As adolescents age, their mental health tends to deteriorate (especially among girls).
Self-perceived health and life satisfaction is poorer, and self-reported symptoms are higher in girls than in boys.
Adolescents from more affluent families tend to perceive themselves as healthier, report fewer symptoms, and be more satisfied with their lives than those from less affluent families.
Belgian adolescents have a better life satisfaction score and a worse perception of their health compared to the average of the EU-15 countries.
2.Self-perception of health
Boys are more likely to report excellent perceived health compared to girls
In 2018, the proportion of adolescents aged 11 to 18 years with excellent self-perceived health was 35% for boys and 24% for girls in Belgium. As they get older, fewer adolescents, especially girls, report themselves to be in excellent health. Between the ages of 11 and 18, the figures drop from 39% to 31% for boys, and from 33% to 16% for girls.
Health perceived as excellent does not vary much between the two communities
The differences in self-perceived health are small between the two communities. The proportion of boys who perceive their health as excellent was slightly higher among the adolescents from the French Community (36% vs 34%) and, among girls, the proportion was slightly higher among the adolescents from the Flemish Community (25% vs 24%).
There is an important gap in health perception between adolescents of low and high levels of family affluence in the Flemish Community
Among 15 year-old adolescents, excellent perceived health status was associated with high family affluence in the Flemish Community. Boys and girls from the most affluent families were respectively 1.7 times and 2 times more likely to report being in excellent health than those in lower affluent families. In the French Community, the difference in affluence was only observed in girls, with girls from the most affluent families being 1.2 times more likely to report an excellent health status than girls from the lowest affluent families.
Some differences between the Communities were also observed by family affluence group: among the low affluence families, boys from the French Community were 1.6 times more likely to report being in excellent health than boys from the Flemish Community. Among both the low affluence families and the high affluence families, girls from the French Community were respectively 2.5 and 1.5 times more likely to report excellent perceived health than girls from the Flemish Community.
Proportion of adolescents aged 15 with an excellent perception of their health, by Community and family affluence, 2018, Belgium Source: HBSC International report 
Belgium ranks lower than the EU-15 average in health perception in 2018
The 2018 HBSC international report reveals that for the EU-15 countries, 34% of 15-year-old boys and 21% of 15-year-old girls rated their health as excellent. This proportion ranged from 19% to 53% across countries for boys and 12% to 33% for girls. With 33% of 15-year-old Belgian boys and 18% of 15-year-old Belgian girls describing their health as excellent, Belgium is below the EU-15 averages.
Sleep difficulties, feeling nervous, and feeling irritable are the top 3 symptoms reported by boys and girls in Belgium
In 2018, for all adolescents aged 11 to 18 years old, the most frequently symptoms reported daily or more than once a week were sleep difficulties (29% for boys, 36% for girls), feeling nervous (24% for boys, 32% for girls) and feeling irritable (19% for boys, 28% for girls). Conversely, feeling dizzy, headache and stomach pain were the least frequently reported symptoms.
Across all school grade levels, more girls than boys reported having experienced each type of symptom more than once a week. In addition, the order of frequency with which symptoms were reported remained the same for boys and girls.
Symptoms increased with age, particularly in girls
Among girls, several symptoms were much more common at age 15 than at age 11. Feeling nervous increases from 21% to 34%, feeling irritable from 18% to 32%, feeling low from 15% to 26%, back pain from 10% to 19%, headaches from 12% to 22%, and feeling dizzy from 8% to 14%. Stomach pain remained more or less stable and only sleep difficulties decreased consistently with age.
For boys, reporting back pain was more common at age 15 than at age 11, as did, to a lesser extent, feeling nervous, feeling irritable, and feeling dizzy. Sleep difficulties became significantly less frequent with age, from 33% at age 11 to 24% at age 15. Stomach pain also decreased with age.
Proportion of boys reporting symptoms more than once a week, by symptoms and age group (%), Belgium, 2018 Source: unweighted Belgian average base on own calculation on 2018 HBSC international Report 
Proportion of girls reporting symptoms more than once a week, by symptoms and age group (%), Belgium, 2018 Source: unweighted Belgian average based on own calculation on 2018 HBSC international Report 
Boys and girls in the French Community had more symptoms than those in the Flemish Community
Boys and girls in the French Community reported symptoms more frequently than those in the Flemish Community. This difference is even more pronounced for girls than for boys, especially for sleep difficulties, feeling nervous, and feeling low.
Family affluence has an impact on some of the reported symptoms
In 2018 at age 15, in the French Community, boys from low affluence families reported more frequently feeling nervous (30% vs. 22%) and feeling irritable (24% vs. 12%) than those from a high affluence background. The frequency of psychosomatic symptoms in boys was not different by family affluence in the Flemish Community.
In both Communities, the proportion of girls feeling irritable was higher in low affluence families (26% on average) than in high affluence families (18% on average). The same was true for feeling low (24% in low affluence families and 14% in high affluence families). Girls from less affluent families were also more likely to report headaches in both Communities (18% vs 13%), although the difference was not statistically significant for those from the French Community.
Proportion of boys aged 11-18 who reported feeling nervous or irritable more than once a week, by Community and family affluence, Belgium, 2018 Source: 2018 HBSC international Report 
Proportion of girls aged 11-18 who reported feeling nervous or low more than once a week, by Community and family affluence, Belgium, 2018 Source: 2018 HBSC international Report 
Belgian numbers are close to the EU-15 average for multiple health complaints in 2018
The 2018 HBSC international report reveals that for the EU-15 countries, on average 30% of 15-year-old boys and 49% of 15 year-old girls reported multiple health complaints (MHC) more than once a week. This proportion ranges from 19% to 44% for boys and 40% to 75% for girls. With 30% of 15 year-old Belgian boys and 50% of 15 year-old Belgian girls reporting MHC, Belgium was comparable to the European average for boys and slightly below the EU average for girls.
Boys were more satisfied with their lives than girls
The proportion of adolescents who felt they were moderately or very satisfied with their lives was 92% for boys and 87% for girls in 2018 in Belgium. This proportion varied little with age for boys, but dropped sharply for girls between ages 11 and 16, then rose slightly at ages 17 and 18.
Adolescent boys and girls were feeling more satisfied with their lives in 2018 than in 2014 in both Communities
In both Communities, the proportion of boys reporting moderate to high satisfaction with their lives increased between 2014 and 2018 (from 88 to 91% for the French Community and from 91 to 95% for the Flemish Community). In the Flemish Community, the proportion of girls with moderate to high life satisfaction increased between 2014 (85%) and 2018 (91%), while in the French Community, it remained stable.
For both genders, the proportion of adolescents reporting moderate to high satisfaction with their lives was higher in the Flemish Community than in the French Community.
Adolescents living in affluent families had a higher life satisfaction
For 15 year-old adolescents of both genders and both Communities, living in a high affluence family was generally associated with a higher life satisfaction score. The greatest difference was observed among adolescents from the Flemish Community with a mean satisfaction score difference of 0.6 points (among girls and boys). By gender, the score was fairly similar across Communities when family affluence level was taken into account.
Mean life satisfaction score in adolescents ages 15, by gender, Community and family affluence, Belgium, 2018 Source: HBSC International report 
Belgian adolescents reported an above average life satisfaction among EU-15 countries
The 2018 HBSC International Report reveals that for EU-15 countries, the average life satisfaction score for 15 year-olds was 7.5 for boys and 7.1 for girls. This variable ranges from 6.7 to 7.9 for boys and from 6.7 to 7.4 for girls. With an average life satisfaction score of 7.6 for Belgian 15 year-old boys and 7.2 for Belgian 15 year-old girls, Belgium is above the EU average.
According to the WHO (World Health Organization), in 2021, one in seven 10-19 year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group . Depression, anxiety and behavioral disorders are among the leading causes of illness and disability among adolescents. The consequences of failing to address adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.
