The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017

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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.,..., & Dandona, L. (2019). The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017. The Lancet Psychiatry, 7(2), 148-161. https://doi.org/10.1016/s2215-0366(19)30475-4

Journal or book title
The Lancet Psychiatry
Publisher
Elsevier BV
Volume
7
Issue
2
Pages
148-161
Publication date: 23 Dec 2019 Added to AutiHub: 29 Sep 2026 Type: Article Article language: English
Publisher source (DOI) OpenAlex source

This publication is integrated into AutiHub through:

Authors

Publication authors
42
Publication authors identified as autistic
1 / 42 (2.4%)
  1. Rajesh Sagar
  2. Rakhi Dandona
  3. Gopalkrishna Gururaj
  4. R S Dhaliwal
  5. Aditya Singh
  6. Alize Ferrari
  7. Tarun Dua
  8. Atreyi Ganguli
  9. Mathew Varghese
  10. Joy K Chakma
  11. G Anil Kumar
  12. K S Shaji
  13. Atul Ambekar
  14. Thara Rangaswamy
  1. Lakshmi Vijayakumar
  2. Vivek Agarwal
  3. Rinu P Krishnankutty
  4. Rohit Bhatia
  5. Fiona Charlson
  6. Neerja Chowdhary
  7. Holly E. Erskine
  8. Scott D Glenn
  9. Varsha Krish
  10. Ana M Mantilla Herrera
  11. Parul Mutreja
  12. Christopher M Odell
  13. Pramod K Pal
  14. Sanjay Prakash
  1. Damian Santomauro *
  2. D K Shukla
  3. Ravinder Singh
  4. R K Lenin Singh
  5. J S Thakur
  6. Akhil S ThekkePurakkal
  7. Chris M Varghese
  8. K Srinath Reddy
  9. Soumya Swaminathan
  10. Harvey A. Whiteford
  11. Hendrik J Bekedam
  12. Christopher J L Murray
  13. Theo Vos
  14. Lalit Dandona

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: 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. 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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Cited references
72
With a DOI
64
Without a DOI, from raw bibliography text
6
6 / 72 (8.3%) cited references include at least one author identified as autistic.
References with data to complete
3 / 72 (4.2%)
References with detected author names
69 / 72 (95.8%)
Without detected author names
3
Without a structured title
0
Without a stable identifier
6
References with raw author names still to review
0
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
7384
From DOI or external metadata
7384
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
499 / 7384 (6.8%) names are linked to an author already present in AutiHub. 6885 / 7384 (93.2%) names are not yet linked.
Names linked to a person identified as autistic
6 / 7384 (0.1%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 6 / 499 (1.2%). Distinct people identified as autistic: 2 / 2219 (0.1%).
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