12.23.2019  /  PHFI Team
First comprehensive estimates of disease burden due to mental disorders and their trends in every state of India
  • About 197 million persons, roughly one in seven Indians, suffered from mental disorders of varying severity in 2017. These include depression, anxiety disorders, schizophrenia, bipolar disorders, idiopathic developmental intellectual disability, conduct disorders, and autism.
  • Depression and anxiety disorders are the commonest mental disorders in India with 45-46 million people suffering from each. Their prevalence is increasing across India and is relatively higher in the southern states and in females.
  • The prevalence of depression is highest in older adults, which has significant implications for the aging population of India. Depression is associated with suicide deaths in India.
  • The prevalence of childhood onset mental disorders such as idiopathic developmental intellectual disability, conduct disorders, and autism is higher in the northern states but is decreasing across India.
  • The contribution of mental disorders to the total disease burden has doubled in India from 1990 to 2017, indicating the need for implementing effective strategies to control this increasing burden.

New Delhi, 23 December 2019 – The first comprehensive estimates of disease burden due to mental disorders and their trends in every state of India from 1990 published in The Lancet Psychiatry by the India State-Level Disease Burden Initiative show that a significant proportion of India’s population faces the burden of mental disorders of varying severity. These include depression, anxiety disorders, schizophrenia, bipolar disorders, idiopathic developmental intellectual disability, conduct disorders, and autism. In 2017, 197 million Indians were suffering from mental disorders of whom 46 million had depression and 45 million anxiety disorders. The contribution of mental disorders to the total disease burden has doubled between 1990 and 2017.

The state-specific findings described in this scientific paper highlight the extent of the effort needed in each state to address mental health which could serve as a reference for policy makers to plan approaches for reducing the growing burden of mental disorders in a systematic way. The trends over about three decades reported in this research paper utilized all available data sources from India, which enables more robust estimates than the estimates based on individual data sources in isolation.

Prof Vinod Paul, Hon’ble Member, NITI Aayog said on the release of the findings, “This research paper reports that a large proportion of India’s population is impacted by mental health issues and systematically highlights the variations between the states, which can guide efforts for more specific health services planning for mental health in each state. Policies and initiatives under Ayushman Bharat including the Health and Wellness Centers and the health insurance coverage are crucial in reducing the adverse impact of mental disorders at the population level across India. Community level mental health care and integration of mental health services with other aspects of health care should receive high priority from state governments to improve mental health promotion and care.”

Prof Balram Bhargav, Secretary to the Government of India, Department of Health Research, Ministry of Health & Family Welfare, and Director General, ICMR said, “The findings of this research demonstrate important differences between the states—the prevalence of adult mental disorders is higher in the southern states and that of childhood onset mental disorders is higher in the northern states of India. The insights provided by this study are important for titrating strategies for mental health improvement in each state. Given the significant contribution of mental disorders to the disease burden in India, further research should continue to track the changing trends of mental disorders in different parts of the country.”

Prof Lalit Dandona, Director of the India State-Level Disease Burden Initiative, Distinguished Scientist and National Chair of Population Health at ICMR, and Distinguished Research Professor Public Health Foundation of India who is the senior author of this paper said, “This study utilizing all accessible relevant data from India over the past three decades reports that mental disorders are the leading cause of non-fatal disease burden in India and their contribution to the total disease burden is increasing. The high rate of depression among the older adults reported in this study is of concern which needs attention, and the significant association of suicide with depression emphasises the need to identify and deal with depression through wider efforts in the community and in the health system.”

Prof Rajesh Sagar, Professor, All India Institute of Medical Sciences, New Delhi and the lead author of the paper said, “Mental illnesses contribute significantly to the burden of disease in India as reported by this study. There is an urgent need to strengthen mental health services, integrate these with general healthcare, and remove barriers such as stigma and access to treatment. It is time to act at all levels with all stakeholders to bring mental health at the forefront to reduce the burden. An interesting finding revealed by this study is the slower pace of improvement in the burden of childhood mental disorders such as developmental intellectual disability and conduct disorder in the less developed states of the country which should be examined.”