According to the latest UNICEF estimates, more than 16.3% of young people aged 10 to 19 in Belgium are diagnosed with a mental disorder in line with the World Health Organization's definition . They suppose that these estimates are probably the tip of the iceberg because many children are not diagnosed and the COVID-19 pandemic has raised immense concerns regarding young people’s well-being.
On 30 March 2015, the Interministerial Conference on Public Health (IMC) approved the “Guide to a new mental healthcare policy for children and young people (GMCY)” . Almost immediately, 11 GMCY networks were set up, focusing on children and young people within their area of action. A GMCY network provides a comprehensive and integrated range of services for all children and young people aged 0-23 with mental and/or psychiatric problems. The aim is to respond to the needs of these children, young people and their context or environment as quickly and continuously as possible.
Although networks offering mental health support to young people are developing in Belgium, to date there are relatively few studies that provide national estimates on children’s mental health, especially among the youngest age groups. In 2018, the Belgian Health Interview Survey (HIS)  extended for the first time its field of investigation to include child mental health difficulties, thus providing new elements on the subject. The HBSC (Health Behaviour in School-aged Children) surveys currently provide the most information on the emotional well-being of Belgian youth aged 11 to 18 years.
We used the HBSC surveys to describe three aspects of adolescent mental well-being in Belgium:
Life satisfaction, assessing how satisfied they are with their life based on the Cantril scale.
Self-reported symptoms (psychosomatic symptom)
Symptoms caused by stress and worry, rather than by a physical problem such as an infection. This HBSC indicator includes a list of eight symptoms, for which adolescents were asked to report the frequency with which they have experienced them over the past six months. Five frequency categories, ranging from "about every day" to "rarely or never," were provided.
Multiple Health Complaints (MHC)
In the HBSC international study, adolescents reporting at least two of the eight listed symptoms with a frequency of at least weekly were classified as having MHC.
The perceived state of health of teenagers attending school was assessed in the HBSC studies by using the question: "Would you say that your health is...". Four response categories were proposed: "excellent", "good", "rather good" and "not very good". Students who rated their health as "rather good" or "not very good" were considered to have a rather negative perception of their health.
In the Belgian HBSC studies, adolescents’ level of satisfaction with their lives is measured using the Cantril scale. It is graduated from 0 to 10, with the value 10 representing "the best possible life" and the value 0, "the worst possible life". Following the international protocol of the HBSC study, adolescents with a level between 6 and 10 were considered to have moderate to high satisfaction with their lives.
To classify different socioeconomic groups, HBSC studies use the Family Affluence Scale (FAS), which asks young people about household material possessions using a six-item questionnaire. Responses are scored and summed to form an HBSC FAS score, which has been shown to be a valid indicator of relative affluence. The affluence score is then used to identify groups of young people in the lowest 20% (low affluence), the middle 60% (medium affluence) and the highest 20% (high affluence).
Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. Volume 2. Key data, WHO Regional Office for Europe, 2020. https://www.who.int/europe/health-topics
In 2018, 12% of the adult population reported suffering from low back pain, 8% reported suffering from neck pain, and 15% reported suffering from osteoarthritis.
Women were more affected by musculoskeletal disorders compared to men in the three regions.
In 2018, in both genders, the age-adjusted prevalence of musculoskeletal disorders was higher in the Walloon Region, followed by the Flemish Region and the Brussels Capital Region.
Between 2008 and 2018, the percentage of adults suffering from a musculoskeletal disorder increased in the Flemish and Walloon Region, for both genders.
2.Prevalence of musculoskeletal disorders
7% to 15% of all Belgians reported suffering from a musculoskeletal disorder
Musculoskeletal disorders refer to complaints that are located in the musculoskeletal system and include, among others, low back pain, neck pain, and osteoarthritis. These complaints are often limiting people in their day-to-day activities, and they might become chronically painful and disabling diseases. Often disregarded due to their low fatality rate, musculoskeletal disorders account for the greatest proportion of persistent pain, affecting physical function and mental health, increasing the risk of developing other chronic health conditions.
In Belgium in 2018, 12% of the population reported suffering from low back pain, 7.8% from neck pain, and 15% from osteoarthritis. In general, the occurrence of musculoskeletal disorders increased with age with 24% of people over 75 years of age reporting suffering from low back pain, 13.2% from neck pain, and 44% from osteoarthritis.
When analyzing the age-adjusted self-reported prevalence for men, the prevalence of low back pain, neck pain, and osteoarthritis was 11%, 5.3%, and 15%, respectively. In women, the age-adjusted prevalence of low back pain, neck pain, and osteoarthritis was 13%, 10%, and 22% respectively.
Low back pain, neck pain, and osteoarthritis were more commonly reported among women for all age groups. An exception is observed for low back pain in the group of people between 25 and 34 years old, where men showed a higher prevalence than women.
The gender difference was more pronounced in people aged 45 and over, for whom the prevalence of low back pain was between 1.1 and 1.5 times higher in women, the prevalence of neck pain was between 1.5 and 2.9 times higher in women, and the prevalence of osteoarthritis was between 1.4 and 1.5 times higher in women.
The highest prevalence of musculoskeletal disorders was found in the Flemish Region and Walloon Region
In 2018, for every musculoskeletal disorder, the highest age-adjusted prevalence was observed in the Walloon Region, followed by the Flemish Region, and the Brussels Capital Region, in men and women. The age-adjusted prevalence of every musculoskeletal disorder was higher in women in all regions.
The number of people that suffer from a musculoskeletal disorder is increasing over time
Between 2008 and 2018, the age-adjusted prevalence of low back pain and neck pain increased in both genders. The number of people suffering from low back pain increased by 26% in men, and 3.9% in women, while the number of people suffering from neck pain increased by 23% in men and 20% in women. For osteoarthritis, data is only available from 2013 onwards, whereby the number of people suffering from osteoarthritis increased between 2013 and 2018 by 16% in men, and 4.8% in women.
In men, the age-adjusted prevalence of low back pain, neck pain, and osteoarthritis have generally increased over time in the Flemish Region and the Walloon Region between 2008 and 2018, and it has remained stable or even decreased in the Brussels Capital Region.
In women, the age-adjusted prevalence of low back pain, neck pain, and osteoarthritis have generally increased over time in the Flemish Region and the Walloon Region between 2008 and 2018, and it has remained stable or even slightly decreased in the Brussels Capital Region.
Musculoskeletal disorders are one of the main causes of morbidity worldwide, particularly in high-income countries. Musculoskeletal disorders include disorders that primarily affect the musculoskeletal system, and the most common musculoskeletal disorders include low back pain, neck pain, and osteoarthritis. Low back pain and neck pain are disorders that are characterized by pain reported in a specific area, for which in 90% of the cases no specific structural cause can be identified. Osteoarthritis is a degenerative joint disease that most frequently occurs in the hands, hips, and knees.
Health determinants for musculoskeletal disorders include socio-demographic, occupational, and lifestyle factors. These socio-demographic factors include low education, middle age, and sex (i.e. women have a higher risk compared to men). Occupational factors include performing manual work, and lifestyle factors include smoking, physical inactivity, and sedentary behavior.
The indicators that are presented on this page:
The prevalence of low back pain, neck pain, and osteoarthritis refer to people who have reported suffering from a specific musculoskeletal disorders during the last 12 months and is derived from the Belgian Health Interview Survey . The prevalence estimates are calculated based on a population aged 15 years and more.
Low back pain
Low back pain is defined as pain in the lumbosacral region, usually accompanied by painful limitation of motion, influenced by strain and the adoption of certain postures, and which may be associated with referred pain. When diagnosed as non-specific low back pain, it is assumed that there are no underlying conditions such as fractures, spondylitis, direct trauma, or neoplastic, infectious, vascular, metabolic, or endocrinology-related processes that might cause pain. The diagnosis is based on the self-reported symptomatology of patients.
