The silent crisis of the century: Capitalizing nearly 1.2 billion people worldwide lived with a mental disorder in 2023, a number that has almost doubled since 1990. The new data, based on the Global Burden of Disease study, paints a disturbing picture of a world where anxiety, depression, post–traumatic stress disorder, attention deficit disorders, autism, eating disorders, and severe mental illnesses are no longer on the medical fringes, but rather at the heart of the healthcare system, the economy, and society.
According to the study, which was published in the Lancet journal and conducted based on data from 204 countries and territories, in 2023 nearly 1.2 billion people in the world lived with one of 12 mental disorders examined. This represents a 95.5% increase compared to 1990. The largest increases were recorded in anxiety and depression, the two disorders that were also the most common. The researchers found an increase across all 12 disorders examined, including bipolar disorder, schizophrenia, autism, attention deficit hyperactivity disorder, anorexia, bulimia, dysthymia, conduct disorders, and developmental intellectual disability from an unknown source.
The data does not only indicate more diagnoses, but also a shift in the patterns of impact. According to the researchers, mental disorders have become a leading cause of years lived with disability globally, and the burden is particularly heavy among women and among those aged 15 to 39. One of the exceptional findings in the study is that the peak shifted for the first time to the 15 to 19 age group, whereas in the past, the burden of mental disorders tended to peak in middle age. The public significance is clear: Mental impairment begins earlier, at a time when education, social connections, personal identity, and the ability to integrate into adult life are being shaped.
Alongside the real increase in distress, the researchers note several possible explanations: The world's population has grown, life expectancy has extended, diagnosis has improved, and the stigma surrounding seeking mental help has decreased in many countries. But these explanations are not sufficient to erase the broad picture. Economic crises, wars, political instability, loneliness, exposure to violence, social gaps, high treatment costs, the coronavirus pandemic, and the effects of social media are all considered factors that intensify mental distress or expose it earlier.
The coronavirus pandemic remains an important turning point. According to the study, an increase in anxiety and depression rates was recorded even before the pandemic, but during and after the pandemic period, depression rose and did not return to pre–crisis levels. Anxiety reached its peak during the pandemic period and remained high in 2023 as well. The researchers emphasize that the increase in the number of people coping was not accompanied by a sufficient expansion of mental health services, and therefore the gap between need and treatment is deepening.
In Israel, a tragic local reality has been added to the global trend since Black Saturday: The October 7 attack and the Swords of Iron war created broad and continuous exposure to trauma: Murder victims, hostages, the wounded, bereaved families, evacuees, party survivors, soldiers, reservists, children, teenagers, and volunteers who were exposed to difficult sights. It is important to distinguish between symptoms and a full psychiatric diagnosis: Not everyone who reports anxiety, low mood, sleep disturbances, or hyperarousal necessarily suffers from a mental illness, and some of the reactions are natural human reactions to extreme events. But when the symptoms persist, impair functioning, or worsen, they require identification and treatment.
A national survey by the Brookdale Institute, conducted at three points in time since the beginning of the war, found that in January 2024, 41% of respondents crossed a clinical threshold in one of the tools for assessing symptoms of anxiety, depression, or post–trauma. In May 2024, the rate dropped to 32%, but in October 2024, it rose again to 35%. Among those who crossed a clinical threshold in January, a large portion had not returned to the norm by October: 69% of those who crossed a clinical threshold for depression, 65% of those who crossed a clinical threshold for post–trauma, and 52% of those who crossed a clinical threshold for anxiety. Meanwhile, 25% of those who did not cross a clinical threshold in previous measurements became new cases.
The meaning is that this is not just a single wave of distress immediately following the events, but a continuous phenomenon. In the Brookdale survey, 19% of respondents reported severe impairment in daily functioning due to their mental state. Among those who crossed any clinical threshold, nearly half, 48%, reported severe impairment in functioning. The rate of those receiving treatment rose from 14% in the first measurement to 18% in the third measurement, and among those who crossed a clinical threshold, it rose from 23% to 34%. Despite this, many have still not received a solution, mainly due to waiting times, distance, or cost.
The State Comptroller's report on mental health care after October 7 also points to a deep gap between the need and the response. According to a survey conducted by the State Comptroller's Office in April 2024, 38% of participants reported symptoms of post–trauma, depression, or anxiety, or a combination thereof, at a moderate or severe level. The report includes an estimate of about 900,000 people who reported such symptoms at a moderate or severe level and did not seek treatment. The average waiting time to receive mental care in the health funds in March and April 2024 was estimated at about 6.5 months.
The report found that in the half–year following October 7, the health funds and resilience centers provided mental care to less than 1% of Israel's population, while 38% reported significant symptoms. Among evacuees, only 11% received mental care from the health funds and resilience centers in the first half–year. Among the evacuated children of Sderot, about 440 out of about 10,500 children, about 4%, received mental care during that period. Among the party survivors, who experienced severe trauma, 24% received treatment and completed it in the resilience centers and health funds.
Globally and also in Israel, the number of people coping with mental disorders and symptoms is much larger than the current capacity of public systems to provide a quick response. Therefore, early identification, expansion of treatment in the community, shortening of queues, integration of family physicians and pediatricians in initial identification, strengthening of school systems, expansion of resilience centers, and making treatment accessible even to those who do not seek it on their own initiative are required. In a reality where distress has already become a widespread phenomenon, mental health must not be a separate area from public health.