099, 698337718)

0.09 (0.07, 0.12)

Serbia (SRB)

Upper-Middle Income Country

European Region

Europe and Central Asia

8746785

1.9

3789 (2707, 5321)

137313976 (98082007, 192802861)

0.08 (0.06, 0.12)

Slovakia (SVK)

High Income Country

European Region

Europe and Central Asia

5437223

1.9

2902 (2048, 3944)

185957197 (131196692, 252698846)

0.1 (0.07, 0.14)

Slovenia (SVN)

High Income Country

European Region

Europe and Central Asia

2074271

1.9

1344 (1025, 1779)

105071306 (80194326, 139134610)

0.12 (0.09, 0.16)

Belarus (BLR)

Upper-Middle Income Country

European Region

Europe and Central Asia

9500785

1.9

8762 (6353, 12109)

349045611 (253075893, 482417863)

0.18 (0.13, 0.24)

Estonia (EST)

High Income Country

European Region

Europe and Central Asia

1312361

1.9

894 (656, 1191)

64113056 (47049979, 85435942)

0.13 (0.09, 0.17)

Latvia (LVA)

High Income Country

European Region

Europe and Central Asia

1915292

1.9

1349 (1003, 1777)

82617941 (61447976, 108833589)

0.13 (0.1, 0.18)

Lithuania (LTU)

High Income Country

European Region

Europe and Central Asia

2794223

1.9

3692 (2939, 4576)

265337864 (211197644, 328828925)

0.25 (0.2, 0.31)

Republic of Moldova (MDA)

Lower-Middle Income Country

European Region

Europe and Central Asia

3688191

1.9

2520 (1978, 3133)

53298880 (41822771, 66257680)

0.13 (0.1, 0.16)

Russian Federation (RUS)

Upper-Middle Income Country

European Region

Europe and Central Asia

146717427

1.9

214848 (182582, 258161)

11702529309 (9945033231, 14061750912)

0.28 (0.24, 0.33)

Ukraine (UKR)

Lower-Middle Income Country

European Region

Europe and Central Asia

44042431

1.9

89079 (69895, 110782)

2340546452 (1836505351, 2910791138)

0.38 (0.3, 0.48)

Brunei Darussalam (BRN)

High Income Country

Western Pacific Region

East Asia and Pacific

437119

2.2

206 (150, 274)

26505665 (19295017, 35237823)

0.1 (0.08, 0.14)

Japan (JPN)

High Income Country

Western Pacific Region

East Asia and Pacific

127788411

2.2

102099 (98822, 106145)

9922619389 (9604109651, 10315856731)

0.18 (0.17, 0.18)

Republic of Korea (KOR)

High Income Country

Western Pacific Region

East Asia and Pacific

53398252

2.2

44002 (31580, 51095)

4375459167 (3140224980, 5080810356)

0.18 (0.13, 0.21)

Singapore (SGP)

High Income Country

Western Pacific Region

East Asia and Pacific

5667451

2.2

2442 (2135, 2772)

494828997 (432630965, 561567332)

0.09 (0.08, 0.11)

Australia (AUS)

High Income Country

Western Pacific Region

East Asia and Pacific

24568113

2.2

26371 (23305, 29733)

3191158004 (2820144482, 3598074493)

0.24 (0.21, 0.27)

New Zealand (NZL)

High Income Country

Western Pacific Region

East Asia and Pacific

4495667

2.2

7014 (6305, 7844)

696770549 (626384084, 779277613)

0.34 (0.31, 0.38)

Andorra (AND)

High Income Country

European Region

Europe and Central Asia

83064

1.9

28 (19, 39)

2021016 (1394397, 2853961)

0.06 (0.04, 0.09)

Austria (AUT)

High Income Country

European Region

Europe and Central Asia

8916185

1.9

6470 (5609, 7442)

746884590 (647496628, 859089503)

0.14 (0.12, 0.16)

Belgium (BEL)

High Income Country

European Region

Europe and Central Asia

11419166

1.9

8898 (7690, 10135)

928366372 (802378777, 1057480495)

0.15 (0.13, 0.17)

Cyprus (CYP)

High Income Country

European Region

Europe and Central Asia

1313477

1.9

461 (305, 618)

33023414 (21829620, 44267506)

0.07 (0.04, 0.09)

Denmark (DNK)

High Income Country

European Region

Europe and Central Asia

5802733

1.9

2301 (1887, 2761)

266218841 (218358071, 319363375)

0.08 (0.06, 0.09)

Finland (FIN)

High Income Country

European Region

Europe and Central Asia

5534095

1.9

5646 (4887, 6405)

548126717 (474443469, 621784669)

0.19 (0.17, 0.22)