Neck pain is defined as pain that starts in the neck and can be associated with radiating pain down one or both of the arms. When diagnosed as non-specific neck pain, it is assumed that there are no underlying conditions such as fractures, spondylitis, direct trauma, or neoplastic, infectious, vascular, metabolic, or endocrinology-related processes that might cause pain. The diagnosis is based on the self-reported symptomatology of patients.
Osteoarthritis is defined as a type of degenerative joint disease that results from the breakdown of joint cartilage and underlying bone. The most common symptoms are joint pain and stiffness. The diagnosis is made with reasonable certainty based on history and clinical examination, using radiographic imaging.
In 2018, 1.3% of the population reported suffering from angina pectoris. This percentage increases with age, reaching 3.8% in people aged 65 years and over.
In people aged 65 years and over, the self-reported prevalence of angina pectoris was higher in men in the three regions.
Between 2008 and 2018, the percentage of people aged 65 years and over reporting to suffer from angina pectoris has decreased in the three regions, in both genders, and more in women than in men.
In 2017, the number of people having been diagnosed with an acute myocardial infarction (AMI) was estimated at 20,253 in Belgium (178 cases per 100,000 inhabitants). Among them, 67.4% were men. The incidence rate of AMI increases with age and is higher in men in all age groups.
In 2017, in both genders, the age-adjusted incidence rate of myocardial infarction was higher in Wallonia, followed by Flanders and Brussels.
Between 2008 and 2017, the age-adjusted incidence of myocardial infarction has decreased in both genders.
Ischemic heart disease (IHD) is the main cause of death worldwide except in lowest-income countries. IHD, also called coronary heart disease, refers to heart problems caused by a narrowing of the coronary arteries (atherosclerosis), resulting in a reduced blood flow and oxygen supply (ischemia) to the heart muscle. In atherosclerosis, the arteries are narrowed when plaques build up inside, containing fat, cholesterol from low-density lipoproteins (LDL), fibrous tissues and sometimes calcium.
Many people do not experience any symptoms in the early stages of IHD. However, if left untreated, atherosclerosis progresses and symptoms may occur, which can be very disabling. The discomfort experienced when the heart muscle is lacking of oxygen is called angina pectoris. When the blockage of the blood flow is complete, the heart cells may die or suffer from serious damages, and this is what is called a myocardial infarction or a heart attack.
The main risk factors for IHD include physical factors such as high blood pressure, high cholesterol risk factor, diabetes, and behavioral factors such as tobacco use, unhealthy diet, alcohol abuse, and lack of exercise, which means that a part of the risk may be preventable by adopting a healthy lifestyle.
Two indicators are presented in the following sections:
The prevalence of angina pectoris refers to people who have reported suffering from angina pectoris during the last 12 months, and is derived from the Belgian Health Interview Survey . We shall first describe the global prevalence in people aged 15 years and more; then we will focus on people aged 65 and over.
Different indicators can be defined to describe the occurrence of acute myocardial infarction (AMI). The "attack rate" (or incidence by episode) represents all first or recurrent events, while the term "incidence" means a first-ever event. Based on the availability of the data, we defined the yearly incidence as the first event in a given year. This indicator is built using the hospital discharge data from the Federal Public Service Health, Foodchain safety and Environment  from which infarction cases that were hospitalized and discharged alive are derived. It has to be noted that data of 2015 are not available due to the change of classification system from ICD-9 to ICD-10. To these cases have been added the cases of people who died of a heart attack (in hospital or not), extracted from the Sciensano Standardized Procedures for Mortality Analysis (SPMA) .
In 2018, 1.3% of the population reported suffering from angina pectoris, a symptom of coronary heart disease. This percentage increases with age, going up from 0% in people aged 15-24 to 3.8% in people aged 65 years and over, and to 4.7% in people aged 75 and over.
Angina pectoris was more commonly reported among men, except in the 25-34 and 55-64 age groups. The age-adjusted self-reported prevalence of angina pectoris was higher in men (1.8%) than in women (1%).
Among people aged 65 and over, the prevalence was 3.8%.
The gender difference was more pronounced in people aged 65 and over, in whom the prevalence of angina pectoris was 2.5 times as high in men.
In people aged 65 and over, between 2008 and 2018, the age-adjusted prevalence of angina pectoris has decreased in both genders, but to a lesser extent in men (-24%, and not statistically significant) compared to women (-61%).
Among men aged 65 and over, the regional patterns have fluctuated over time and do not allow clear conclusions about the evolution.
Among women aged 65 and over, the prevalence of angina pectoris has steadily decreased in Flanders between 2008 and 2018. In Brussels, it has decreased between 2008 and 2013 and remained stable between 2013 and 2018. In Wallonia the decrease was not significant.
The crude self-reported prevalence of angina pectoris is higher in people with a low level of education, but after adjustment for age, there are no socio-economic disparities between the different levels of education, even among people aged 65 and over.
4.Acute myocardial infarction incidence
Situation in 2017
In 2017, the number of persons having been diagnosed with an acute myocardial infarction (AMI) was estimated at 20,253 (178 diagnoses per 100,000 inhabitants), among which 15,928 were discharged alive and 4,325 died.
Among people with AMI, 67.4% were men. The number of person having suffered of AMI was higher in men at any age excepted in oldest age groups (+85 years). The highest number of AMI was observed in age group 60-65 among men, and in age group 85-89 among women. The incidence rate of AMI increases with age and was higher in men in all age groups.
In Brussels, in 2017 the age-adjusted incidence of AMI was 227 per 100,000 among men and 81 per 100,000 among women, and hence lower compared to the other regions in both genders. In Wallonia, the age-standardized incidence rate of AMI was 284 per 100,000 among men and 108 per 100,000 among women, which was above the age-standardized Belgian incidence rate (respectively 269 per 100,000 and 102 per 100,000). In Flanders, the age--standardized incidence rate of AMI was 251 per 100,000 among men and 92 per 100,000 among women.
Between 2008 and 2017 (2015 not included), the age-adjusted incidence of myocardial infarction has decreased in both genders, going from 301 per 100,000 in 2008 to 269 per 100,000 in 2017 in men and from 134 per 100,000 in 2008 to 102 per 100,000 in 2017 in women. This decrease was less pronounced among men (-10.6%) compared to women (-23.9%).
Between 2008 and 2017 (2015 not included), in both genders, the age-adjusted incidence of myocardial infarction has decreased in the three regions. Among men, this decrease was similar across all regions with a decrease of 11.3% in Flanders, a decrease of 10.6% in Brussels, and a decrease of 11.5% in Wallonia. Among women, the change was more pronounced in Brussels (-26.4%) and Flanders (-26.4%) compared to Wallonia (-21.7%).
Angina pectoris, or angor, is one of the symptoms of coronary heart disease. Angor is defined as a pain or discomfort in the chest or adjacent areas, precipitated by exercise, emotion or a heavy meal, caused by a reduced supply of oxygen to the heart (ischemia) due to a stenosis (narrowing) or blockage of the coronary arteries.
Acute myocardial infarction
Acute myocardial infarction (AMI), also called heart attack, is a necrosis (death) of the heart cells, resulting from an acute obstruction of a coronary artery. The symptoms include chest pain or discomfort, dyspnea (shortness of breath), and nausea. In some cases, AMI can be asymptomatic. The main risk factors are age, tobacco, high blood pressure, high blood cholesterol, alcohol abuse, obesity and diabetes.
Suicidal behaviors (thoughts, attempts, and completed suicides) represent an important public health and societal problem in Belgium.
In 2018, 4.3% of the population had seriously considered suicide and 0.2% had attempted to commit suicide in the last 12 months. Women, middle-aged people, and the lowest educated group were more at risk.
In February 2023, around one out of 6 young people (18-29 years old) reported having seriously considered suicide during the last 12 months.
While more women consider and attempt to commit suicide, more men succeed: 1260 suicides were recorded in men and 475 in women in 2020.
