If it wasn’t alarming enough for India to be labelled as the world’s ‘most depressed country’ by WHO; there is further bad news regarding the country’s mental health. Between 1990 to 2017 one in seven people from the country have suffered from mental illness ranging from depression, anxiety to severe conditions such as schizophrenia, according to a study. The large scale findings churning from an exhaustive course of meta-analysis of years of Indian research was published by Lancet Psychiatry on Monday.
The study titled, The burden of mental disorders across the states of India: the Global Burden of Disease Study, addressed the need for a state-specific prevalence of mental health issues which has been missing from Indian mental health research. While some studies have previously established the distribution of mental disorders in particular areas and states, no study until now has covered all the geographical units including the 29 states and a combined set of union territories. It also underlines the magnitude of mental illnesses and the major factors maintaining them which have not been inclusively covered by research prior to this.
Authored by the India State-Level Disease Burden Initiative Mental Disorders Collaborators, the study was approved by the Health Ministry Screening Committee at the Indian Council of Medical Research (ICMR) and the ethics committee of the Public Health Foundation of India. It addresses a major concern for healthcare reforms in India. The implications of calling attention to major risk factors that are behind the emergence of mental illness is also a hallmark of this research.
Despite many efforts in highlighting the causes of mental health issues, be it biological, social, political or an integration of the three, what remains to be seen is how different states and regions have fared in providing care to the people struggling through psychological distress. Not only such studies bring to light the debilitating state of healthcare in India, they also allow a diverse set of theories, ideas and perspectives to explain the crisis.
It has been found that in 2017 there were about two crore (197.3 million) people suffering from one of the diagnosed mental disorders described in the International Classification of Diseases (ICD) or the Diagnostic & Statistical Manual of Mental Disorders (DSM). This amounts to 14.3 percent of the entire Indian population — an estimation that is the double of what was noted in 1990.
Among all the diagnostic labels for mental disorders, major depressive disorder and anxiety disorders were highest in prevalence. Around 44 million people (four crore) were diagnosed with major depressive disorder and anxiety disorders in 2017 with most of them belonging to the southern states. Bipolar disorder followed this with an estimation of 7.6 million people, including a large number of them from Sikkim and Goa. Schizophrenia was found to have affected 3.5 million citizens of the country. Eating disorders, a category mostly studied in the developed countries, was also noted with the highest population residing in Delhi, Sikkim and Goa.
Disorders that emerge during childhood and adolescence phase peaked incidence in the north and central region with states like Madhya Pradesh, Uttar Pradesh and Bihar ranking the highest on cases of intellectual disability, UP and Jharkhand with conduct disorders and Jammu & Kashmir with autism spectrum disorders. The growing number of childhood-related conditions among the states with low socioeconomic population sits consistently with the serious concerns about the state of healthcare in them.
The researchers further attempted to find a relationship between the elevated reports of suicide in India with the existing rate of mental illness. They established a significant relationship between suicide and growing rates of depression and schizophrenia. In this category, women with mood disorders such as depression and anxiety were more likely to have died of suicide than men.
Serious implications; poor support
The term, risk factors, is used in medicine to denote the possible causes behind a particular illness that may have had a crucial role in the genesis of that illness. The study points out some grave risk factors to be operating in the background with most of them having a psychosocial nature.
Child sexual abuse and intimate partner violence are associated with an increase in people with clinical depression while victimisaion due to bullying was linked with the development of anxiety disorders. The link between childhood sexual abuse and depression was found to be more prevalent in females than their male counterparts.
Additionally, the paper in their discussion section attributes the comparatively higher rates of mental illness such as depression and anxiety in women to the patriarchal society of India. It quotes, “The observed higher preva-lence of depressive and anxiety disorders in females than in males has also been reported previously which could be related to gender discrimination, violence, sexual abuse, antenatal and postnatal stress, and adverse socio-cultural norms.”
These risk factors support the concerns mental health activists in India have been raising for quite a long time: mental ill-health is no more an entity solely surfacing due to biological causes; they have deep sociological reasons speaking of gender, caste and class-based persecution. Political factors playing an active role in precipitating mental health issues have also been discussed in the Indian context.
What’s worrying has both social and political implications. Firstly, the numbers presented in the study are expected to only grow in the coming time considering that there is no notable decline in violence against women or children in India, not to mention a doubling of the likelihood of gender-based violence. Secondly, India barely has the budget to take care of its mental healthcare system. Mental healthcare does not make it to even one percent of the total amount in India Researchers from NIMHANS have suggested a gross estimation of about 94,000 crore rupees to properly implement the recent Mental Healthcare Act, 2017; India has received about 50 crores for mental health in the 2018-19 budget.
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Updated Date: Dec 31, 2019 10:23:10 IST