France (FRA)

High Income Country

European Region

Europe and Central Asia

66204315

1.9

37223 (31218, 44061)

3513301143 (2946562093, 4158789643)

0.11 (0.09, 0.13)

Germany (DEU)

High Income Country

European Region

Europe and Central Asia

84914056

1.9

46129 (39821, 53095)

5139813715 (4437003470, 5916082182)

0.1 (0.09, 0.12)

Greece (GRC)

High Income Country

European Region

Europe and Central Asia

10337172

1.9

1964 (1544, 2479)

118424768 (93094793, 149514616)

0.04 (0.03, 0.05)

Iceland (ISL)

High Income Country

European Region

Europe and Central Asia

344876

1.9

207 (167, 249)

23322716 (18890798, 28152658)

0.11 (0.09, 0.14)

Ireland (IRL)

High Income Country

European Region

Europe and Central Asia

4910357

1.9

4091 (3474, 4782)

729009212 (619097788, 852248892)

0.16 (0.13, 0.19)

Israel (ISR)

High Income Country

European Region

Middle East and North Africa

9309583

1.4

4533 (3734, 5400)

279717169 (230439743, 333241286)

0.07 (0.06, 0.08)

Italy (ITA)

High Income Country

European Region

Europe and Central Asia

60313170

1.9

15030 (13968, 16184)

1310941971 (1218387010, 1411591573)

0.05 (0.04, 0.05)

Luxembourg (LUX)

High Income Country

European Region

Europe and Central Asia

618550

1.9

335 (265, 417)

70550031 (55728613, 87721011)

0.1 (0.08, 0.13)

Malta (MLT)

High Income Country

European Region

Middle East and North Africa

439221

1.4

130 (102, 165)

8564879 (6681676, 10868439)

0.04 (0.03, 0.05)

Netherlands (NLD)

High Income Country

European Region

Europe and Central Asia

17156788

1.9

8859 (7747, 10157)

1014601032 (887224358, 1163210009)

0.1 (0.09, 0.11)

Norway (NOR)

High Income Country

European Region

Europe and Central Asia

5348847

1.9

4420 (4085, 4744)

593645498 (548762608, 637225126)

0.16 (0.15, 0.17)

Portugal (PRT)

High Income Country

European Region

Europe and Central Asia

10651263

1.9

3443 (2801, 4276)

234431973 (190698040, 291191737)

0.06 (0.05, 0.08)

Spain (ESP)

High Income Country

European Region

Europe and Central Asia

46021218

1.9

11907 (9976, 14229)

986786358 (826752733, 1179270364)

0.05 (0.04, 0.06)

Sweden (SWE)

High Income Country

European Region

Europe and Central Asia

10222546

1.9

7712 (6877, 8566)

821587692 (732658147, 912574988)

0.14 (0.13, 0.16)

Switzerland (CHE)

High Income Country

European Region

Europe and Central Asia

8775204

1.9

5130 (4470, 5882)

732713581 (638438745, 840150910)

0.11 (0.1, 0.13)

United Kingdom (GBR)

High Income Country

European Region

Europe and Central Asia

67220447

1.9

34336 (32817, 36265)

3226305774 (3083562975, 3407533018)

0.1 (0.09, 0.1)

Argentina (ARG)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

45115284

1.4

84496 (71233, 99844)

2742789833 (2312266442, 3240982781)

0.26 (0.22, 0.31)

Chile (CHL)

High Income Country

Region of the Americas

Latin America and the Caribbean

18198359

1.4

21283 (18018, 24893)

772734919 (654203989, 903801599)

0.16 (0.14, 0.19)

Uruguay (URY)

High Income Country

Region of the Americas

Latin America and the Caribbean

3436137

1.4

6068 (5055, 7193)

191926559 (159901231, 227526792)

0.25 (0.21, 0.29)

Canada (CAN)

High Income Country

Region of the Americas

North America

36519840

1.4

38187 (32932, 43595)

2805284199 (2419243578, 3202548916)

0.15 (0.13, 0.17)

United States of America (USA)

High Income Country

Region of the Americas

North America

327978730

1.4

381773 (362676, 400715)

35583465309 (33803546397, 37348967272)

0.16 (0.15, 0.17)

Antigua and Barbuda (ATG)

High Income Country

Region of the Americas

Latin America and the Caribbean

88489

1.4

26 (18, 37)

816043 (558227, 1144735)

0.04 (0.03, 0.06)

Bahamas (BHS)

High Income Country

Region of the Americas

Latin America and the Caribbean

376940

1.4

102 (73, 140)

5509084 (3941873, 7567583)

0.04 (0.03, 0.05)

Barbados (BRB)