There is no increase in the suicide rate in 2020.
Suicide is the leading cause of death among young people. In the 15-24 age group, more than one death out of four were due to suicide.
2.Suicidal behaviour during the COVID-19 crisis
Suicidal thoughts and suicide attempts were high during the COVID-19 crisis
10% of individuals in February 2023 reported having seriously considered suicide in the last 12 months. Among young women (18-29 years), this percentage rises to 18%.
0.4% of individuals in February 2023 reported having attempted suicide in the last 12 months. Among young people (18-29 years), this percentage rises to 2.0%.
Middle-aged women are more likely to report suicidal thoughts
In 2018, in Belgium, 14% of the population aged 15 years and over had at least once in their life seriously considered suicide; within this group, one in three (or 4.3% of the total population) had thought about committing suicide in the last 12 months. More women (16%) than men (12%) reported suicidal thoughts in their life, while there were no gender differences in suicidal thoughts in the past year (4.4% in women vs 4.2% in men). People aged 65 years and over were less likely to report suicidal thoughts in their life or in the past year than people younger than 64 years. Women in the age group 45-54 years had a particularly high prevalence.
The proportion of people that considered suicide in the last 12 months (as well as in their lifetime) is lower in 2018 than in 2013, but the proportion is still higher than the values observed in 2008 (differences are not significant).
Suicidal thoughts are more frequent in the Walloon Region and the Brussels Capital Region
Lifetime suicidal thoughts were more frequent in the Walloon Region (16%) than in the Flemish Region (13%); suicidal thoughts in the last year were more prevalent in the Walloon Region (5.9%) and in the Brussels Capital Region (5.1%) than in the Flemish Region (3.3%). The prevalence of suicidal thoughts decreased in the Flemish Region between 2013 and 2018 while it remained relatively stable in the Brussels Capital Region and in the Walloon Region.
Prevalence of suicidal thoughts in the last 12 months among women aged 15 years and over by region, Belgium, 2008-2018 Source: Own calculations based on Health Interview Survey, Sciensano 
Suicidal thoughts are more frequent in the lowest educational group
Suicidal thoughts (lifetime and in the past year) are linked with the educational level. People from the lowest educational group were 1.5 more likely to have considered suicide in their life and 2.5 more likely to have considered it in the last year compared to people from the highest educational group.
Prevalence of suicidal thoughts in the lifetime and in the past year among the population aged 15 years and over by educational level, Belgium, 2018 Source: Own calculations based on Health Interview Survey, Sciensano 
More women have a failed suicide attempts
In 2018, in Belgium, 4.3% of the population aged 15 years and over reported to have attempted to commit suicide in their lifetime and 0.2% in the last year. More women (5.4%) than men (3.1%) tried to commit suicide in their lifetime and in the last year (0.3% in women and 0.2% in men). The prevalence of lifetime suicide attempts was higher in people aged between 35 and 54 years. Younger people (15-24 years) and 45-54 years were more likely to report a suicide attempt in the last year.
Trends in the prevalence of lifetime suicide attempts are relatively stable in Belgium and its regions. Suicide attempts decrease between 2013 and 2018 in men and women in the Brussels Capital Region but this was not significant.
Suicide attempts are more frequent in the Walloon Region
People from the Walloon Region were more likely to have attempted to commit suicide (6%) than people from the Brussels Capital Region (4.2%) and the Flemish Region (3.3%).
Suicidal attempts are more frequent in the lowest educational group
Suicide attempts (lifetime and in the past year) were linked with the educational levels. People from the highest educational group were less likely to attempt suicide than people from the lower educational group.
Prevalence of lifetime and past year suicide attempts among the population aged 15 years and over by educational level, Belgium, 2018 Source: Own calculations based on Health Interview Survey, Sciensano 
Suicide remains stable at 1735 deaths in 2020
In 2020, in Belgium, 1735 deaths from suicide were registered (compared to 1728 in 2019). There were more deaths by suicide in men (1260) than in women (475). The highest number of suicide deaths occurred in the 45-64 age group. These numbers are probably underestimated due to the limitations mentioned in the background section.
The mortality rate due to suicide is higher in men
The age-adjusted mortality rate due to suicide was 15.2 (per 100 000 people) in 2020 in Belgium. It was 2.8 times higher in men (23) than in women (8.1).
Suicide rates by age group are presented pooled over a 3-year period to avoid jumps due to small numbers. Suicide rates are higher for men than for women at any age, showing a gender difference in suicide. Suicide rates are the highest for men aged over 85 and for women between 45 et 64 years old.
Suicide represents a high share of deaths among young people
The share of deaths due to suicide by age group represents the relative importance of this cause in all deaths occurring in that age group. This has a different age distribution from that of the suicide mortality rates because the denominator of the share (all deaths in a given age group) is much larger at older ages, whereas the denominator of the rates (number of people in a given age group) is smaller at older ages.
Suicides accounted for a significant proportion of deaths among young people, indeed suicide deaths represent 28% of deaths in men aged 15-24 and 25% of deaths among men aged 25-44. Suicides represent 25% of deaths in women aged 15-24 and 14% in women aged 25-44.
Due to the increase in the number of deaths from concomitant causes at higher ages, the share of suicide deaths decreases with age.
Trends in suicide deaths are better understood together with deaths of undetermined intent
Between 2010 and 2020, suicide rates are decreasing in men and, to a smaller extent, in women. However, pooling the suicides with the external deaths of undetermined intention reveals a stagnation to no decrease in both genders.
Suicide alone and suicide pooled with events of undetermined intent age-adjusted mortality rates by sex, Belgium, 2000-2020 Note: In the past, suicide rates in Brussels were underestimated for some years due to the delay of the justice department in transmitting files. Source: Own calculations based on the death certificates database, Statbel 
Deaths from suicide are decreasing in the Walloon Region
Between 2010 and 2020, suicide rates among men decreased by 15% in the Flemish Region and by 26% in the Walloon Region. Among women, the suicide rates are, during the whole period, at a much lower level than among men in all regions and showed a similar decrease.
When pooling suicide with the deaths from events of undetermined intent, the rates are decreasing slower or even increasing in the Flemish Region.
Between 2019 and 2020, age-adjusted mortality rates decreased in the Walloon Region but increased in the Brussels Capital and Flemish Region.
Suicide alone and suicide pooled with events of undetermined intent age-adjusted rates among men by region, Belgium, 2000-2020 Note: In the past, suicide rates in Brussels were underestimated for some years due to the delay of the justice department in transmitting files. Source: Own calculations based on the death certificates database, Statbel 
Suicide alone and suicide pooled with events of undetermined intent, age-adjusted rates among women by region, Belgium, 2000-2020 Note: In the past, suicide rates in Brussels were underestimated for some years due to the delay of the justice department in transmitting files. Source: Own calculations based on the death certificates database, Statbel 
The high suicide rate in Belgium must be interpreted with caution
Belgium has the highest suicide rates among the EU-14 countries, both among men and women. The rates are 1.5 times higher for men and 1.6 times higher for women than the average rate of the EU-14 countries. However, international comparison of suicide mortality rates should be interpreted with caution as differences in socio-cultural context and data quality hamper the comparability between countries. Nevertheless, this warning should not serve to minimize the problematic suicide rates in Belgium.
Suicide age-adjusted rates among men by country, EU-14, 2020 Source: Eurostat 
Suicide age-adjusted rates among women by country, EU-14, 2020 Source: Eurostat 
If you are in distress or in need of emotional/psychological support, do not hesitate to call 02 648 40 14 for the community help service helpline, or visit the Community Help Service online.
Suicide and suicide attempts are important societal and public health issues. They have ripple effects on families, friends, colleagues, communities, and society on the whole. Suicide occurs throughout the lifespan and was the second leading cause of death among 15-29-year-olds in the world in 2016. Suicide is preventable and its prevention has been prioritized by the World Health Organization (WHO) as a global target and included as an indicator in the United Nations Sustainable Development Goals (SDGs) . To effectively develop suicide prevention strategies, efficient monitoring of suicide as well as identification of specific groups at risk is needed.