Dr Hendrik J Bekedam, WHO Representative to India said, “The findings of this study underscore the need to further strengthen mental health services and support to deal with this issue that affects one in seven Indians. With Ayushman Bharat as the core of India’s current health policies the Health and Wellness Centers (HWCs) component provides a great opportunity to define the role of HWCs and bring prevention, detection and support closer to the people with mental health conditions. WHO continues to support Government of India to achieve the highest standard of mental health and well- being and to advance Universal Health Coverage.”

Prof K Srinath Reddy, President, Public Health Foundation of India said, “The high burden of mental health disorders poses a public health challenge that calls for a concerted response that prioritises prevention through reduction in stress and strife, social support in different settings, timely detection and predominantly community based care and access to competent medical care and drugs as needed. The higher burden in children and adolescents in north Indian states is especially worrisome. Our identity as a caring society with a competent health system will be most sharply defined over the next decade by how we effectively and empathetically prevent and tend to mental health disorders.”

Prof Christopher J L Murray Director, Institute for Health Metrics and Evaluation said “Before state governments can invest substantially more in mental health services, it is imperative that health officials have an accurate accounting of how depression, anxiety, and other mental disorders are distributed across the country. This study provides a crucial first step in determining state-by-state need.”

The findings reported in the paper published today are part of the Global Burden of Disease Study 2017. The analytical methods of this study have been refined over two decades of scientific work, which has been reported in over 16,000 peer-reviewed publications, making it the most widely used approach globally for disease burden estimation. These methods enable standardized comparisons of the health loss caused by different diseases and risk factors, between different geographies, sexes, and age groups, and over time in a unified framework. A key metric used for this comparison is disability-adjusted life years (DALYs), which are the sum of the number of years of life lost due to premature death and a weighted measure of the years lived with disability due to a disease or injury.

Scientific paper published today:

India State-Level Disease Burden Initiative Mental Disorders Collaborators. The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017. Lancet Psychiatry. 23 December 2019.
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30475-4/fulltext

Key findings from the paper:

  • In 2017, 197.3 million Indians (14.3% of the total population) were suffering from various mental disorders. Of these, 45.7 million had depression and 44.9 million had anxiety disorders.
  • The contribution of mental disorders to the total disease burden in India in terms of DALYs increased from 2.5% in 1990 to 4.7% in 2017.
  • Mental disorders were the leading contributor in India to years lived with disability (YLDs), contributing 14.5% of all YLDs in 2017.
  • Depression contributed 33.8% of all mental disorder DALYs in India in 2017, followed by anxiety disorders (19.0%), idiopathic developmental intellectual disability (10.8%), and schizophrenia (9.8%).
  • Among the major mental disorders that manifest predominantly during adulthood, the prevalence of depression was 3.3%, anxiety disorders 3.3%, bipolar disorder 0.55%, and schizophrenia 0.25%. Among the mental disorders that have onset predominantly during childhood and adolescence, the prevalence for idiopathic developmental intellectual disability was 4.5%, conduct disorder 0.80%, attention-deficit hyperactivity disorder 0.42%, and autism spectrum disorders 0.35%.
  • The prevalence of predominantly childhood and adolescent onset mental disorders was higher in the less developed northern states, and that of the mental disorders manifesting predominantly during adulthood higher in the more developed southern states.
  • There was a significant association between the prevalence of depression and suicide death rate at the state level, with this association slightly stronger in females than in males.
  • The prevalence of depression, anxiety disorders, and eating disorders was significantly higher among females, and the prevalence of conduct disorder, autism spectrum disorders, and attention-deficit hyperactivity disorder was significantly higher among boys.
  • The prevalence of depressive disorders increased with age in India in 2017, with the highest prevalence in elderly.
  • The burden of mental disorders which manifest predominantly during adulthood increased in India from 1990 to 2017.
  • The burden of mental disorders of predominantly childhood and adolescent onset decreased in India from 1990 to 2017, but this decrease was relatively less in the less developed states.

