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Mental health

First Nations Burden of Disease mental health summary

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Key points

The leading causes of total disease burden among First Nations people in 2018 were mental health conditions and substance use disorders (23%), followed by injuries (12%) and cardiovascular diseases (10%).

Burden due to mental health conditions and substance use disorders increased by 21% between 2003 and 2018 for First Nations people.

First Nations males experienced a higher burden from alcohol use disorders while females experienced a higher burden from anxiety disorders.

What is First Nations burden of disease?

The concept of burden of disease has been developed as a way of measuring the impact of diseases and injuries on a population (in this report, First Nations people in Australia). It is the difference between a population's actual health and its ideal health, where ideal health is living to old age in good health (without disease or disability). The AIHW uses "First Nations people" to refer to Aboriginal and/or Torres Strait Islander people in this report.

Burden of disease is measured using the summary measure of disability-adjusted life years (DALY, also know as the total burden in this report). One DALY is one year of healthy life lost to disease and injury. DALY caused by living in poor health (non-fatal burden) are the 'years lived with disability' (YLD). DALY caused by premature death (fatal burden) are the 'years of life lost' (YLL) and are measured against an ideal life expectancy. The use of DALY allows the impact of premature deaths and living with health impacts from disease or injury to be compared and reported in a consistent manner.

This page also presents the total burden or DALY as an age-standardised or 'age-specific' rate (per 1,000 population). Refer below for more information on rates for burden of disease.

Note that the reference year for this report is 2018 as this is the latest year for which Australian burden of disease estimates are available for First Nations people. The First Nations burden of disease results for 2018 are comparable to the national burden of disease results in 2018. However, the First Nations burden of disease results for 2018 should not be compared to the national burden of disease results in 2023 due to different methodology.

What are mental health conditions and substance use disorders?

This report looks at the burden of disease for First Nations people, particularly how the mental health burden compares to the burden from all diseases and injuries. The Australian Burden of Disease Study (ABDS) reports on the mental health conditions and substance use disorders group which encompasses a broad range of conditions including affective disorders (major depressive disorder, dysthymia and bipolar disorder), anxiety disorders, alcohol and drug use disorders, child behavioural & developmental disorders, schizophrenia, and intellectual disability. It excludes suicidal behaviour, self-harm, drug poisoning and drug overdose (which are included in injuries) and dementia, a condition affecting the nervous system (which is included in neurological conditions). For brevity, the label for this group is shortened to 'mental & substance use disorders' for this report.

Spotlight data

What is the burden of mental and substance use disorders for First Nations people?

Overview dashboard: In 2018 for First Nations people there was 65 DALY per 1,000 population for mental and substance use disorders and 289 DALY per 1,000 population for all diseases. The peak rate of burden for mental and substance use disorders occurred in those aged 35–39. Mental and substance use disorders had a much lower age-specific rate for years of life lost compared to other disease groups (mental health and substance use burden is mostly years lived with disability).

Change over time dashboard: From 2003 to 2018 there was a 26% increase in the DALY rate for anxiety disorders with the increase mostly occurring between 2011 and 2018 and peaking in those aged 35–44. There was only a 3% increase for alcohol use disorders from 2003 to 2018, the age-standardised rate for males was over 3 times that for females from 2003 to 2018.

Gap in health outcomes dashboard: In 2018, mental health and substance use contributed to 23% of the DALY burden for First Nations people and 12% for Non-Indigenous Australians. The largest contribution to the gap between First Nations and non-Indigenous Australians for mental and substance use disorders was in those aged 15–24 (51% DALY) and 25–44 (39% DALY). When considering burden type, the gap was largest for years lived with disability (42%).

Source: AIHW Australian Burden of Disease Database.

Data files: Australian Burden of Disease Study 2018 National estimates for Indigenous Australians.

The Australia Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018 found that mental and substance use disorders were responsible for 23% of the total burden of disease (DALY) among First Nations people. This disease group was the leading cause of total burden, followed by injuries (12%) and cardiovascular diseases (10%).

In 2018, the largest contributors to total burden for mental and substance use disorders for First Nations people were:

  • anxiety disorders (23% of total mental and substance use disorders burden)
  • alcohol use disorders (19%)
  • depressive disorders (19%).

After adjusting for differences in population size and age (using age-standardised rates), First Nations people experience an overall burden from disease and injury at 2.3 times the rate on non-Indigenous Australians in 2018. Mental and substance use disorders were the largest contributor to the gap in disease burden (based on age-standardised DALY rate differences), contributing 20% of the gap (AIHW 2022).

How does the mental and substance use disorder total burden vary by sex and age?

First Nations males had a higher age-specific rate (310 per 1,000 population) than First Nations females (268) in 2018. The same pattern applied for the mental and substance use disorders group, First Nations males had a higher age-specific rate (71 per 1,000 population) than females (60).

For specific types of mental and substance use disorders, First Nations females had higher age-specific DALY rates for:

  • anxiety disorders (18 per 1,000 population)
  • depressive disorders (15)
  • bipolar affective disorders (3.5)
  • eating disorders (2.6).

First Nations males had higher age-specific DALY rates for:

  • alcohol use disorders (18 per 1,000 population)
  • drug use disorders (6.8)
  • schizophrenia (6.4)
  • conduct disorders (3.7)
  • intellectual disability (2.9)
  • autism spectrum disorders (2.6)
  • attention deficit hyperactivity disorder (1.8).

Note: results for conduct disorders and autism spectrum disorders should be interpreted with caution due to data quality issues.

Mental and substance use disorders DALY age-specific rate was highest in people aged 35–39 for males and 30–34 for females, males had a higher total burden. This age trend was similar across most types of mental and substance use disorders, except for:

  • attention deficit hyperactivity disorder, autism spectrum disorders and conduct disorders where the burden was highest in children and adolescents
  • eating and drug use disorders where the burden was highest in those aged 25–29 years old.

The leading mental and substance use disorders contributing the most gap between First Nations people and non-Indigenous Australians in 2018 were alcohol use disorders for males (7% of the gap) and anxiety disorders (6%) for females (AIHW 2022).

What is the mental and substance use disorder fatal and non-fatal burden?

Overall, fatal burden (YLL) contributed 47% to the total burden experienced by First Nations people in 2018. However, the burden from mental and substance use disorders was predominantly non-fatal, with fatal burden (YLL) contributing only 2% of the disease group burden in 2018.

For First Nations people in 2018, substance use disorders contributed more to fatal burden than mental and substance use disorders, for example, 64% of the fatal burden was from alcohol disorders and 24% was from drug use disorders (AIHW 2022).

How has the mental and substance use disorder total burden changed over time?

After removing the impact of the increasing age and size of the First Nations population (by using age-standardised rates), the burden from mental and substance use disorders among First Nations people increased by 21% from 2003 to 2018. This pattern from the overall change in total burden for First Nations people, where there was a 15% decrease in the total burden for First Nations people over the same period. The gap in total burden (as measured by the DALY rate difference) between First Nations people and non-Indigenous Australians narrowed by 16% between 2003 and 2018. This was driven by a 28% decrease in the fatal burden (predominately in disease groups other than mental and substance use disorders).

For specific mental and substance use disorders, the largest notable percentage increases in the age-standardised DALY rate from 2003 to 2018 for First Nations people were:

  • 56% for drug use disorders (excluding alcohol)
  • 32% for attention deficit hyperactivity disorder
  • 26% for anxiety disorders
  • 22% for depressive disorders.

Where can I find more information?

This section was last updated in July 2024.