Suicidal thoughts never have just one cause but arise due to an interaction of risk and protective factors. These risk factors are always a combination of biological, psychological, social, and psychiatric risk factors. Suicidal thoughts also do not evolve linearly but with ups and downs. An entire process always precedes suicide . The strongest risk factor for suicide is a previous suicide attempt . The current COVID-19 crisis is particularly affecting the population's mental health and has a negative impact on some of the risk factors linked to suicide.
To apprehend this complex phenomenon, we use several indicators:
Suicidal thoughts are an important risk factor for future suicide and important for prevention.
Suicide attempts are a strong risk factor for completed suicide and a key moment to provide help to the person [9,14].
Suicide deaths: we report the number of deaths, the mortality rate, and the share of total deaths that are due to suicide by age group. As suicides are often poorly recorded, these numbers are probably underestimated [10-13]. Misclassifications can occur when the exact cause of death is unknown (suicide may thus be classified as ‘unknown cause’); when the intention is not clear (suicide may thus be classified as 'deaths of undetermined intent'); or when the intention is wrongly evaluated (suicide may thus be classified as ‘accidents’ or ‘homicides’). It may also be possible that the doctor avoids mentioning suicide to protect the family from different problems (insurance, administration, religion, …). Additionally, administrative procedures can lead to misclassifications. For example, in Brussels, for certain years, the prosecution office failed to classify violent deaths (suicides, homicides), leading to a consequent under-reporting of suicides which were then classified as deaths of undetermined intent . Moreover, the reasons for misclassification strongly vary across countries, which limits the interpretation of international comparisons. To partly reduce these biases in the interpretation of trends, we present, in addition to the suicide mortality rates, mortality rates grouping suicides (codes X60-X84; Y87.0) and events of undetermined intent (codes Y10-Y34; Y87.2).
First, we give an overview of suicidal thoughts and attempts during the COVID-19 crisis based on the data collected through the online COVID-19 health surveys. Then, we go more in-depth into the suicidal thoughts and attempts based on the previous health interview surveys. Finally, we look at mortality due to suicide.
Age-standardized rates (prevalence, incidence, or mortality)
Since most health indicators are strongly influenced by age, comparisons (among regions, educational levels, and over time) need to be standardized by age. The age-standardization removes the impact of differences in the age structure between populations or over time. The age-standardized rate is a weighted average of age-specific rates. The weights are derived from the same reference (standard) population.
The EU-14 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, and Sweden. We compare the Belgian health status to that of the EU-14 because these countries have similar socioeconomic conditions. Note: The United Kingdom is not included since 2020.
Sixième enquête de santé COVID-19 : résultats préliminaires. Deposit number D/2021/14.440/30. Brussels: Sciensano; 2021. doi: 10.25608/j877-kf56
Centre de prévention du suicide. LE SUICIDE UN PROBLEME MAJEUR DE SANTE PUBLIQUE Introduction à la problématique du suicide en Belgique Chiffres de 2014. Bruxelles, Belgique: Centre de prévention du suicide; 2017 Sep.
De Spiegelaere M, Wauters I, Haelterman E. Le suicide en Région de Bruxelles-Capitale: Situation 1998-2000. Brussels: Observatoire de la santé et du social de Bruxelles- Capitale; 2003.
Ohberg A, Lonnqvist J. Suicides hidden among undetermined deaths. Acta Psychiatr Scand. 1998.
Jougla E, Pequignot F, Chappert J, Rossollin F, Le TA, Pavillon G. Quality of suicide mortality data. RevEpidemiolSante Publique. 2002.
Moens GFG. The reliability of reported suicide mortality statistics: An experience from Belgium. Int J Epidemiol. 1985.
In 2021, 6.8% of the Belgian population had a known diabetes diagnosis. However, more than one in three people with diabetes are not aware of their diabetes, which sets the estimated true prevalence of diabetes at 10.0%.
Diabetes prevalence is increasing over time as a result of the ageing population and an increase in the risk of developing diabetes.
The prevalence of diabetes is higher in the Walloon Region and the Brussels Capital Region compared to the Flemish Region. The prevalence is also higher for individuals with a lower socioeconomic status. These socioeconomic differences in the prevalence of diabetes are especially found for the prevalence of unknown or insufficiently controlled diabetes.
Five percent of Belgians are not aware of their diabetes
In 2021, 6.8% of the Belgian population was diagnosed with diabetes according to the IMA-AIM Atlas. The prevalence of diabetes increases with age and is higher among men, especially in the older age groups.
Prevalence of diagnosed diabetes by age and sex, Belgium, 2021 Source: IMA-AIM Atlas 
According to the BELHES in 2018, the estimated total prevalence of diabetes reached 10%, which includes more than one in three people with diabetes (37%) that is unaware of their diabetes status. 7.7% of people used diabetes medication. Still, among those, 19% have diabetes which is not well controlled. In other words, 5% of the population is suffering from diabetes either without awareness or proper diabetes control.
Prevalence of diabetes by sex and status, Belgium, 2018 Source: BELHES 
The prevalence of diabetes is increasing over time
The prevalence of diagnosed diabetes is the highest in the Walloon Region and the lowest in the Flemish Region, despite the relatively higher age of the Flemish population. The relatively low diagnosed diabetes prevalence in the Brussels Capital Region is probably the result of the younger age of its population. When corrected for age, the diagnosed prevalence of diabetes in the Brussels Capital Region becomes higher than the Belgian average. The BELHES has also shown that in the Walloon Region, more people are unaware of their diabetes status compared to the Brussels Capital Region and the Flemish Region.
From 2007 to 2021, the prevalence of diagnosed diabetes has increased in all three regions, as a result of both the ageing of the populations and a true increase in the risk of developing diabetes that could, for example, be related to an increase in overweight/obesity. The age-adjusted prevalence of diabetes increased by 25% in the Walloon Region, with 24% in the Brussels Capital Region and the Flemish Region.
Crude prevalence of diagnosed diabetes in Belgium and its regions, 2007-2021 Source: IMA-AIM Atlas 
Age-standardized prevalence of diagnosed diabetes in Belgium and its regions, 2007-2021 Source: Own calculations based on IMA-AIM Atlas 
Belgians with an increased compensation status have an increased risk of diabetes
The prevalence of diagnosed diabetes (IMA) is nearly twice as high among individuals with an increased compensation status than among individuals with a normal compensation status. The prevalence of diagnosed diabetes has been increasing in both groups over time.
The BELHES has shown that people with a lower education are significantly more likely to suffer from ignored or poorly controlled diabetes compared to people with a higher education (RR=3.6, adjusted for age and gender). This could indicate that there are socioeconomic inequalities in the screening and follow-up of diabetes.
Age-standardized prevalence of diagnosed diabetes by compensation status, Belgium, 2007-2021 Source: Own calculations based on IMA-AIM Atlas 
Diabetes is a condition that is characterized by recurrent high blood sugar levels. If left untreated, diabetes may cause long-term complications such as foot ulcers, damage to the eyes, chronic kidney disease, and cardiovascular disease. A diabetic diet and exercise are important parts of diabetes management, but in a large number of cases, drug therapy will also be required.
A distinction is made between three main types of diabetes:
Type 1 diabetes, resulting from autoimmune destruction of the insulin-producing beta cells in the pancreas;
Type 2 diabetes, due to the body's inefficient use of insulin, mainly caused by a combination of excessive body weight and insufficient exercise; and
Gestational diabetes occurs in pregnant women without a previous history of diabetes.
In the absence of an exhaustive diabetes register, several sources of information can be used in Belgium:
The InterMutualistic Agency (IMA-AIM) is a platform where data gathered from the seven Belgian health insurance funds are collected and analyzed. IMA-AIM data are, amongst others, made available through the IMA-AIM Atlas .
