The global economic burden of youth self-harm: A systematic analysis of 204 countries and territories for 2019

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.