High Income Country

Region of the Americas

Latin America and the Caribbean

297771

1.4

81 (58, 110)

1678188 (1205805, 2278909)

0.04 (0.03, 0.05)

Belize (BLZ)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

410094

1.4

347 (263, 455)

3666305 (2783095, 4802867)

0.12 (0.09, 0.16)

Cuba (CUB)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

11358510

1.4

5788 (4377, 7487)

80662111 (60998569, 104341353)

0.07 (0.05, 0.09)

Dominica (DMA)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

68681

1.4

33 (21, 48)

584863 (382003, 854980)

0.07 (0.04, 0.1)

Dominican Republic (DOM)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

10881855

1.4

7291 (4586, 10846)

198351383 (124778902, 295093153)

0.09 (0.06, 0.14)

Grenada (GRD)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

103215

1.4

42 (31, 56)

1082980 (800869, 1425795)

0.06 (0.04, 0.08)

Guyana (GUY)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

770705

1.4

3305 (2334, 4491)

67473884 (47650994, 91684468)

0.6 (0.42, 0.82)

Haiti (HTI)

Low Income Country

Region of the Americas

Latin America and the Caribbean

12402099

1.4

16629 (10432, 24796)

51364162 (32223411, 76591406)

0.19 (0.12, 0.28)

Jamaica (JAM)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

2810754

1.4

849 (610, 1165)

12078586 (8668349, 16560900)

0.04 (0.03, 0.06)

Saint Lucia (LCA)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

174626

1.4

91 (66, 124)

1923274 (1391910, 2629099)

0.07 (0.05, 0.1)

Saint Vincent and the Grenadines (VCT)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

113144

1.4

55 (41, 73)

991520 (729526, 1319768)

0.07 (0.05, 0.09)

Suriname (SUR)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

575888

1.4

1443 (1080, 1882)

35198940 (26361095, 45907070)

0.35 (0.26, 0.46)

Trinidad and Tobago (TTO)

High Income Country

Region of the Americas

Latin America and the Caribbean

1387457

1.4

1462 (1019, 2049)

64562387 (45016577, 90506543)

0.15 (0.1, 0.21)

Bolivia (Plurinational State of) (BOL)

Lower-Middle Income Country

Region of the Americas

Latin America and the Caribbean

12011750

1.4

13244 (8478, 19125)

166816433 (106784060, 240889857)

0.15 (0.1, 0.22)

Ecuador (ECU)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

17588392

1.4

40788 (26028, 54381)

693043883 (442247298, 924007864)

0.32 (0.21, 0.43)

Peru (PER)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

33995397

1.4

17520 (11597, 25458)

333657762 (220845988, 484820832)

0.07 (0.05, 0.1)

Colombia (COL)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

47776679

1.4

52039 (37061, 70928)

1139751120 (811702495, 1553462086)

0.15 (0.11, 0.21)

Costa Rica (CRI)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

4716744

1.4

5135 (3742, 6769)

148484219 (108211362, 195736395)

0.15 (0.11, 0.2)

El Salvador (SLV)

Lower-Middle Income Country

Region of the Americas

Latin America and the Caribbean

6256143

1.4

9393 (6180, 13346)

126616597 (83305296, 179901584)

0.21 (0.14, 0.3)

Guatemala (GTM)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

17776490

1.4

23953 (17470, 31694)

295362397 (215414326, 390813527)

0.19 (0.14, 0.25)

Honduras (HND)

Lower-Middle Income Country

Region of the Americas

Latin America and the Caribbean

9814396

1.4

3100 (1569, 6082)

27298081 (13821045, 53563254)

0.04 (0.02, 0.09)

Mexico (MEX)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

124940175

1.4

147938 (126638, 171822)

4282423082 (3665837483, 4973794138)

0.17 (0.14, 0.19)

Nicaragua (NIC)

Lower-Middle Income Country

Region of the Americas

Latin America and the Caribbean

6510365

1.4

9230 (6489, 12656)

74637371 (52473049, 102338397)

0.2 (0.14, 0.27)

Panama (PAN)

High Income Country

Region of the Americas

Latin America and the Caribbean

4160457

1.4

3265 (2286, 4500)

153857244 (107710576, 212052177)

0.11 (0.08, 0.15)

Venezuela (Bolivarian Republic of) (VEN)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

28068986

1.4

36375 (25142, 50435)

340780788 (235545069, 472493763)

0.18 (0.13, 0.25)

Brazil (BRA)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

216664814

1.4

150539 (138184, 166479)

3257289504 (2989959471, 3602187616)

0.1 (0.09, 0.11)

Paraguay (PRY)

Upper-Middle Income Country

Region of the Americas

Latin America and the Caribbean

6930455

1.4

9662 (5994, 13495)

