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The Vulnerability Paradox in Global Mental Health: Psychologist Density, Social Development, and the Disease Burden of Mental Disorder

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Global efforts underscore the imperative of increasing the mental health workforce to improve mental health. However, the “vulnerability paradox” in global mental health questions the effectiveness of increased workforce. Evidence is lacking on whether mental health workforce input can reduce the disease burden of mental disorders at different levels of social development. Data from the Global Burden of Disease Study 2019, United Nations Statistics, and Our World in Data and all data are publicly available. The concentration index (CCI) and slope index (SI) were used to assess psychologist density inequality across 204 countries and territories from 1990 to 2019. Generalized additive mixed model was used to analyze the nonlinear associations among psychologist density, the socio-demographic index (SDI), and age-standardized rates (ASRs) of DALY for mental disorders. Psychologist density increased globally from 1990 to 2019, excluding Zimbabwe. The psychologist density SI increased from 3.8 in 1990 to 10.5 in 2019. CCI decreased from 66.8 in 1990 to 52.8 in 2019. The psychologists were concentrated in countries and territories with higher SDI rankings. Psychologist density had a negative nonlinear association with DALY ASR (EDF, 5.86; P<.001), with a slowing decline as psychologist density increased. SDI correlated positively with DALY ASRs (EDF, 6.36; P<.001). In the interaction between psychologist density and SDI, as SDI increased, the impact of the increase in psychologist density on the reduction of DALY ASRs for mental disorders gradually weakened. Despite an overall increase, substantial global inequality persists in psychologist density. Psychologist density has a notable negative nonlinear association with the disease burden of mental disorders, with varying input-response relationships across different SDI levels. Formulating equity-oriented mental health workforce policies and allocating resources to low human resources for mental health and underdeveloped areas are imperative. And consider reshaping mental health services rather than just increasing the mental health workforce, especially in high-development areas.

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This study was funded by the National Natural Science Foundation of China [grant number 71974114].

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Authors and Affiliations



Yifan Chen: Conceptualization (lead); formal analysis (lead); methodology (lead); software (lead); visualization (lead); writing, original draft (lead); writing, review and editing (equal); data curation (lead); validation (equal). Xiao Li: Methodology (supporting), validation (equal), supervision (supporting), writing—review and editing (equal). Yunxi Zhong: Software (supporting), writing, review and editing (lead). Qixiu Li: Writing—review and editing (equal). Xiaoying Su: Writing—review and editing (equal). Long Sun: Conceptualization (supporting); funding acquisition (lead); project administration (lead); supervision (lead); writing, review and editing (lead); validation (equal); data curation (supporting); validation (equal); resources (lead).

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Correspondence to Long Sun.

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Chen, Y., Li, X., Zhong, Y. et al. The Vulnerability Paradox in Global Mental Health: Psychologist Density, Social Development, and the Disease Burden of Mental Disorder. Int J Ment Health Addiction (2024).

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