Vikram Patel, et. Al. on “Burden of mental disorders and socioeconomic determinants”

This report describes the results of a review of the epidemiological evidence on mental disorders in India, with the aim of using the evidence to generate estimates of the population burden of mental disorders, the role of socio-economic risk factors for mental disorders and the implications for public health policy in Gujarat. The review covered a large number of sources of data, and included all community and primary or general health care setting studies published over the past two decades (since 1980). Only studies where there was data either on prevalence/incidence or risk factors, were included. The four major categories of mental disorders which were included in the review were: Common Mental Disorders (CMD) such as depression and anxiety; Severe Mental Disorders (SMD) such as schizophrenia; Substance Abuse (SA) disorders such as alcohol and drug dependence; and Childhood Mental Disorders. There are two key findings of the review. First, the review points to an enormous burden of mental disorders in the population. Based on the median or average rates of the different categories of mental disorders reported in community studies, we estimate that there are more than 1 lakh adults with schizophrenia in Gujarat, about 2 million adults with CMD, and about 2 million children with one or another form of mental or developmental disorder at any given point in time. Second, the major risk factors for mental disorders are poverty, low education, social displacement and violence (both domestic and civil). Whereas women are more vulnerable to suffer CMD, SA is overwhelmingly more common in men. Gender factors such as violence against women and the sex of the newborn child are risk factors for mental disorders in women. The elderly are a risk group for CMD.

The implications of these findings point to the need for prevention as the major public health policy imperative. In the context of a large unmet need for basic care, secondary prevention is a priority for the mental health policy. Strategies aimed at secondary prevention must include strengthening the human and infrastructure resources in primary and general health care to provide mental health services; improving and reforming the quality of care in public, private and traditional psychiatric care services, in particular the mental hospitals; implementing community based rehabilitation programs for severe mental disorders; and providing psychosocial interventions to high-risk groups such as victims of violence. In addition, concerted campaigns to raise the mental health literacy of the population may ensure that stigma against mental disorders is reduced and early treatment sought for mental illnesses. In the longer-term, primary prevention strategies, essentially programs aiming to foster social harmony, reduce the impact of acute poverty and promote equitable human development, may be expected to have benefits for community mental health. Inter-sectoral collaboration between the mental health policy mission and other sectors related to human and social development lie are a key, short-term, priority to integrate mental health paradigms in such primary prevention programs.

There is need to build research capacity in Gujarat so that key research priorities for the future may be implemented. Research priorities include investigating the mental health aspects of existing public health priorities such as reproductive health, health services research aimed at evaluating the quality of care and outcomes of different models of health care for mental disorders, and trials of the efficacy and cost-effectiveness of new models of prevention and management of mental disorders.

Address for Correspondence
Dr Vikram Patel, Sangath Centre, 841/1 Alto Porvorim, Goa 403421.
Email: vikpat@goatelecom.com
Tel: 0832-413527
Fax: 0832-415244