In the IMA-AIM database, information is found on the use of antidiabetic treatment or on diabetes referring nomenclature. This is considered a good proxy for the prevalence of diagnosed diabetes. Socio-economic characteristics are scarce in the IMA-AIM Atlas. The status of “insured people having the right to an increased compensation” is the only available proxy indicator, and it has only two values, yes or no. Persons with a low income or specific medical characteristics such as invalidity are entitled to an increased compensation status.
Since diabetes is a disease with insidious onset, many cases remain undiagnosed. Information on undiagnosed diabetes prevalence is available in the BELHES. The BELHES used self-reported data on diabetes medication use from the Health Interview Survey and objective measurements on blood samples (blood glucose and glycated haemoglobin) to estimate the total diabetes prevalence.
The age-standardized prevalence is a weighted average of the individual age-specific prevalences using an external standard population. It is the prevalence that would be observed if the population had the age structure of the standard population. Since age has an important influence on the risk of diabetes, this standardization is necessary when comparing several populations that differ with respect to their age structure. Here, the Belgian 2018 mid-year population is used as standard population.
Increased compensation status
Persons with a low income are entitled to an increased compensation status. They pay less for healthcare and have other financial benefits. Currently, this is the only variable available in the IMA-AIM Atlas that allowsfor assessing socio-economic differences.
Diagnosed diabetes prevalence
The diagnosed diabetes prevalence is estimated based on the number of insured people with the delivery of antidiabetics (ATC code A10) or with another diabetes referring nomenclature (diabetes convention, diabetes pass, diabetes care trajectory). Women who gave birth during the year under review are excluded in order to exclude gestational diabetes.
Estimated total diabetes prevalence
The estimated total diabetes prevalence is defined as fasting blood glucose ≥ 126 mg/dl or glycosylated haemoglobin (HbA1C) ≥ 6.5% or the use of anti-diabetic drugs (self-reported).
Please note that the following numbers should be interpreted in the context of COVID-19
In 2020, 68,782 new diagnoses of cancer were registered, including 31,942 new cases in women and 36,840 in men. The most frequently diagnosed cancers were prostate cancer, lung cancer, and colorectal cancer in men, and breast cancer, colorectal cancer, and lung cancer in women.
Since 2006, the number of new cancer diagnoses has increased in both men and women, driven in part by the aging of the population. After adjusting for age, incidence have only increased in women.
The age-adjusted incidence for women are highest in the Flemish Region in 2020. In men, they are highest in the Flemish and the Walloon Region in 2020 for men.
Since 2006, the age-adjusted incidence of lung cancer has increased by 13% in women and decreased by 8.4% in men. Over the same time period, the age-adjusted incidence of melanoma has increased by 130% in men and 88% in women.
The number of registered new cancer cases drops from 71,651 in 2019 to 68,782 in 2020
In 2020, 68,782 new diagnoses of cancer (excluding non-melanoma skin cancer) were registered, including 36,840 new cases in men and 31,942 new cases in women.
Cancer incidence increases with age, with the highest incidence in the 80-84 age group. Before the age of 55, cancers are more commonly diagnosed among women, while in the older age groups, cancer diagnoses become more common among men.
The number of new cases is the highest in the Flemish Region in 2020
Trends in unadjusted incidence in Belgium, show an overall increase between 2006 and 2020 for both men and women. After adjusting for age the trend patterns changed; the incidence increased from 486 per 100,000 in 2006 to 548 per 100,000 women in 2020 while the age-adjusted incidence decreased from 508 per 100,000 to 465 per 100,000 in men in the same time period.
In men, unadjusted incidences are the highest in the Flemish Region followed by the Walloon Region, and the Brussels Capital Region. In women, unadjusted rates are similar in the Walloon Region and the Flemish Region, with lower rates in the Brussels Capital Region. This pattern is mainly driven by the age structure as the differences are greatly reduced once they are adjusted for age. A large drop in the unadjusted and age-adjusted incidence was observed in 2020, the first year of the COVID-19 pandemic. This drop may have more to do with reduced capacity for diagnosis rather than reflecting a true reduction in incidence and therefore, should be interpreted with caution.
By region, the unadjusted incidence of cancer increased between 2006 and 2020 for both men and women in the Flemish Region and Walloon Region but decreased in the Brussels Capital Region. In men, the age-adjusted incidence decreased in the Walloon Region, the Brussels Capital Region, and the Flemish Region. In women, the age-adjusted incidence increased in Flemish Region and the Walloon Region, while staying stable in the Brussels Capital Region.
Age-standardized cancer incidence per 100,000 men in Belgium and its regions, 2006-2020 Source: Belgian Cancer Registry ; Age-adjustment based on European Standard Population.
Age-standardized cancer incidence per 100,000 women in Belgium and its regions, 2006-2020 Source: Belgian Cancer Registry ; Age-adjustment based on European Standard Population.
Prostate and breast cancer rank number one among men and women
In 2020, prostate cancer and breast cancer were the most frequently diagnosed cancers among men and women, respectively. The age-adjusted incidence of breast cancer in women was stable, while the age-adjusted incidence of prostate cancer decreased in men between 2006 and 2014, but has slightly increased since then.
Lung cancer has been the second most frequent cancer in men and since 2018 has also been the second most frequently diagnosed cancer in women. The age-adjusted incidence of lung cancer increased by 84% between 2006 and 2020 in women, while it decreased by 19% in men.
Colorectal cancer diagnoses decreased between 2006 and 2020 by 26% in men and 24% in women. When the colorectal screening program was introduced in the Flemish Region, a peak in age-adjusted incidence was observed in 2014.
The incidence of melanoma increased in both sexes. In men, the age-adjusted incidence increased by 130% between 2006 and 2020, while in women it increased by 89%, ranking melanoma 4th among the most frequently diagnosed cancers in women since 2010 ahead of cervical cancer. Greater awareness and more active screening can play some role in the observed increase in incidence, but these factors likely do not explain the entire increase.
Unadjusted incidence of the six most commonly diagnosed cancers (excluding non-melanoma skin cancer) in men, Belgium, 2006-2020 Source: Belgian Cancer Registry 
Age-standardized incidence of the six most commonly diagnosed cancers (excluding non-melanoma skin cancer) in men, Belgium, 2006-2020 Source: Belgian Cancer Registry ; Age-adjustment based on European Standard Population.
Unadjusted incidence of the six most commonly diagnosed cancers (excluding non-melanoma skin cancer) in women, Belgium, 2006-2020 Source: Belgian Cancer Registry 
Age-standardized incidence of the six most commonly diagnosed cancers (excluding non-melanoma skin cancer) in women, Belgium, 2006-2020 Source: Belgian Cancer Registry ; Age-adjustment based on European Standard Population.
The incidence of cancer is higher compared to the EU average in Belgium
Crude cancer incidence per 100,000 is higher in Belgium than the EU-15 average for men and women. Compared to the EU-15 average, the incidence per 100,000 in Belgium is 7.5% higher among men and 4.2% higher among women.
International comparisons should be interpreted with caution, given the various methods of data collection in different countries (registers versus routine reporting systems), with different levels of accuracy. Data for Greece and Spain are not available.
In 2020, 472,360 persons (4.1% of the total Belgian population) were living with cancer (including non-melanoma skin cancer) and had been diagnosed between 2011 and 2020. This number included 240,462 men and 231,898 women. The crude and age-adjusted prevalence per 100,000 was highest in the Flemish Region compared to the other Regions.
Prostate cancer was the most prevalent cancer type among men (71,647 cases, or 1.3% of the total male population in Belgium). Among women, breast cancer was the most prevalent cancer type (87,789 cases, or 1.5% of the total female population in Belgium). Another 49,227 Belgians were alive by the end of 2020 after having been diagnosed with colon cancer in the past 10 years.