154761271 (96005978, 216165942)

0.2 (0.12, 0.27)

Algeria (DZA)

Lower-Middle Income Country

African Region

Middle East and North Africa

41847290

1.4

22829 (15096, 34170)

369877147 (244586300, 553619395)

0.08 (0.05, 0.11)

Bahrain (BHR)

High Income Country

Eastern Mediterranean Region

Middle East and North Africa

1442691

1.4

616 (439, 839)

38128716 (27158058, 51877693)

0.06 (0.04, 0.08)

Egypt (EGY)

Lower-Middle Income Country

Eastern Mediterranean Region

Middle East and North Africa

99069551

1.4

44603 (26376, 72041)

765219438 (452500239, 1235940450)

0.06 (0.04, 0.1)

Iran (Islamic Republic of) (IRN)

Upper-Middle Income Country

Eastern Mediterranean Region

Middle East and North Africa

84297882

1.4

60470 (48354, 69384)

1070982226 (856389330, 1228847146)

0.1 (0.08, 0.12)

Iraq (IRQ)

Upper-Middle Income Country

Eastern Mediterranean Region

Middle East and North Africa

42119490

1.4

33799 (21889, 50591)

534019568 (345843409, 799314746)

0.11 (0.07, 0.17)

Jordan (JOR)

Upper-Middle Income Country

Eastern Mediterranean Region

Middle East and North Africa

11636717

1.4

3581 (2602, 5018)

58535034 (42526902, 82018978)

0.04 (0.03, 0.06)

Kuwait (KWT)

High Income Country

Eastern Mediterranean Region

Middle East and North Africa

4426561

1.4

1093 (789, 1472)

70537498 (50901421, 94988531)

0.03 (0.02, 0.05)

Lebanon (LBN)

Upper-Middle Income Country

Eastern Mediterranean Region

Middle East and North Africa

5177069

1.4

2455 (1456, 3881)

56635782 (33594930, 89538729)

0.07 (0.04, 0.1)

Libya (LBY)

Upper-Middle Income Country

Eastern Mediterranean Region

Middle East and North Africa

6735543

1.4

4352 (2882, 6342)

121922471 (80745945, 177645935)

0.09 (0.06, 0.13)

Morocco (MAR)

Lower-Middle Income Country

Eastern Mediterranean Region

Middle East and North Africa

35952186

1.4

29911 (18923, 46416)

354345647 (224173894, 549867531)

0.12 (0.07, 0.18)

Palestine (PSE)

Lower-Middle Income Country

Eastern Mediterranean Region

Middle East and North Africa

4956597

1.4

2319 (1318, 3214)

22194362 (12608752, 30751280)

0.07 (0.04, 0.09)

Oman (OMN)

High Income Country

Eastern Mediterranean Region

Middle East and North Africa

4583999

1.4

1820 (1211, 2762)

72365155 (48156665, 109844591)

0.06 (0.04, 0.08)

Qatar (QAT)

High Income Country

Eastern Mediterranean Region

Middle East and North Africa

2864548

1.4

1334 (843, 2051)

176061814 (111222649, 270726130)

0.07 (0.04, 0.1)

Saudi Arabia (SAU)

High Income Country

Eastern Mediterranean Region

Middle East and North Africa

35731972

1.4

13958 (9051, 20915)

875649879 (567782616, 1312052508)

0.05 (0.04, 0.08)

Syrian Arab Republic (SYR)

Low Income Country

Eastern Mediterranean Region

Middle East and North Africa

14491247

1.4

5281 (3494, 7725)

158584259 (104928437, 231990288)

0.05 (0.03, 0.07)

Tunisia (TUN)

Lower-Middle Income Country

Eastern Mediterranean Region

Middle East and North Africa

11571604

1.4

4326 (2647, 6672)

69539274 (42538518, 107244604)

0.05 (0.03, 0.08)

Turkey (TUR)

Upper-Middle Income Country

European Region

Europe and Central Asia

81359693

1.9

33658 (24594, 45402)

1841228492 (1345384134, 2483696368)

0.08 (0.06, 0.11)

United Arab Emirates (ARE)

High Income Country

Eastern Mediterranean Region

Middle East and North Africa

9241704

1.4

1801 (1139, 2797)

164022252 (103700569, 254659101)

0.03 (0.02, 0.04)

Yemen (YEM)

Low Income Country

Eastern Mediterranean Region

Middle East and North Africa

31502896

1.4

25882 (12498, 41730)

80246201 (38747954, 129383175)

0.12 (0.06, 0.19)

Afghanistan (AFG)

Low Income Country

Eastern Mediterranean Region

South Asia

38277536

2.8

28846 (18341, 44475)

