ORIGINAL ARTICLE

Epidemiology of common mental disorders: Results from “National Mental

Health Survey” of India, 2016
Pavithra Jayasankar, Narayana Manjunatha1, Girish N. Rao2, Gopalkrishna Gururaj3, Mathew Varghese,
Vivek Benegal4, NMHS India National Collaborator Group
Department of Psychiatry, National Institute of Mental Health and Neurosciences, 1Department of Psychiatry, Tele‑Medicine
Centre, National Institute of Mental Health and Neurosciences, 2Department of Epidemiology, Centre for Public Health,
National Institute of Mental Health and Neurosciences, 3Department of Epidemiology, WHO Collaborative Centre for
Injury Prevention and Safety Promotion, Centre for Public Health, National Institute of Mental Health and Neurosciences,
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4
Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences,
Bengaluru, Karnataka, India

ABSTRACT

Background: Despite their higher prevalence, the Common Mental Disorders (CMDs) are under‑recognized and
under‑treated resulting in huge disability. India, home to one‑fifth of the global population, could offer insights for
organizing better services for CMDs. However, the prevalence and resultant disability in the general population is
unknown, and consequently, gaps in management or plan for services are enormous, by default overlooked.
Aim: Estimating the current prevalence, disability, socioeconomic impact, and treatment gap of CMDs in a nationally
representative sample from India. We attempt to identify the missed opportunities and list priorities for planning.
Methodology: The National Mental Health Survey of India (2016) is a multisite nationwide household survey conducted
across India using a uniform methodology. Overall, 39,532 adults were surveyed with a response rate of 88%. Diagnoses
are based on the Mini International Neuropsychiatric Interview 6.0.0. CMDs for this analysis include depressive and
anxiety disorders (generalized anxiety disorder, social phobia, agoraphobia, panic disorder, obsessive‑compulsive
disorder, and posttraumatic stress disorder).
Results: The weighted prevalence of current CMDs was 5·1% (95% CI: 5.06–5.13). Prevalence was highest in females,
among the 40–59 years of age group, and in metros. Nearly 60% of them reported disabilities of varying severity. The
treatment gap was 80·4%. On average, patients and their families spent ₹1500/month towards the treatment of CMDs.
Conclusions: This survey gives valuable insights regarding the disability and treatment gap due to CMDs and is imperative
for reframing mental health policies and planning interventions. This study also suggests an international investigation to
understand the difference in the prevalence of CMDs in developing versus developed countries.

Key words: Anxiety disorders, common mental disorders, depressive disorders, India, national mental health survey, prevalence

Address for correspondence: Dr. Narayana Manjunatha,

Department of Psychiatry, National Institute of Mental Health
and Neurosciences, Bengaluru ‑ 560 029, Karnataka, India.
E‑mail: manjunatha.adc@gmail.com, nmhs.nimhans@gmail.com
This is an open access journal, and articles are distributed under the terms of
Submitted: 21-Oct-2021,  Revised: 06-Nov-2021, the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
Accepted: 30-Nov-2021,  Published: 21-Jan-2022 which allows others to remix, tweak, and build upon the work non‑commercially,
as long as appropriate credit is given and the new creations are licensed under
the identical terms.
Access this article online
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Website:
www.indianjpsychiatry.org
How to cite this article: Jayasankar P, Manjunatha N, Rao GN,
Gururaj G, Varghese M, Benegal V, NMHS India National
DOI:
Collaboarator Group. Epidemiology of common mental
disorders: Results from “National Mental Health Survey” of
10.4103/indianjpsychiatry.indianjpsychiatry_865_21
India, 2016. Indian J Psychiatry 2022;64:13-9.

