Depression Tops India's Mental Health Burden, Study Finds; Smaller States Show Higher Disability

Depression contributes more to India's mental health burden than anxiety disorders, bipolar disorder, or schizophrenia, according to a nationwide analysis of Global Burden of Disease (GBD) 2021 data. The study also found that several smaller states and Union Territories reported higher disability per patient despite having fewer diagnosed cases.

A nationwide analysis based on the Global Burden of Disease (GBD) 2021 data identified depression as the leading contributor to India's mental health burden. The study also found that schizophrenia causes the highest level of disability per affected individual and reported substantial differences in the burden of mental health disorders across Indian states and Union Territories.

The research, published in the Annals of Indian Psychiatry, examined data from all 36 states and Union Territories to evaluate the prevalence and disability associated with four major mental health conditions: depression, anxiety disorders, bipolar disorder, and schizophrenia.¹

GBD 2021 Study Assesses India's Mental Health Burden

Researchers used data from the Global Burden of Disease (GBD) 2021 study to compare the impact of common mental health disorders across the country. Mental health disorders are among the leading causes of years lived with disability worldwide, making regional burden estimates important for healthcare planning and resource allocation. The analysis measured both the number of people affected and the disability caused by each condition using Disability-Adjusted Life Years (DALYs), a standard public health measure that combines years lived with disability and years of life lost due to premature death.

To estimate how severely each patient is affected, researchers introduced a new metric called the Per-Case Disability Index (PCDI), which compares the disability caused by a disorder with the number of people living with it. This metric estimates the average disability experienced by each patient with a mental health disorder.

Depression Is India's Leading Contributor to Mental Health Burden

Among the four disorders evaluated, depression had the greatest overall impact on health in India. It recorded the highest mean Disability-Adjusted Life Year (DALY) rate at 827.7 per 100,000 population, followed by anxiety disorders (474.5), schizophrenia (213.2), and bipolar disorder (77.4).¹ A higher DALY rate indicates a greater loss of healthy life due to illness, making depression the largest contributor to India's mental health burden.

State-level analysis showed that Tamil Nadu recorded the highest depression DALY rate among all states and Union Territories, meaning it experienced the greatest health loss from depression relative to its population. Kerala reported the highest burden of anxiety disorders, while Telangana also ranked among the states with a high burden of depression.¹

Schizophrenia Causes the Greatest Disability Per Patient

Although schizophrenia affects fewer people than depression or anxiety disorders, the study found that it causes the greatest disability for each affected individual.

To better understand disease severity, researchers calculated the Per-Case Disability Index (PCDI) by comparing disability-adjusted life years with disease prevalence. According to the study, schizophrenia had the highest PCDI among the four disorders, indicating a greater average impact on daily functioning for affected individuals.

Smaller States Report Higher Disability Per Patient

The analysis found that several smaller states and Union Territories, including Goa, Mizoram, Tripura, and Manipur, recorded some of the highest Per-Case Disability Index values.

These findings indicate that although these regions may have fewer diagnosed cases, people living with mental health disorders in these states experience a higher average level of disability compared to many larger states.

The regional differences highlighted in the study also underscore longstanding concerns about unequal access to mental healthcare across India.

The findings align with broader concerns about unequal access to mental healthcare across India. Commenting on these challenges in an earlier interview with MedBound Times, Dr. Rucha Arun Shete, MD (Community Health), Ex-State Mental Health Authority, Government of Maharashtra (GoM), India, emphasized the importance of strengthening mental health services at the community level, saying:

Study Finds Gender Differences in India's Mental Health Burden

Researchers also examined gender differences using a Gender Disparity Index (GDI), where values greater than 1 indicate a higher burden among women. The analysis found that women experienced a higher burden of depression and anxiety disorders in several states.

The researchers noted:

However, the pattern varied across different regions of the country. Study authors found that Bihar, Punjab, and Madhya Pradesh showed male-predominant burden for bipolar and anxiety disorders. 

Study Highlights Regional Differences in Mental Health Burden Across India

The study reported considerable variation in both the prevalence and severity of mental health disorders across India. Researchers also found a strong positive correlation between disease prevalence and disability-adjusted life years, suggesting that DALYs remain a reliable measure of population-level mental health burden.

By combining prevalence with the newly proposed Per-Case Disability Index, the study provides additional information about the severity of mental illness in different regions. The findings show that evaluating both the number of affected individuals and the disability associated with each disorder may offer a more comprehensive understanding of India's mental health burden.

Together, the findings suggest that measuring not only how many people are affected but also how severely they are affected may help policymakers better identify regions requiring additional mental health resources and community-based services.

The authors of the study concluded, "Future health programs in India should incorporate the GDI and Per-Case Disability Index into their programmatic choices to improve on more conventional metrics such as prevalence and DALY. This all-encompassing strategy is necessary to build a mental health system that is genuinely responsive and equitable."

References

1. Patel, Nisheet M., Prajesh M. Kalathiya, Dhatri C. Sarvaiya, Parthvi J. Mehta, Grishma V. Savaliya, and Lakhan R. Kataria. 2025. "Regional Differences in the Mental Health Burden among Indian States: A Global Burden of Disease 2021-Based Analysis." Annals of Indian Psychiatry 10 (2): 173–182. https://doi.org/10.4103/aip.aip_119_25.

2. GBD 2019 Diseases and Injuries Collaborators. 2020. "Global Burden of 369 Diseases and Injuries in 204 Countries and Territories, 1990-2019: A Systematic Analysis for the Global Burden of Disease Study 2019." The Lancet 396 (10258): 1204-1222. https://doi.org/10.1016/S0140-6736(20)30925-9.

(Rh/SS/MSM)