These persons could be contacted for discussion on the findings and their implications:

Prof Balram Bhargava, Indian Council of Medical Research, New Delhi
Prof Rajesh Sagar, All India Institute of Medical Sciences, New Delhi
Prof Rakhi Dandona, Public Health Foundation of India, Gurugram
Prof Gopalkrishna Gururaj, National Institute of Mental Health and Neuro Sciences, Bengaluru
Prof Mathew Varghese, National Institute of Mental Health and Neuro Sciences, Bengaluru
Prof K S Shaji, Government Medical College, Thrissur, Kerala
Dr Thara Rangaswamy, Schizophrenia Research Foundation, Chennai
Prof Vivek Agarwal, King George’s Medical University, Lucknow
Dr Hendrik J Bekedam, WHO India Country Office, New Delhi
Dr Tarun Dua, WHO, Geneva
Dr Neerja Chowdhury, WHO, Geneva
Dr R S Dhaliwal, Indian Council of Medical Research, New Delhi
Prof Lalit Dandona, Indian Council of Medical Research, New Delhi, India; Public Health Foundation of India, Gurugram

About the India State-Level Disease Burden Initiative

The India State-Level Disease Burden Initiative is a collaborative effort between the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), Institute for Health Metrics and Evaluation (IHME), and a number of other key stakeholders in India, including academic experts and institutions, government agencies and other organizations, under the aegis of the Ministry of Health & Family Welfare. About 300 leading scientists and experts representing close to 100 institutions across India are engaged with this collaborative work. The work of this Initiative is overseen by an Advisory Board consisting of eminent policymakers and involves extensive engagement of 16 domain expert groups with the estimation process. The Health Ministry Screening Committee at the Indian Council of Medical Research and the ethics committee of the Public Health Foundation of India approved the work of the India State-Level Disease Burden initiative.

The first set of findings by the India State-Level Disease Burden Initiative on the variations in epidemiological transition across the states of India were presented in a Report released by the Vice- President and Health Minister of India and in a scientific paper published in The Lancet in November 2017:

The Initiative has subsequently published detailed topic-specific papers in the Lancet journals in 2018 and 2019 on the state-level trends of cardiovascular diseases, diabetes, chronic respiratory diseases, cancer, suicide, air pollution, and malnutrition as well as a commentary in The Lancet on the relevance of these findings for health policy in India:

The Indian Council of Medical Research (ICMR), is the apex government body in India for the formulation, coordination and promotion of biomedical and health research. It is one of the oldest medical research bodies in the world. Besides the headquarters in New Delhi, ICMR has 26 research institutes, centres and units across India. ICMR funds both intramural and extramural research in India. The priorities of ICMR coincide with the national health priorities and have the goal of reducing the total burden of disease and to promote health and well-being of India’s population. As part of this agenda, ICMR is interested in improving the estimates of disease burden and risk factors in India, especially at the sub-national levels, for better health planning, policy framing and fund allocation. For more information please visit http://www.icmr.nic.in

The Public Health Foundation of India (PHFI) is a premier public health institution in India with presence across the country. It collaborates with multiple constituencies including Indian and international academia, state and central governments, multi- and bi-lateral agencies, and civil society groups. The vision of PHFI is to strengthen India’s public health institutional and systems capability and provide knowledge to achieve better health outcomes for all through strengthening training, research and policy development in public health. As part of this vision, PHFI has major interest in improving the robustness of sub-national disease burden estimates to inform health action and in evaluating the impact of large-scale population health interventions. For more information please visit www.phfi.org

The Institute for Health Metrics and Evaluation (IHME) is a global research institute at the University of Washington in Seattle that provides independent, rigorous, and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME aims to identify the best strategies to build a healthier world by measuring health, tracking program performance, finding ways to maximize health system impact and developing innovative measurement systems to provide a foundation for informed decision-making that will ultimately allocate resources to best improve population health. For more information please visit www.healthdata.org

For more information, please contact:

Indian Council of Medical Research
Mr. Syed Adil Shamim Andrabi
syed.adil@icmr.gov.in
Mobile: +91 9599332718

Public Health Foundation of India
Ms. Gina Sharma
gina.sharma@phfi.org
Mobile: +91 9811887088

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