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Indian Journal of Community Medicine

Epidemiological Study of Prevalence of Mental Disorders in India

Author(s): Murali Madhav S.

Vol. 26, No. 4 (2001-10 - 2001-12)

Deptt. of Community Medicine, Kasturba Medical College, Mangalore - 575001

Abstract:

Research question: What are the national prevalence rates of major mental disorders in India?

Objectives: 1. To estimate the national prevalence rate for all mental disorders. 2. To estimate the national prevalence rates for five specific disorders - Schizophrenia, depression, anxiety neurosis, hysteria and mental retardation. 3. To estimate rural-urban differences in mental disorders.

Study design: Analysis of ten Indian studies on psychiatric morbidity to estimate the median values for the prevalence rates.

Results: Prevalence rates for all mental disorders was observed to be 65.4 per 1000 population. Prevalence rates for schizophrenia, affective disorders (depression), anxiety neurosis, hysteria and mental retardation were 2.3, 31.2, 18.5, 4.1 and 4.2 per 1000 population respectively. The urban morbidity rate was 2 per 1000 higher than the rural rate. The results will be useful to mental health planners and administrators for planning the national mental health programme.

Keywords: Epidemiological studies, Prevalence rates, Mental disorders, Rural-urban differences

Introduction:

The WHO had declared that the World Health Day theme for the year 2001 is "Mental Health: Stop exclusion - dare to care"., in order to focus global public health attention on this relatively neglected problem. Information regarding the prevalence of mental disorders in India needs to be generated to establish a database for mental health planners to assess the status of mental health in the country. The Bhore Committee1 concluded that mental patients requiring institutional treatment would be 2 per 1000 in the country. In 1966, the Mental Health Advisory Committee to the Govt. of India suggested a prevalence rate of mental illnesses of 20 per 1000 population with 14 per 1000 in rural areas (Elnagger MN et al)2. An analysis of the epidemiological studies done in the country would be a rational method of estimating the national prevalence rates for mental disorders. The present article aims to do this.

Since 1960, epidemiological studies of psychiatric morbidities in different samples of Indian population have been conducted. The present study analyses ten such epidemiological studies.

Material and Methods:

Sample: The ten epidemiological studies analysed in the present study were:

  • Uttar Pradesh: Sethi BB et al. (1978)3
  • West Bengal: Nandi DN et al. (1975)4, (1979)5, (1980)6,
  • Gujarat: Shah AV et al. (1980)7
  • Tamil Nadu & Pondicherry: Verghese A et al (1973)8,
  • Premarajan KC et al (1993)9
  • Kerala: Shaji S et al, (1995)10
  • Andhra Pradesh: Reddy MV et al (1998)11
  • Delhi: Ganguli HC (2000)12

The above list contains ten major Indian studies in this field.

Methodology: A common feature of the studies listed above was similarity of design-all were conducted in three phases or steps:

  1. delineation of the sample and initial contact with subjects including collection of background demographic data,
  2. identification of suspected cases, usually on the basis of interviews and questionnaire by non-psychiatric personnel like social workers and sometimes by psychological tests. Physical examination of suspected cases by medical personnel was part of this phase,
  3. psychiatric examination and clinical diagnosis and classification of suspected cases was the third stage.

Overall, a certain uniformity in these studies existed that permitted pooling of data for arriving at larger inferences of relevance for the Indian society.

Results:

Prevalence rates are given for all mental disorders and for five specific disorders, viz. schizophrenia, affective disorders (depression-psychotic and neurotic), anxiety neurosis, hysteria and mental retardation. All mental disorders or total mental disorders included all categories of recognized psychiatric syndromes.

(i) All mental disorder (national):

Table I: National prevalence rates for all mental disorders (All India rates/1000 population).

  Rural Urban Combined
Median 64.4 66.4 65.4
Range 18-142 24-207 18-207

Table I gives the Indian national prevalence rates for all mental disorders, computed from the epidemiological studies being considered here. Table I shows the all-India national rate (rural + urban) to be 65.4/1000, rural rate as 64.4 and urban rate as 66.4. Thus the urban rate is marginally higher than the rural rate.

(ii) Specific disorders:

Table II: National prevalence rates for specific disorders (Rates/1000 - median and range).

