Indian Jounal of Community Medicine Vol, XXVI, No.6, Oct-Dee., 2001 EPIDEMIOLOGICAL STUDY OF PREVALENCE OF MENTAL DISORDERS IN INDIA Murali Madhav. Deptt. of Community Medicine, Kasturba Medical College, Mangalore - 575001 Abstract Ceseach question: What ae the national revalence res of major mental sores in fi? Gfjectes Tocsumate Renanonal pevaiise oral neal Ges 2'Feeximateiealonl prevaene ‘acs or hive spi order -Soropveni, depeson ant neurosis, ystria nd ent retardation 5 To estimate rural-urban differences in mental disorders. Siudy design: Analysis often Indian studies on psychialrie morbidity to estimate the median values forthe prevalence rates. Results: Prevalence rates forall mental disorders was observed to be 65.4 per 1000 popiilation. Prevalence rates Tor schizophrenia, alfecuive disorders (depression), anxiety neurosis, hysteria and mental retardation were 2.8, 31.2, 18.5, 4.) and 4.2 per 1000 population respectively. The urban mot ‘dministatrs for planning t mal mental health programme. rate was 2 per 1000 higher than the rural rat. The rst ‘wll be useful to mental health planners and Key words: 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 inthe country. ‘The Bhore Committee’ 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)’. 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 bbeen 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 etal. (1978)" ‘West Bengal: Nandi DN et al. (1975)*, (1979), (1980), Gujarat: Shah AV etal. (1980)" ‘Tamil Nadu & Pondicherry: Verghese A etal (1973)*, Premarajan KC et al (1993)" Kerala: Shaji Set al, (1995)"” Andhra Pradesh: Reddy MV etal (1998)"" Delhi: Ganguli HC (2000)"* ‘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 rnon-psychiatric personnel like social workers and. sometimes by psychological tests. Physical examination of suspected cases by medical personnel was part ofthis phase, (3) psychiatric examination and clinical diagnosis and classification of suspected cases was the third stageInlan Joumal of Comemurity Medicine Vol XXVI, No, Oct-Dec., 2001 ‘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 forall 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. (All mental disorder (national): ‘Table I: National prevalence rates for all mental disorders (All India rates/1000 population). Rural Urban Combined ‘Median 644 66.4 65.4 Range 18142 2420718207 ‘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 (i) Specific disorders: Table Il: National prevalence rates for specific disorders (Rates/1000 - median and range). Schizophreni . Affective disorder-depression 31.2 05-53 (psychotic and neurotic) Anxiety neurosis 185 11-70 Hysteria 4a 25-17 Mental retardation 42 14.253 ‘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, Prevalance of mental 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) Rurab-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 etal” 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 (2.31000) isthe only rate whose prevalence i 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 Dobrenwen BP ta ‘who reported difference of 1.1/1000 ‘The prevalence rates of major mental disorders arrived atin the study may be looked upon as baseline rates and used for evaluation of mental health data inthe coming years. Its 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. II, Appendix New Delhi, Govt. of India: 1946; 73,Indian Jounal of Community Medicine Vol. XXVI, No, Oct-Dec. 2001 2. Elnaggar MN, Moitra P, Rao MN. Mental health in an J Psych 1974; 46: 3. Sethi BB, demographic and cultural correlates of psychi disorders with special reference to India. Ind J Psych 1978; 20: 199-21 Manchandra R. Socio-economic, ric 4, Nandi DN, Ajmani S, Ganguli H et al. Psychiatric disorders in a rural community in West Bengal - an epidemiotogical 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, 9. 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 Med Res 1973; 61: 608-20. 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. Shaji $, Verghese A, Promodu K, George B, Shibu YP. Prevalence of priority psychiatric disorders in a ‘ural area of Kerala. Ind J Psych 1995; 37: 91-6, Reddy MV, Chandreshkar CR. Prevalence of mental ‘and behavioural disorders in India: A meta-analysis, Ind J Psych 1998; 40: 149-57, Ganguli HC. Epidemiological findings on prevalence ‘of mental disorders in India. Ind J Psych 2000; 42: 14-20, Sethi BB, Gupta SC, Mahendra RK, Kumari P. ‘Mental health and urban life: A study of 850 families. British J Psych 1974; 124: 243-6. Dohrenwend BP, Dohrenwend BS, Social and cultural influences “on psychopathology. Ann Rev Psych 1974; 25: 417-52. 1 A P S M MEMBERSHIP FEES Life Membership : Rs. 1100/- Annual Membership : Rs. 255/- (Should be in the form of Demand Draft in favour of “Indian Association of Preventive & Social Medicine” payable at Rohtak) Itis ALWAYS beneficial to become a Life Member! Contact: Prevalence of mental dsorders ‘The Secretary General TAPSM Deptt. of S.P.M. Pandit B.D. Sharma P.G.LM.S. Rohtak-124001, Haryana Murai Madhav S