Hyderabad: The COVID-19 pandemic has profoundly impacted the mental health of people worldwide. According to the World Health Organization (WHO), the pandemic has resulted in a 25% increase in global depression and anxiety.
Interestingly, the southern Indian states had a higher prevalence of mental ailments, particularly depression and anxiety, even before the pandemic. A study published in the Lancet journal just before the outbreak of the COVID-19 pandemic reported that more than 3,750 individuals per lakh population in Telangana and Andhra Pradesh experienced some form of depressive disorder.
As one of the largest pan-India studies on mental health, it was found that, in 2017, 197.3 million people had mental disorders in India, comprising 14.3 per cent of the total population.
Recognising the impact of mental disorders on public health, India launched its first National Mental Health Policy in 2014 and a revised Mental Healthcare Act in 2017, with the objectives of providing equitable, affordable, and universal access to mental healthcare.
Prevalence of mental ailments
Of the 197.3 million, around 45.7 million had depressive disorders and 44.9 million suffered anxiety disorders.
Depressive disorders contributed the most to the total mental disorders of Disability-Adjusted Life Year or DALYs at 33.8 per cent, followed by anxiety disorders (19%), idiopathic developmental intellectual disability (IDID) and schizophrenia (9.8%), bipolar disorder (6.9%), conduct disorder (5.9%), autism spectrum disorders (3.2%), eating disorders (2.2%), and attention-deficit hyperactivity disorder (ADHD) at 0.3 per cent. Other mental disorders comprised 8 per cent of DALYs.
Burden of mental disorders
Titled ‘The burden of mental disorders across the states of India: The global burden of disease study 1990-2017,’ it was funded by the Indian Council of Medical Research (ICMR), Department of Health Research, Ministry of Health and Family Welfare (GoI) and Bill and Melinda Gates Foundation.
The prevalence of depressive disorders was highest at more than 3,750 persons per lakh population in the states of Telangana, Andhra Pradesh, Tamil Nadu, Kerala, Goa and Odisha. Ranging between 3,500 and 3,749 persons, it was moderate in Karnataka and Maharashtra, Punjab, Himachal Pradesh and Manipur. Anxiety disorders were highest in Kerala and Manipur (more than 3,600 persons per lakh population).
More adults face anxiety, depression
Here are some of the key findings from the Lancet report:
1 out of 7 Indians affected: One among every seven persons in India had a mental disorder, ranging from mild to severe.
Doubled within 3 decades: The proportional contribution of mental disorders to the total disease burden in India almost doubled from 1990 to 2017 i.e. from 2.5 per cent in 1990 to 4.7 per cent of the total DALYs in 2017.
Depression and anxiety highest among adults: Among the mental disorders that manifest predominantly during adulthood, the highest disease burden in India was caused by depressive and anxiety disorders, followed by schizophrenia and bipolar disorder. Their prevalence was generally higher in the more developed southern states than in the less developed northern states.
IDID, conduct disorder higher among children: Among the mental disorders that have their onset predominantly during childhood and adolescence, the highest disease burden was caused by idiopathic developmental intellectual disability (IDID), followed by conduct disorder and autism spectrum disorders (ASD). These occurred more in the northern states than in the south.
Modernisation – a major risk factor
The higher prevalence of depressive and anxiety disorders in southern states could be related to the higher levels of modernisation and urbanisation in these states.
There was a relationship between depressive disorders and suicide death rates, which was also higher in the southern states than in the northern ones. Some depressive disorders and anxiety disorders were attributed to known risk factors including childhood sexual abuse, intimate partner violence and exposure to bullying. A large proportion IDID was attributable to lead exposure.
Calling the causes multi-factorial, Dr Charan Teja Koganti, a neuropsychiatrist at KIMS Hospital, said, “The higher prevalence of depression and anxiety disorders in the southern states has been related to the higher levels of modernisation and urbanisation in these states. With higher education and better employment, the academic and job stress are both higher and there is immense pressure to excel in one’s career. Also, with more awareness about mental health, the diagnosis is also better compared to the north of India and thus the numbers are higher.”
Methodology used
All accessible data, published papers and reports from multiple sources were used to estimate the prevalence of mental disorders, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by these disorders for all the states of India from 1990 to 2017, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD).
The states were grouped based on their socio-demographic Index (SDI), which is a composite measure of per-capita income, mean education, and fertility rate in women of less than 25 years of age.
State-wise prevalence of mental disorders
In 2017, 45.7 million (42.4 to 49.8) persons had depressive disorders in India. Prevalence of depressive disorders varied 1.9 times among the states, with the highest prevalence observed in Tamil Nadu, Kerala, Goa, and Telangana in the high SDI state group; Andhra Pradesh in the middle SDI state group and Odisha in the low SDI state group.
In 2017, 44.9 million (41.2 to 48.9) persons had anxiety disorders in India. The prevalence varied 1.4 times across the states, with the highest prevalence observed in the states of Kerala, Karnataka, Telangana, Tamil Nadu, Himachal Pradesh, and Maharashtra in the high SDI state group and Andhra Pradesh, Manipur and West Bengal in the middle SDI state group.
In 2017, 7.6 million persons had bipolar disorder in India. The prevalence varied 1.3 times across the states, with Goa, Kerala, Sikkim, and Himachal Pradesh of the high SDI state group having the highest prevalence among all states.
Around 3.5 million people had schizophrenia in India in 2017. Prevalence varied 1.6 times among states, with the highest prevalence observed in the states of Goa, Kerala, Tamil Nadu, and Delhi of the high SDI state group.
Correlation with age and sex
The prevalence of depressive disorders, anxiety disorders and eating disorders was significantly higher in females than in males while the prevalence of conduct disorder, autism spectrum disorders, and ADHD was substantially higher in males than in females.
The age-specific prevalence of depressive disorders increased with age in India, with the highest prevalence observed in older adults, starting at 45 years. The prevalence of anxiety disorders in both sexes increased rapidly in adolescents and young adults and was higher in females than in males in most age groups.
The prevalence of bipolar disorder increased during adolescence and plateaued during most of adulthood, with a slight decline in older age groups. The prevalence of schizophrenia increased swiftly in young age groups, peaked in the 35 to 44 years age group, and declined steadily in older age groups.
