Anxiety is the main cause of disability among Brazilian children aged 5 to 9

The research, published in The Lancet Regional Health - Americas, uses data from the GBD 2023 study (Global Burden of Disease, or Global Burden of Disease Study) and shows that more than 15 million Brazilian children, adolescents and young adults aged 5 to 29 live with at least one mental disorder - 20.91% of the entire population in this age group in the country.

Another 2.5 million, 3.36% of the total, meet criteria for a substance use disorder. This is the first time that the situation is detailed by age group, in windows every five years. The research is led by psychiatrist Christian Kieling, from UFRGS (Federal University of Rio Grande do Sul) and Hospital Moinhos de Vento, in Porto Alegre.

For him, this cut from childhood to early adulthood is decisive for thinking about public policy. "If I look at childhood and adolescence as a single whole, soon I will be offering services that address depression issues for children under ten."

It's not that depression doesn't exist in this age group, but it is a much less common problem. After the age of 14 or 15, this prevalence increases, more in girls than in boys. With alcohol, the pattern is reversed, increasing more among boys.

For Kieling, this granularity also exposes a structural error: the abrupt cutoff at age 18, which separates services for children and adolescents from those for adults precisely at the peak of demand for mental health. "It's just at the age when teenagers are going through the biggest transitions in life that we say to them: this is no longer the case. This break doesn't seem to help, it even seems to get in the way."

According to the study, between the ages of five and nine, more than 10% of Brazilian children meet the criteria for at least one mental disorder, a proportion that rises throughout childhood and youth, reaching almost 25% between the ages of 25 and 29.

In the state of São Paulo, hospitalizations for mental and behavioral disorders among children and adolescents grew the most between 2020 and 2025. The age group from 5 to 9 years old recorded the highest percentage increase in hospitalizations among all ages, with an increase of 98.3%.

Comparing with the more than 300 health conditions monitored by GBD in Brazil, anxiety disorders appear first as a cause of disability in all age groups. From the age of 15 onwards, anxiety and depression occupy first and second place in the general ranking, ahead of any physical illness, with a greater impact among girls and women. Alcohol and other drugs are more prevalent among men aged 20 and over.

Kieling points out that "anxiety" is an umbrella that changes shape throughout life. Separation anxiety in childhood, social anxiety disorder in adolescence and, later on, generalized anxiety or panic disorder predominate.

The data becomes even more expressive between 20 and 29 years old, among women, a pattern that had already appeared in a previous global survey of the same group. "In comparison with global data, Brazil draws a lot of attention due to its higher anxiety data, mainly driven by anxiety in women."

The study also paints a picture of suicide mortality among young Brazilians: 5,402 annual deaths between the ages of 10 and 29, of which 77% among boys. The rate per 100 thousand inhabitants rises from 1.24 between 10 and 14 years of age to 13.43 between 25 and 29. From the age of 15, suicide becomes the third cause of premature death among all causes monitored by the GBD in the country.

"The numbers show a large difference between the sexes, which needs to guide specific prevention policies aimed at young males, a group historically little reached by mental health services", says Claudia Buchweitz, researcher and first author of the study. Among indigenous peoples, rates reach more than double the national average, reflecting a serious gap in information and public policy.

For Kieling, even low absolute numbers in young children should be unacceptable: "Any number for a child in terms of suicide is above what should be acceptable to society."

The sharp growth in adolescence, he says, accompanies the increase in mental disorders. "Here we see an opportunity for prevention, to act early before the problem becomes chronic."

The priorities, he summarizes, should be early identification and access to effective care, which the majority of the Brazilian population does not have. "The pattern of seeking help in the country tends to be late. The condition needs to be very serious to arrive at an emergency, often in a suicide attempt, to obtain an adequate referral."

Despite the scale of the problem, the study reveals a gap in knowledge production. To estimate the situation of the entire population aged 5 to 29, the GBD relied on only 66 national data sources, concentrated almost entirely in São Paulo and Rio Grande do Sul, with practically nothing coming from the North, Northeast and Central-West.

"This limited volume reflects and contributes to the lack of attention to the mental health of young people in Brazil", says Buchweitz. "Even with limited sources, the analyzes are rigorous. We need action, immediately."

The GBD uses statistical modeling to estimate prevalence even in "epidemiological gaps", extrapolating from income and regional demographic structure. Kieling defends the methodology, but reinforces the need for more regional data.

However, he says that it is not possible to wait for them to act: "I have a lot of difficulty believing that very different numbers will come from the rest of the country. Waiting for the data to act would be a disservice to the children and the