183061007 (116395064, 282249129)

0.21 (0.13, 0.33)

Bangladesh (BGD)

Lower-Middle Income Country

South-East Asian Region

South Asia

159259850

2.8

140583 (98853, 197071)

1978914137 (1391503714, 2774080615)

0.25 (0.17, 0.35)

Bhutan (BTN)

Lower-Middle Income Country

South-East Asian Region

South Asia

754250

2.8

470 (266, 917)

15808310 (8946424, 30809118)

0.17 (0.1, 0.34)

India (IND)

Lower-Middle Income Country

South-East Asian Region

South Asia

1390706968

2.8

3562912 (3012663, 4175977)

71098857448 (60118492219, 83332732126)

0.72 (0.61, 0.84)

Nepal (NPL)

Lower-Middle Income Country

South-East Asian Region

South Asia

30416382

2.8

67291 (44787, 92936)

679899510 (452520136, 939015132)

0.62 (0.41, 0.86)

Pakistan (PAK)

Lower-Middle Income Country

Eastern Mediterranean Region

South Asia

224062847

2.8

446253 (261540, 699272)

6883086031 (4034033371, 10785689978)

0.56 (0.33, 0.87)

Angola (AGO)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

30138521

4.2

23761 (14412, 35751)

731787879 (443873486, 1101060924)

0.33 (0.2, 0.5)

Central African Republic (CAF)

Low Income Country

African Region

Sub-Saharan Africa

5299863

4.2

7476 (4565, 12089)

29891166 (18251672, 48335281)

0.59 (0.36, 0.96)

Congo (COG)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

5265846

4.2

3497 (2163, 5600)

67071691 (41488934, 107401310)

0.28 (0.17, 0.45)

Democratic Republic of the Congo (COD)

Low Income Country

African Region

Sub-Saharan Africa

87670444

4.2

69905 (44768, 108618)

338597522 (216840982, 526111932)

0.33 (0.21, 0.52)

Equatorial Guinea (GNQ)

Upper-Middle Income Country

African Region

Sub-Saharan Africa

1419839

4.2

1130 (580, 1989)

98926521 (50762103, 174130481)

0.33 (0.17, 0.59)

Gabon (GAB)

Upper-Middle Income Country

African Region

Sub-Saharan Africa

1750038

4.2

1447 (812, 2366)

95059824 (53319254, 155451673)

0.35 (0.19, 0.57)

Burundi (BDI)

Low Income Country

African Region

Sub-Saharan Africa

11934361

4.2

11654 (7730, 16765)

43453920 (28821713, 62512596)

0.41 (0.27, 0.59)

Comoros (COM)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

714351

4.2

387 (166, 654)

5055669 (2172381, 8542757)

0.23 (0.1, 0.38)

Djibouti (DJI)

Lower-Middle Income Country

Eastern Mediterranean Region

Middle East and North Africa

1202797

1.4

731 (359, 1238)

4411569 (2164977, 7467939)

0.09 (0.04, 0.14)

Eritrea (ERI)

Low Income Country

African Region

Sub-Saharan Africa

6711213

4.2

7297 (3982, 12078)

57066045 (31143164, 94451979)

0.46 (0.25, 0.76)

Ethiopia (ETH)

Low Income Country

African Region

Sub-Saharan Africa

107591164

4.2

77563 (56636, 102167)

795191006 (580641522, 1047437944)

0.3 (0.22, 0.4)

Kenya (KEN)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

50227709

4.2

34721 (26061, 48024)

715823103 (537286739, 990065676)

0.29 (0.22, 0.4)

Madagascar (MDG)

Low Income Country

African Region

Sub-Saharan Africa

26690344

4.2

20999 (14143, 30723)

149229569 (100504601, 218335895)

0.33 (0.22, 0.48)

Malawi (MWI)

Low Income Country

African Region

Sub-Saharan Africa

18442238

4.2

18089 (11161, 27258)

80583379 (49719802, 121425927)

0.41 (0.25, 0.62)

Mauritius (MUS)

Upper-Middle Income Country

African Region

Sub-Saharan Africa

1276663

4.2

1610 (1246, 2034)

166359212 (128678781, 210115752)

0.53 (0.41, 0.67)

Mozambique (MOZ)

Low Income Country

African Region

Sub-Saharan Africa

29528037

4.2

31796 (19484, 47177)

176690900 (108271129, 262161971)

0.45 (0.28, 0.67)

Rwanda (RWA)

Low Income Country

African Region

Sub-Saharan Africa

12688117

4.2

9943 (6102, 15036)

98743798 (60593814, 149318995)

0.33 (0.2, 0.5)

Seychelles (SYC)

