The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017
Authors: Rajesh Sagar, Rakhi Dandona, Gopalkrishna Gururaj, R S Dhaliwal, Aditya Singh, Alize Ferrari, Tarun Dua, Atreyi Ganguli, Mathew Varghese, Joy K Chakma, G Anil Kumar, K S Shaji, Atul Ambekar, Thara Rangaswamy, Lakshmi Vijayakumar, Vivek Agarwal, Rinu P Krishnankutty, Rohit Bhatia, Fiona Charlson, Neerja Chowdhary, Holly E Erskine, Scott D Glenn, Varsha Krish, Ana M Mantilla Herrera, Parul Mutreja, Christopher M Odell, Pramod K Pal, Sanjay Prakash, Damian Santomauro, D K Shukla, Ravinder Singh, R K Lenin Singh, J S Thakur, Akhil S ThekkePurakkal, Chris M Varghese, K Srinath Reddy, Soumya Swaminathan, Harvey Whiteford, Hendrik J Bekedam, Christopher J L Murray, Theo Vos, Lalit Dandona
Journal: The Lancet Psychiatry (2019)

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.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.In 2017, 197·3 million (95% UI 178·4-216·4) people had mental disorders in India, including 45·7 million (42·4-49·8) with depressive disorders and 44·9 million (41·2-48·9) with anxiety disorders. We found a significant, but modest, correlation between the prevalence of depressive disorders and suicide death rate at the state level for females (r2=0·33, p=0·0009) and males (r2=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.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.Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.