  Median Range
Schizophrenia 2.3 1.1-14.2
Affective disorder - depression (psychotic and neurotic) 31.2 0.5-53
Anxiety Neurosis 18.5 11-70
Hysteria 4.1 2.5-17
Mental Retardation 4.2 1.4-25.3

Table II gives the prevalence rates in the country for five disorders. For schizophrenia, the national rate observed was 2.3 per 1000. The category - affective disorders incorporates data regarding all depressive disorders, neurotic and psychotic. The all India value observed was 31.2 per 1000. Mental retardation was observed to have national rate of 4.2 per 1000. The most widely prevalent disorders were observed to be depression and anxiety, in that order (18.5 per 1000 for the later). (iii) Rural-urban difference: The urban morbidity rate was observed to be 2 per 1000 higher than the rural morbidity rate (66.4 and 64.4 respectively).

Discussion:

The overall prevalence of all mental disorders analysed to be 65.4 per 1000 population in present study compares closely with the observations of Sethi BB et al13 who reported it as 67/1000 in an independent study not included in the list of studies considered for present analysis. The prevalence of schizophrenia (2.3/1000) is the only rate whose prevalence is consistent across cultures and over time. All the studies analysed have consistently observed that depression and anxiety neurosis are the most widely prevalent disorders.

The urban-rural difference of morbidity of 2 per 1000 compares closely with the findings of Dohrenwen BP et al14 who reported difference of 1.1/1000.

The prevalence rates of major mental disorders arrived at in the study may be looked upon as baseline rates and used for evaluation of mental health data in the coming years. It is hoped that the present results will be useful to mental health planners and administrators for planning the mental health care delivery system.

Acknowledgements:

The author is sincerely grateful for the motivation and guidance provided by Dr. N. Udaya Kiran, Professor of Community Medicine, Kasturba Medical College, Mangalore in undertaking this study. The author is also thankful to the Head of the department of Community Medicine for permitting him to undertake this study.

References:

  1. Govt. of India. Report of health survey and development committee (Bhore committee), Vol. III, Appendix New Delhi, Govt. of India: 1946; 73.
  2. Elnaggar MN, Moitra P, Rao MN. Mental health in an Indian rural community: British J Psych 1974; 46: 327-59.
  3. Sethi BB, Manchandra R. Socio-economic, demographic and cultural correlates of psychiatric disorders with special reference to India. Ind J Psych 1978; 20: 199-21.
  4. Nandi DN, Ajmani S, Ganguli H et al. Psychiatric disorders in a rural community in West Bengal - an epidemiological study. Ind J Psych 1975; 17: 87-99.
  5. Nandi DN, Banerjee G, Boral GC et al. Socio-economic status and prevalence of mental disorders in certain rural communities in India: Act Pschy Scand 1979; 59: 276-93.
  6. Nandi DN, Das NN, Chaudhury A et al. Mental morbidity and urban life - an epidemiological study: Ind J Psych 1980; 22: 324-30.
  7. Shah AV, Goswami UA, Maniar RC, Hajariwala DC, Sinha BK. Prevalence of psychiatric disorders in Ahmedabad (an epidemiological study). Ind J Psych 1980; 22: 384-9.
  8. Verghese A, Beig A, Senseman LA, Sunder Rao SS, Benjamin VA. Social and psychiatric study of a representative group of families in Vellore town. Ind J Med Res 1973; 61: 608-20.
  9. Premarajan KC, Danabalan M, Chandreshkar R, Srinivasa DK. Prevalence of psychiatric morbidity in an urban community of Pondicherry: Ind J Psych 1993; 35: 99-102.
  10. Shaji S, Verghese A, Promodu K, George B, Shibu VP. Prevalence of priority psychiatric disorders in a rural area of Kerala. Ind J Psych 1995; 37: 91-6.
  11. Reddy MV, Chandreshkar CR. Prevalence of mental and behavioural disorders in India: A meta-analysis. Ind J Psych 1998; 40: 149-57.
  12. Ganguli HC. Epidemiological findings on prevalence of mental disorders in India. Ind J Psych 2000; 42: 14-20.
  13. Sethi BB, Gupta SC, Mahendru RK, Kumari P. Mental health and urban life: A study of 850 families. British J Psych 1974; 124: 243-6.
  14. Dohrenwend BP, Dohrenwend BS. Social and cultural influences on psychopathology. Ann Rev Psych 1974; 25: 417-52.
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