High Income Country

African Region

Sub-Saharan Africa

102145

4.2

71 (49, 102)

9923668 (6871028, 14293233)

0.29 (0.2, 0.42)

Somalia (SOM)

Low Income Country

Eastern Mediterranean Region

Sub-Saharan Africa

20343112

4.2

21706 (11789, 36237)

14660241 (7962350, 24474119)

0.45 (0.24, 0.75)

United Republic of Tanzania (TZA)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

56736116

4.2

40981 (26659, 61917)

483292944 (314395427, 730192957)

0.3 (0.2, 0.46)

Uganda (UGA)

Low Income Country

African Region

Sub-Saharan Africa

41117856

4.2

32979 (19386, 50736)

296612500 (174355414, 456319975)

0.34 (0.2, 0.52)

Zambia (ZMB)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

18237683

4.2

19019 (12516, 27735)

297381156 (195707330, 433669383)

0.44 (0.29, 0.64)

Botswana (BWA)

Upper-Middle Income Country

African Region

Sub-Saharan Africa

2338721

4.2

4260 (2475, 6639)

327326149 (190198648, 510148474)

0.77 (0.44, 1.19)

Lesotho (LSO)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

2091588

4.2

7900 (4339, 12143)

100612949 (55260523, 154655606)

1.59 (0.87, 2.44)

Namibia (NAM)

Upper-Middle Income Country

African Region

Sub-Saharan Africa

2403124

4.2

3412 (1954, 5440)

152357926 (87253273, 242928557)

0.6 (0.34, 0.95)

South Africa (ZAF)

Upper-Middle Income Country

African Region

Sub-Saharan Africa

55588425

4.2

68438 (51473, 87062)

3812829364 (2867663792, 4850434450)

0.52 (0.39, 0.66)

Eswatini (SWZ)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

1142109

4.2

3217 (1906, 4981)

117057569 (69346287, 181238570)

1.18 (0.7, 1.83)

Zimbabwe (ZWE)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

15010852

4.2

33169 (20204, 50032)

356468756 (217129222, 537689390)

0.93 (0.57, 1.4)

Benin (BEN)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

12665751

4.2

9569 (5590, 15289)

122694917 (71672032, 196032636)

0.32 (0.19, 0.51)

Burkina Faso (BFA)

Low Income Country

African Region

Sub-Saharan Africa

22691773

4.2

18098 (10157, 28637)

164906681 (92548910, 260930831)

0.33 (0.19, 0.53)

Cameroon (CMR)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

29101868

4.2

26932 (15550, 41672)

428902117 (247628823, 663636189)

0.39 (0.22, 0.6)

Cabo Verde (CPV)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

563563

4.2

552 (360, 810)

18200222 (11863422, 26736635)

0.41 (0.27, 0.6)

Chad (TCD)

Low Income Country

African Region

Sub-Saharan Africa

16398860

4.2

14359 (8601, 21812)

101839056 (61001824, 154703780)

0.37 (0.22, 0.56)

CÔøΩÔøΩte d’Ivoire (CIV)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

26171532

4.2

21587 (12239, 34516)

408594043 (231646640, 653310494)

0.35 (0.2, 0.55)

Gambia (GMB)

Low Income Country

African Region

Sub-Saharan Africa

2245866

4.2

1637 (903, 2615)

15765363 (8694962, 25185637)

0.31 (0.17, 0.49)

Ghana (GHA)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

31536232

4.2

22058 (13136, 33894)

457533180 (272479527, 703043181)

0.29 (0.17, 0.45)

Guinea (GIN)

Low Income Country

African Region

Sub-Saharan Africa

12643149

4.2

10767 (6507, 16582)

111753744 (67542063, 172105692)

0.36 (0.22, 0.55)

Guinea-Bissau (GNB)

Low Income Country

African Region

Sub-Saharan Africa

1901191

4.2

2046 (1264, 3115)

20391996 (12592291, 31045592)

0.45 (0.28, 0.69)

Liberia (LBR)

Low Income Country

African Region

Sub-Saharan Africa

4789907

4.2

3194 (1912, 4769)

18157941 (10871914, 27114065)

0.28 (0.17, 0.42)

Mali (MLI)

Low Income Country

African Region

Sub-Saharan Africa

21917467

4.2

14069 (7908, 22439)

149724451 (84154805, 238796935)

0.27 (0.15, 0.43)

Mauritania (MRT)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

4014273

4.2

1648 (871, 2927)

33075353 (17485362, 58736157)

0.17 (0.09, 0.31)

Niger (NER)

Low Income Country

African Region

Sub-Saharan Africa

23295353

4.2

14931 (8402, 24188)

71226169 (40079361, 115380576)