Information on the prevalence of cancer yields a different picture than the information on the incidence of cancer. Indeed, cancer prevalence is a function of cancer incidence and survival, and the latter may be very different from one cancer to another. Lung cancer, for instance, has a low survival rate, such that few survivors will be alive at a given point in time, despite the high incidence. On the other hand, prostate and breast cancer have both high incidence and survival rates, explaining their predominance in prevalence estimates.
Cancer is a broad family of diseases that involve abnormal cell growth with the potential to invade or spread to other parts of the body. It is one of the most important causes of premature mortality, ill health, and healthcare expenditure. Cancer can be caused by inherited genetic traits, but the vast majority is due to genetic mutations caused by carcinogenic agents related to behavioral, metabolic, and/or environmental factors.
Data on new cancer cases in Belgium are collected by the Belgian Cancer Registry Foundation. The data from the Belgian Cancer Registry are nationally representative and exhaustive. They collect and record both clinical and pathological data. The recording of data (topography and morphology) is done using the International Classification of Diseases for Oncology.
The total number of cancer cases is usually presented excluding non-melanoma skin cancers. Although these cancers frequently occur, they are typically not clinically significant. In addition, there is large heterogeneity in the registration of these cancers, making comparisons and trend analyses very difficult.
Facts and figures about cancer are calculated and published every year by the Cancer Registry. These figures include the crude and age-standardized incidence, which refer to new cases; and prevalence, which refer to the number of people living with cancer at a given period after initial diagnosis. In this chapter, the presented cancer prevalence estimates from the year 2013 onwards have been calculated in the framework of the Belgian Burden of Disease project.
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have similar socioeconomic conditions.
The age-standardized incidence is a weighted average of the individual age-specific incidence using an external standard population. Here, the European Standard Population is used as standard population. It is the incidence that would be observed if the population had the age structure of the standard population. Since age has a powerful influence on the risk of cancer, this standardization is necessary when comparing several populations that differ with respect to their age structure.
The unadjusted incidence is calculated by dividing the number of new cases observed during a given time period by the corresponding number of people in the population at risk. The unadjusted incidence is expressed as the number of new cases per 100,000 person years.
Ten-year prevalence data were estimated with an index date of 31st December 2020, representing people living in Belgium who were diagnosed with at least one invasive malignancy in the period from 1st January 2011 to 31st December 2020 and who were still alive at the end of 2020. Persons with more than one malignancy were included as prevalent cases in each cancer type but were counted only once in analysis regrouping multiple tumor sites.
Gorasso, V., Silversmit, G., Arbyn, M., Cornez, A., De Pauw, R., De Smedt, D., ... & Speybroeck, N. (2022). The non-fatal burden of cancer in Belgium, 2004–2019: a nationwide registry-based study. BMC cancer. doi: https://doi.org/10.1186/s12885-021-09109-4
In 2018, around one in ten person had an anxiety disorder and/or a depressive disorder.The prevalence of anxiety disorders remained at the same level as in 2013 (11% vs 10%) but was still higher than in the period 2001-2008 (just over 6%).
In 2018, 12% of the population reported the use of sleeping pills or tranquilizers in the last 2 weeks, and 8% reported recent use of antidepressants. The consumption of sleeping pills or tranquilizers started to decrease in 2008, while the consumption of antidepressants continued to increase.
Anxiety and depression are more prevalent in women. In general, the indicators of mental health show a better situation in the Flemish region compared to the two other regions. Mental health also differs by educational level: mental health disorders and consumption of psychotropic medicines were more frequent in the lowest educated group compared to the highest educated group.
Mental health is the capacity of each of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections, and personal dignity . Due to the high frequency of mental problems in western societies and the significance of their costs in human, social, and economic terms, mental health is now regarded as a public health priority. In Belgium, the Health Interview Survey is one of the main sources of systematic data on mental health parameters in the general population.
Among the various dimensions of mental health that are monitored in this survey, we focus on the following three indicators:
Indicators concerning the use of psychotropic medicines.
However, it should be noted that the evaluation of mental health problems in the population through a health survey has a number of limitations. These are mainly related to the fact that the estimates are based on screening instruments for psychological problems and thus are not obtained by clinical diagnostic tools, which may be more nuanced. Nevertheless, the results of general population health surveys are generally in line with the findings of specific mental health surveys.
More serious mental health disorders like schizophrenia and bipolar disorders are not presented here. Indeed, health interview surveys are not a valid instrument to capture such complex conditions. Moreover, information about suicidal thoughts and attempts can be found on a specific page (in preparation).
3.Mental health disorders
Situation in 2018
Based on the assessment of the psychometric instruments, in 2018, 11.2% of the total Belgian population had an anxiety disorder and 9.4% had a depressive disorder. For both disorders, women had a higher prevalence (14.2% for anxiety and 10.7% for depression) than men (7.9% for anxiety and 8% for depression).
There is a strong socio-economic gradient in the prevalence of mental health disorders. After age-adjustment, anxiety disorders were 2.3 times more frequent in people from the lowest educational group compared to the highest educational group. Depressive disorders were 3 times more frequent in people from the lowest educational group compared to the highest educational group.
In 2018, 12.3% of the population used sedatives (sleeping pills or tranquilizers) and 7.6% used antidepressants in the past 2 weeks. More women than men consumed sedatives (15% in women vs 9.5% in men) and antidepressants (9.8% vs 5.3%).
The consumption of sedatives increased with age, particularly after 45 years in women and after 65 years in men.
The consumption of antidepressants is particularly high in women after 45 years of age.
In 2018, the consumption of sedatives is slightly higher in Wallonia and in Flanders than in Brussels, but the regional differences are narrow and not significant.
The consumption of antidepressants is slightly lower in Flanders than in the other regions, but the differences are only significant in women.
From 1997 to 2008, the consumption of sedatives in the population increased, then it decreased in 2013 and in 2018 when considering both genders together. In men the consumption remained stable round 10%, while it decreased from 19% in 2008 to 15% in 2018 in women.
Since 1997, the consumption of antidepressants has doubled in both genders.
The consumption of sedatives used to be significantly lower in Flanders than in the 2 other regions until 2008 in both genders. After 2008, as the use of sedatives continued to increase in Flanders while slightly decreasing in the other regions, the regional differences narrowed and quasi disappeared by 2018.
There was a socio-economic gradient in the consumption of sedatives and antidepressants. A higher proportion of people from the lowest educational group consumed sedatives (17.7% vs 12.3%) and antidepressants (10.3% vs 6%) than from the highest educational group.
The GAD-7 is a screening tool for general anxiety disorder. Participants are asked to evaluate the frequency, if ever, of experiencing 7 core symptoms in the last 2 weeks. The scores obtained allow to evaluate the symptom severity.
Participants with a score of 10 or over out of 21 in the GAD-7 tool were considered to have an anxiety disorder.
PHQ-9: Patient Health Questionnaire 9-item depression scale
The PHQ-9 is a screening tool for major depressive disorder and other depressive disorders. Participants are asked to evaluate the frequency in which they have been bothered by 9 problems in the last 2 weeks.
Participants with a combination of answers meeting the criteria specific for major depressive disorder and other depressive disorders for the PHQ-9 were considered to have a depressive disorder.
In 2018, 29% of the Belgians aged 15 years and over reported living with a chronic disease. This percentage increases strongly with age: 44% of the population over 75 years reports living with a chronic disease. The prevalence of chronic diseases is higher in women (31%) compared with men (27%).
The most commonly reported chronic diseases in the population are low back disorders, high blood pressure, allergy, arthrosis, high blood cholesterol, and neck disorders. The prevalence of the most frequent chronic diseases has increased between 1997 and 2018.
Individuals with a lower educational level usually suffer more frequently from chronic diseases.
The prevalence of multimorbidity has significantly increased since 1997, mainly because of the aging of the population.
