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Country-level association of socio-cultural factors with the burden of four common mental disorders. An ecological analysis using the Global Burden of Disease database


Developed countries have been related to a higher prevalence of mental disorders. This led us to hypothesize that cultural values typical of developed countries could be associated with mental disorders. Here, we sought to determine the association of indulgence (seeking momentary pleasure and freely expressing oneself) and individualism (being able to deviate from in-group norms) with the burden of four mental disorders: depressive, bipolar, anxiety, and eating disorders. We controlled for socio-economic factors (socio-demographic development, income inequality, and unemployment rate), negative life experiences, quality of health care systems, and quality of measurements. We also included world regions fixed effects to account for unobserved geo-spatial factors clustered at the regional level. Our sample included ninety-seven countries. Fully adjusted models revealed that indulgence was associated with an increase in the burden of all four disorders (p < 0.05). A 30 points increase in the indulgence dimension (from Italy = 47 to the UK = 77) was associated with an increase in DALYs by 8.4% (depressive disorders) to 21.0% (eating disorders). Other factors did not demonstrate any such systematic association. Developed nations may be exposed to mental disorders due to socio-cultural factors: seeking pleasure and freedom might be deleterious to population-level mental health.

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The data that support the findings of this study are available from the corresponding author upon reasonable request.


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We wish to acknowledge the contribution of the GBD collaborator network in providing the disease burden estimates, which we downloaded from their publicly available data source ( The GBD network was not consulted nor involved in this paper.

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GB has conceived the study and extracted the data. GB and SL have analysed and interpreted the data, drafted the paper and revised it. Both authors have approved the submitted version and have agreed to be personally accountable for the accuracy and integrity of any part of the work.

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Correspondence to Guillaume Barbalat.

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Barbalat, G., Liu, S. Country-level association of socio-cultural factors with the burden of four common mental disorders. An ecological analysis using the Global Burden of Disease database. Curr Psychol (2022).

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