0.27 (0.15, 0.44)

Nigeria (NGA)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

214823786

4.2

89666 (58082, 136770)

2012228858 (1303432395, 3069308914)

0.18 (0.11, 0.27)

Sao Tome and Principe (STP)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

205385

4.2

65 (36, 99)

1152881 (643326, 1751400)

0.13 (0.07, 0.2)

Senegal (SEN)

Lower-Middle Income Country

African Region

Sub-Saharan Africa

15134067

4.2

12453 (7357, 19177)

178125208 (105237855, 274303184)

0.35 (0.2, 0.53)

Sierra Leone (SLE)

Low Income Country

African Region

Sub-Saharan Africa

8284755

4.2

6378 (3692, 10089)

51915854 (30050988, 82118304)

0.32 (0.19, 0.51)

Togo (TGO)

Low Income Country

African Region

Sub-Saharan Africa

7921527

4.2

6326 (3811, 9558)

45355200 (27324807, 68527143)

0.34 (0.2, 0.51)

American Samoa (ASM)

Upper-Middle Income Country

Western Pacific Region

East Asia and Pacific

55505

2.2

95 (65, 135)

2462689 (1688954, 3517205)

0.38 (0.26, 0.54)

Bermuda (BMU)

High Income Country

Region of the Americas

North America

64030

1.4

12 (9, 15)

1440346 (1074392, 1913681)

0.03 (0.02, 0.03)

Cook Islands* (COK)

High Income Country

Western Pacific Region

East Asia and Pacific

17987

2.2

30 (21, 43)

1923330 (1321382, 2734527)

0.37 (0.25, 0.53)

Greenland (GRL)

High Income Country

European Region

Europe and Central Asia

56188

1.9

323 (251, 409)

66326749 (51565333, 84174739)

1.09 (0.85, 1.38)

Guam (GUM)

High Income Country

Western Pacific Region

East Asia and Pacific

170628

2.2

594 (458, 734)

48642266 (37568543, 60154533)

0.77 (0.59, 0.95)

Monaco (MCO)

High Income Country

European Region

Europe and Central Asia

37572

1.9

20 (14, 28)

6296243 (4449011, 8883685)

0.1 (0.07, 0.14)

Nauru (NRU)

High Income Country

Western Pacific Region

East Asia and Pacific

10551

2.2

53 (32, 76)

1284130 (786755, 1861053)

1.1 (0.67, 1.59)

Niue (NIU)

High Income Country

Western Pacific Region

East Asia and Pacific

1672

2.2

4 (2, 6)

100714 (65668, 149763)

0.49 (0.32, 0.73)

Northern Mariana Island (MNP)

High Income Country

Western Pacific Region

East Asia and Pacific

42494

2.2

128 (95, 167)

6651363 (4919528, 8690874)

0.66 (0.49, 0.87)

Palau (PLW)

High Income Country

Western Pacific Region

East Asia and Pacific

18007

2.2

32 (22, 45)

1219531 (827440, 1722096)

0.39 (0.26, 0.55)

Puerto Rico (PRI)

High Income Country

Region of the Americas

Latin America and the Caribbean

3521431

1.4

1274 (881, 1756)

67908231 (46923685, 93569239)

0.05 (0.04, 0.07)

Saint Kitts and Nevis (KNA)

High Income Country

Region of the Americas

Latin America and the Caribbean

59508

1.4

15 (11, 21)

592036 (409909, 824830)

0.04 (0.02, 0.05)

San Marino (SMR)

High Income Country

European Region

Europe and Central Asia

33100

1.9

20 (12, 30)

2363289 (1494788, 3636808)

0.11 (0.07, 0.17)

Tokelau (TKL)

High Income Country

Western Pacific Region

East Asia and Pacific

1411

2.2

2 (2, 4)

89218 (55924, 133541)

0.38 (0.24, 0.58)

Tuvalu (TUV)

Upper-Middle Income Country

Western Pacific Region

East Asia and Pacific

11798

2.2

38 (24, 55)

374814 (242113, 551313)

0.7 (0.45, 1.03)

United States Virgin Islands (VIR)

High Income Country

Region of the Americas

Latin America and the Caribbean

103985

1.4

28 (17, 43)

1530684 (947169, 2365938)

0.04 (0.02, 0.06)

South Sudan (SSD)

Low Income Country

African Region

Sub-Saharan Africa

9282963

4.2

5636 (3359, 9398)

20703760 (12341451, 34523883)

0.25 (0.15, 0.43)

Sudan (SDN)

Low Income Country

Eastern Mediterranean Region

Sub-Saharan Africa

40808425

4.2

44320 (25293, 69442)

823260978 (469835229, 1289923574)