Non-communicable diseases (NCDs) are medical conditions or diseases that are not caused by infectious agents. Chronic diseases are defined by their longstanding nature. Since most NCDs are also chronic diseases, both terms are sometimes used interchangeably. This is however not entirely correct: some NCDs are acute, e.g. myocardial infarction; conversely, some chronic diseases may be caused by infectious agents, e.g. cervix cancer or tuberculosis. For the sake of simplicity, however, the term "chronic disease" will be used here as a synonym of NCDs.
Chronic diseases are by far the leading causes of (premature and general) mortality. In addition, they are also one of the most relevant health problems with a potential impact on the health-related quality of life, especially for the elderly, and are one of the main reasons for the use of healthcare services. Especially among older individuals, multiple chronic diseases can be present simultaneously. This phenomenon, referred to as multimorbidity, has a considerable impact on the functional status and the quality of life of the population. It also causes an increase in healthcare consumption and a higher risk of complications due to a larger use of medication, and thus requires important resources mobilization.
Most of the main chronic diseases are preventable, e.g. by adopting policies that promote healthier lifestyles, better environment and facilitate healthcare access. The prevalence of chronic diseases is, therefore, an important indicator of the level of (ill) health in the population.
The Belgian Health Interview Survey (HIS) is one of the main sources of information on the prevalence of chronic diseases at the population level. The advantage of this source is that it also takes into account people who rarely or never make use of health care facilities. The results are weighted to match the population structure as much as possible. It is therefore a valuable tool to obtain representative information on chronic diseases prevalence at the population level (for the whole country or at the regional level), and to monitor this prevalence over time. However, the results must be interpreted with caution because the information is self-reported, and thus reflects individual perceptions of health that may differ from the actual health state. Indeed, some people may not report an illness because they are not (yet) aware of it, or because the disease is perceived as socially unacceptable.
In the HIS 2018, a first question was asked on the presence of a chronic disease/condition/handicap in general, followed by a list of questions on the presence of 38 specific chronic diseases. Multimorbidity was measured as the simultaneous presence of at least two out of the following six chronic diseases: heart disease, chronic respiratory disease, diabetes, cancer, arthritis and/or arthrosis, and hypertension.
This overview is only based on the self-reported diseases as reported in the Health Interview Survey. In Belgium, other sources are available on diagnosis-based prevalence of chronic diseases such as specific registries, general practitioner networks or health insurance databases. These sources will be used to provide in-depth information on selected chronic diseases. Since the prevalence of chronic diseases and conditions is strongly related to age, the comparisons over time or between regions have been made after correction for the age-structure (age-adjustment). The adjustment has been performed using direct standardization based on the Belgian population of 2018 as reference. The weighting related to the design of the HIS was taken into account when calculating standardized rates.
In 2018, 29% of the population aged 15 years and over reported suffering from at least one chronic disease. This percentage increases considerably with age, going up from 14% for people aged 15-24 to 44% for the people aged 75 or over.
The prevalence of chronic disease is significantly higher in women (31%) compared to men (27%).
Between 2001 and 2018, the percentage of people reporting to suffer from a chronic disease increased from 25% to 29% (+17%). This increase is partly due to the aging of the population, but not entirely since there is still an increase after adjustment for age.
Some differences are observed between the regions: the age-adjusted percentage of self-reported chronic diseases is higher in the Walloon region (33%) than in the Flemish and Brussels regions (respectively 27% and 31%). In the Brussels region, the crude self-reported prevalence of chronic diseases has dropped below the national average, but it is not the case when compared with the age-adjusted prevalence, which suggests an effect of the younger age structure of the Brussels region.
In the Flemish region, the percentage of self-reported chronic diseases has significantly increased from 21% in 2001 to 28% in 2018 (+34%). This increase is less important but still remains after standardization for age (+22%).
In the Brussels region, the age-adjusted percentage of people reporting to live with a chronic disease has decreased significantly from 34% in 2013 to 31% in 2018.
In the Walloon region, the crude and the age-adjusted percentage of people with a chronic disease remained stable since 2001.
The percentage of people reporting to suffer from a chronic disease is higher in people with no diploma or a primary school education (41%) compared to those with higher levels of education. Similarly, people with a secondary (low or high) level of education report more often living with a chronic disease than those with the highest level of education (27%).
In 2018, 15% of the Belgian population over 15 years of age reported suffering from at least two of the following diseases in the past year: heart disease, chronic respiratory disease, diabetes, cancer, arthritis and/or arthrosis, and hypertension. This percentage increases strongly with age, going up from 0.8% for people aged 15-24, to 42% for the people aged 75 and over. The prevalence of multimorbidity is higher in women, but this difference is no longer statistically significant after adjustment for age.
Between 1997 and 2018, the crude prevalence of multimorbidity increased from 8.9% to 15% (+71%). When considering the age-adjusted prevalence estimates, the increase is less important but still significant (+26%), which means that the increase is partly, but not only, due to the aging of the population.
In the Walloon and the Flemish regions, the age-adjusted prevalence of multimorbidity is higher (respectively 17% and 15%) than in the Brussels region (14%), where it has decreased since 2013. However, this decrease is not significant.
The percentage of people reporting living with at least two chronic diseases decreases as their educational level increases, from 19.8% in people with no diploma or only a primary school education, to 13.3% in people with the highest level of education.
The top 6 of the most commonly reported chronic diseases is the same in men and women, although the order differs. The top 6 comprises three problems of the musculoskeletal system (low back disorders, neck disorders, and arthrosis), two cardiovascular risk factors (high blood pressure and high blood cholesterol), and allergy.
Since 2013, the top 6 remained the same in men but not among women, for whom allergy and neck disorders have taken the place of high blood pressure and high blood cholesterol as third and fourth most important disease, respectively.
The evolution in terms of prevalence differs in function of the specific disease:
1. Between 1997 and 2018, significant increases were observed in the prevalence of high blood pressure, low back disorders, neck disorders, arthrosis, diabetes, thyroid disorders, and allergy. These increases may in part be explained by the aging of the population; however, even after adjustment for age, the increases remained significant.
The age-adjusted prevalence of thyroid disorders has strongly increased, from 3.5% in 1997 to 7.0% in 2018 (+100%); this increase is not due to the aging of the population.
The age-adjusted prevalence of diabetes has increased by 67%, from 3.6% in 1997 to 6.0% in 2018; this increase is partly due to the aging of the population.
The age-adjusted prevalence of allergy remained stable between 1997 and 2013 (at around 14%), but increased in 2018 to 19%.
2. On the other hand, since 2001, the prevalence of a number of other chronic diseases has decreased, including coronary heart disease, chronic obstructive pulmonary disease, severe headache and migraine, and osteoporosis.
Crude prevalence of selected chronic diseases, Belgium, 1997-2018
Regional differences in the prevalence of the included diseases are generally quite limited. The following differences are observed:
Arthrosis and thyroid disorders are more commonly reported in the Walloon and Flemish regions than in the Brussels region, even after adjustment for age.
High blood pressure is more often reported in the Walloon region than in the two other regions, after standardization for age.
The socio-economic status, measured in this report by the educational level, is one of the main determinants of chronic diseases. Most chronic diseases included in the HIS occur more frequently in people with lower educational levels. This applies in particular to serious chronic diseases such as cardiovascular diseases, diabetes, and chronic respiratory diseases. One notable exception is allergy, which occurs more frequently with increasing educational levels.
In the Belgian Health Interview Survey, a global question is asked on the presence of one or more chronic diseases, chronic conditions or handicaps, without specifying the nature of the disease, condition or handicap. For the sake of simplicity, this indicator is referred to in this report as the presence of “chronic disease”.
Non-communicable diseases (NCDs) are medical conditions or diseases that are not caused by infectious agents. While sometimes referred to as synonymous with "chronic diseases", NCDs are distinguished only by their non-infectious cause, not necessarily by their duration, though some chronic diseases of long duration may be caused by infections.