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Cited by 886Mental Health Treatment and AccessGlobal Health and EpidemiologyHealth Systems, Economic Evaluations, Quality of Life

The burden of mental disorders across the states of India: the global burden of disease study 1990–2017

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Sagar, Rajesh, Dandona, Rakhi, Gururaj, Gopalkrishna, Dhaliwal, R S, Singh, Aditya, Ferrari, Alize, Dua, Tarun, Ganguli, Atreyi +34 more·2020·The Lancet Psychiatry
DOI 10.1016/s2215-0366(19)30475-4PMC PMC7029418
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Abstract

BACKGROUND: Mental disorders are among the leading causes of non-fatal disease burden in India, but a systematic understanding of their prevalence, disease burden, and risk factors is not readily available for each state of India. In this report, we describe the prevalence and disease burden of each mental disorder for the states of India, from 1990 to 2017. METHODS: We used all accessible data from multiple sources 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. We assessed the heterogeneity and time trends of mental disorders across the states of India. We grouped states on the basis of their Socio-demographic Index (SDI), which is a composite measure of per-capita income, mean education, and fertility rate in women younger than 25 years. We also assessed the association of major mental disorders with suicide deaths. We calculated 95% uncertainty intervals (UIs) for the point estimates. FINDINGS: =0·19, p=0·015). The contribution of mental disorders to the total DALYs in India increased from 2·5% (2·0-3·1) in 1990 to 4·7% (3·7-5·6) in 2017. In 2017, depressive disorders contributed the most to the total mental disorders DALYs (33·8%, 29·5-38·5), followed by anxiety disorders (19·0%, 15·9-22·4), idiopathic developmental intellectual disability (IDID; 10·8%, 6·3-15·9), schizophrenia (9·8%, 7·7-12·4), bipolar disorder (6·9%, 4·9-9·6), conduct disorder (5·9%, 4·0-8·1), autism spectrum disorders (3·2%, 2·7-3·8), eating disorders (2·2%, 1·7-2·8), and attention-deficit hyperactivity disorder (ADHD; 0·3%, 0·2-0·5); other mental disorders comprised 8·0% (6·1-10·1) of DALYs. Almost all (>99·9%) of these DALYs were made up of YLDs. The DALY rate point estimates of mental disorders with onset predominantly in childhood and adolescence (IDID, conduct disorder, autism spectrum disorders, and ADHD) were higher in low SDI states than in middle SDI and high SDI states in 2017, whereas the trend was reversed for mental disorders that manifest predominantly during adulthood. Although the prevalence of mental disorders with onset in childhood and adolescence decreased in India from 1990 to 2017, with a stronger decrease in high SDI and middle SDI states than in low SDI states, the prevalence of mental disorders that manifest predominantly during adulthood increased during this period. INTERPRETATION: One in seven Indians were affected by mental disorders of varying severity in 2017. The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. Substantial variations exist between states in the burden from different mental disorders and in their trends over time. These state-specific trends of each mental disorder reported here could guide appropriate policies and health system response to more effectively address the burden of mental disorders in India. FUNDING: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

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  • A large study from India reported an adjusted prevalence of diagnosed ADHD of 0.22% or lower for individuals aged 50 and older.

    “A large study from India reported an adjusted prevalence of diagnosed ADHD of 0.22 % or lower for individuals aged 50 and older (Sagar et al., 2020).”

    From Prevalence of attention-deficit/hyperactivity disorder in older adults: a systematic review and meta-analysis (2020) · cites this paper as Sagar et al., 2020

    The Results section reports ADHD prevalence in India, including an overall crude prevalence of 0.4%, and describes its age pattern. It does not give a prevalence of 0.22% or lower for people aged 50 and older. The Methods section describes modelled prevalence based on clinical diagnostic criteria, not a measured prevalence of diagnosed cases. (LLM, conf=0.85)

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Authors
Sagar, R., Dandona, R., Gururaj, G., Dhaliwal, R. S., Singh, A., Ferrari, A., Dua, T., Ganguli, A., Varghese, M., Chakma, J. K., Kumar, G. A., Shaji, K. S., Ambekar, A., Rangaswamy, T., Vijayakumar, L., Agarwal, V., Krishnankutty, R. P., Bhatia, R., Charlson, F., Chowdhary, N., Erskine, H. E., Glenn, S. D., Krish, V., Mantilla Herrera, A. M., Mutreja, P., Odell, C. M., Pal, P. K., Prakash, S., Santomauro, D., Shukla, D. K., Singh, R., Singh, R. K. L., Thakur, J. S., ThekkePurakkal, A. S., Varghese, C. M., Reddy, K. S., Swaminathan, S., Whiteford, H., Bekedam, H. J., Murray, C. J. L., Vos, T., & Dandona, L.
Corresponding author
Dandona, Lalit
ORCID
Venue
The Lancet Psychiatry
Publisher
Elsevier BV
Published
2020-02
Volume
7
Issue
2
Pages
148-161
ISSN
2215-0366 (ISSN-L)
DOI
10.1016/s2215-0366(19)30475-4
PMC
PMC7029418
OpenAlex
W2995213289
Cited by
886
References
13
Citations by year
2026: 91 · 2025: 141 · 2024: 162 · 2023: 177 · 2022: 137 · 2021: 99 · 2020: 76 · 2019: 2 · 2013: 1
FWCI
98.64
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
mental illness, disease burden, India, state-level variation, years lived with disability, disability-adjusted life years, depressive disorders, anxiety disorders, schizophrenia, intellectual disability, autism spectrum disorder, eating disorders, attention deficit hyperactivity disorder, conduct disorder, suicide, socio-demographic index, temporal trends, risk factors, mental health policy, mental health services, mental health professionals
MeSH terms
Global Burden of Disease, Suicide, Completed, Adolescent, Adult, Aged, Aged, 80 and over, Anxiety Disorders, Mental Disorders, Depressive Disorder, Female, Humans, India, Male, Middle Aged, Sex Factors, Socioeconomic Factors, Prevalence, Quality-Adjusted Life Years, Persons with Intellectual Disabilities, Persons with Mental Disabilities, Young Adult

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