0.46 (0.26, 0.71)

Footnotes: Values rounded to nearest whole number. UI = Uncertainty Interval

Results

The global economic burden of youth self-harm in 2019 was $251,779,943,868 (95% UI: 208845558648 – 303,222,010,830). Figure 1 depicts economic burden of youth self-harm across countries. Of the 204 countries, India had the largest economic burden of youth self-harm of $71,098,857,448 (60,118,492,219 – 83,332,732,126). The values of economic burden relative to country GDP ranged from 1.5% in Lesotho to 0.03% in Bermuda. Among the World Bank Income Groups, lower-middle income countries had the largest economic burden followed by high-income, upper-middle income, and low-income countries. Among World Health Organization (WHO) regions, South-east Asia had the largest economic burden. Table 2 summarizes disease and economic burdens by WHO regions, World Bank regions, and World Bank Income Groups.

Figure 1: Economic burden of self-harm in people up to 24 years of age as assessed by value-of-life-years (VLYs).

Figure 1: Economic burden of self-harm in people up to 24 years of age as assessed by value-of-life-years (VLYs).

Values are expressed in $ PPP (2020). The color ranges represent quantile breaks. Economic burden = DALY * GDP per capita * factor (defined for World Bank Region)

Table 2: Disease and economic burden of youth (up to 24 years of age) self-harm for different regions and groups.

Group

Youth Self-harm DALYs (95% UI)

Value of Life-Years lost to Youth Self-harm in $ PPP (2020) (95% UI)

Global

 

8455104 (6683109, 10636334)

251779943868 (208845558648, 303222010830)

World Bank Income Groups

High Income Country

947290 (846750, 1054926)

87313653566 (78381337180, 96731973284)

Low Income Country

557811 (346898, 842901)

4292003420 (2685606374, 6433408496)

Lower-Middle Income Country

5158616 (4052159, 6507432)

98973892676 (78509075460, 123666268045)

Upper-Middle Income Country

1791387 (1437303, 2231076)

61200394206 (49269539634, 76390361005)

WHO Regions

African Region

839523 (539804, 1247642)

14405518329 (9584430081, 20799342312)

Eastern Mediterranean Region

779460 (473231, 1194512)

12597469402 (7773911280, 19146496156)

European Region

784795 (647993, 951866)

46544303030 (39233586010, 55443781437)

Region of the Americas

1092861 (932700, 1279003)

53888395577 (48905871496, 59367437110)

South-East Asian Region

4048649 (3352427, 4847754)

81778780713 (67654236545, 98054469814)

Western Pacific Region

909816 (736955, 1115558)

42565476817 (35693523236, 50410484001)

World Bank Regions

East Asia and Pacific

1136573 (896484, 1427702)

48561297335 (39934892177, 58661177802)

Europe and Central Asia

780132 (644158, 946300)

46256020981 (38996464590, 55099671712)

Latin America and the Caribbean

672889 (537083, 834678)

15498205724 (12682007129, 18814007241)

Middle East and North Africa

265828 (175200, 384822)

5351560340 (3627392984, 7661888476)

North America

419972 (395617, 444326)

38390189853 (36223864368, 40553429869)

South Asia

4296991 (3472779, 5279357)

82849107234 (67563296040, 100871715120)

Sub-Saharan Africa

882719 (561790, 1319151)

14873562400 (9817641360, 21560120610)

Footnotes: UI = Uncertainty Interval.

Discussion & Conclusion

To our knowledge, these are the first such comprehensive estimates. Self-harm in youth massively burdens the economies around the world. This necessitates urgent policy attention from the finance, youth empowerment, human resource development, and family welfare ministries beyond health ministries. Multi-sectoral collaboration is essential for planning and implementing effective suicide prevention strategies.9 Policy changes and better financing lie at the foundation of real action to ensure no youth self-harm in the future. 

Acknowledgements

I would like to thank Dr. Divya Shrinivas for help with data assimilation.

 

Disclosure Statement

I represent the Association for Socially Applicable Research (ASAR) on the drafting committee of the Maharashtra State Mental Health Policy.

References

 

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About the Author

Mr. Siddhesh Zadey, BSMS MScGH

Siddhesh Zadey is a health systems, surgical care, and mental health researcher. He is a co-founding director of the non-profit think-and-do tank – Association for Socially Applicable Research (ASAR) based in India. He is also affiliated with Duke University where he leads the work on alcohol use behavioral phenotyping. He is a part of the Mental Health Innovation Network, Global Mental Health Action Network, and currently serves on the Drafting Committee for the State Mental Health Policy of Maharashtra, India. He completed his training from the Indian Institute of Science Education and Research (IISER) Pune and Duke Global Health Institute (US).