© 2022 Indian Journal of Psychiatry | Published by Wolters Kluwer - Medknow 13

 Jayasankar, et al.: Common Mental Disorders in India’s National Mental Health Survey, 2016
INTRODUCTION
Common mental disorders (CMDs) encompassing neurotic
and nonpsychotic affective disorder refers to two major
symptom dimensions – depression and anxiety and[1]
are “common” because they are widely prevalent in the
community and primary care.[1] CMDs are regarded as
“invisible disorders” as they are often overlooked by patients,
caregivers, health professionals, and policymakers yet cause
significant health burdens. International Classification of
Diseases 10th Edition (ICD‑10)[2] classifies CMDs as: “neurotic,
stress‑related and somatoform disorders” and “mood
disorders.” Due to the high degree of comorbidity between
sub‑categories and the similarity in epidemiological profiles
and treatment responsiveness,[3] the CMDs construct is a more
practical and valid concern for public health interventions.
Fortunately, there has been a growing recognition of the
disability caused by CMDs globally and of late in India also.
Depressive and anxiety disorders contributed to 7·5% and
3·4% of years lived with disability (YLD).[4]
A World Health Organization (WHO) analysis emphasized that
for every $1 invested in the scaling‑up treatment of depressive
and anxiety disorders, the return is $4 in terms of health and
economic benefits.[5] This return‑on‑investment underscores
the strong recommendation for greater investment in mental
health services for CMDs in every country.[6]
India hosts 17.7% of the global population,[7] but very few
epidemiological studies have estimated the prevalence
of CMDs or their burden. The World Mental Health
Survey (WMHS) India component observed the past
12‑month prevalence of CMDs to be 5.5%,[8] and this included
anxiety disorders, depressive disorders, and substance use
disorders (SUDs) and three sub‑types (specific phobia, panic
disorder, generalized anxiety disorder [GAD]) were estimated
among anxiety disorders. However, researchers did not
include agoraphobia, social phobia, obsessive‑compulsive
disorder (OCD), and posttraumatic stress disorder (PTSD).
There are no other existing nationally representative
studies on CMDs in India. However, the prevalence of CMDs
among the geriatric population from NMHS 2016 is already
published.[9]
This analysis from the National Mental Health
Survey (NMHS) of India (2015‑2016) focuses on the current
prevalence of CMDs among all adults (18 years and above),
its sociodemographic correlations, disability burden,
treatment gap, and its socioeconomic impact with an
attempt to identify missed opportunities and list priorities
for planning services.
METHODOLOGY
A detailed description of the methodology is available
online (http://indianmhs. nimhans.ac.in/nmhs‑reports.php)
14
and elsewhere.[10,11] In summary, NMHS 2016 was a large
population‑based study conducted across 12 states of India
using a multi‑stage, stratified, random cluster sampling
technique based on probability proportionate to size at
each stage (MSRS‑PPS) and sampled nearly two‑thirds of
the population of India. As per India’s census 2011, each
inhabited village constituted the rural cluster, and each
ward in the urban area formed the metro/nonmetro urban
cluster.
All adults 18 years and older were included. All eligible
adult respondents within the identified household were
interviewed. Persons who could not be interviewed
even after three visits were considered nonresponders.
A rigorous attempt was made to include all eligible people
in the study.
We obtained ethical clearance from the Institute Ethics
Committee of “National Institute of Mental Health and
Neurosciences,” Bengaluru, India, and corresponding IECs
of partner institutions in each state. Obtained informed
consent from the respondents before conducting the
interview.
The Mini‑International Neuropsychiatric Interview (MINI)
version 6.0.0[12] was used to diagnose CMDs. The MINI is
a structured diagnostic tool for screening and diagnosing
mental disorders as per ICD‑10 in multiple Indian
languages. Other instruments used were the Sheehan
Disability Scale,[13] a specially designed questionnaire
exclusively for this NMHS survey to assess treatment, and
healthcare‑seeking pattern to evaluate the treatment gap
and socioeconomic impact. The NMHS field team conducted
diagnostic interviews at each state with a psychology/social
work/communications and rural development background.
The training for the data collection team conceptually relied
on SEE–PRACTICE–CONDUCT–REFINE principle and was
conducted over 7–8 weeks in a uniform training schedule.
Further complete detail is available elsewhere.[10]
For the present communication, depressive disorder (without
psychotic symptoms) and anxiety disorders were included
as CMDs. Anxiety disorders comprised GAD, panic
disorder, social anxiety disorder, agoraphobia, PTSD,
and OCD. Diagnosis of all the above disorders was as per
ICD‑10 ‑ Diagnostic Criteria for Research. The current
prevalence refers to the last month for social phobia,
agoraphobia, panic disorder, PTSD, 6 months for GAD, and
2 weeks for depressive disorder.
Considering the unequal probability of selection and
nonresponse rates, the weighted prevalence estimates
were derived for CMDs. All estimates are presented with
95% CIs. Multiple logistic regression was done considering
CMDs as the dependent variable and sociodemographic
characteristics (i.e., gender, age, education, occupation,
Indian Journal of Psychiatry Volume 64, Issue 1, January-February 2022
 Jayasankar, et al.: Common Mental Disorders in India’s National Mental Health Survey, 2016
marital status, and place of residence) as independent
variables considered necessary from a clinical and public
health implication for identifying risk factors associated with
CMDs. The adjusted odds ratio was calculated. IBM SPSS
(Statistical Package for Social Sciences) version 27.0 from
International Business Machines Corporation, New York,
USA[14] was used for all analyses.
RESULTS
Across the 12 states of India, identified 10,610 households
for the survey, and among these, 9666 households were
surveyed (household response rate of 91·1%). Thirty‑nine
thousand five hundred and thirty‑two eligible adults
18 years and above were contacted, and 34,802 were
finally interviewed (individual response rate 88.0%). The age
and gender composition of the surveyed population were
similar to the population of India as per Census 2011: 52%
of the sample were females and 48% there was a more
significant proportion of the elderly; 34% belonged to the
18–29 age group, while 16% were above 60 years. Nearly
75% of the study samples were married, and 68% were from
rural areas. Around 51% of respondents were unemployed,
and 24% were “not literate.”
The overall weighted prevalence of current CMDs was
5·1% (95% confidence interval [CI]: 5·06–5·13) [Table 1].
The prevalence of CMDs was highest at age 50–59 years
compared with other age groups (5.71% in 40–49, 6·03% in
50–59, and 5.87% in those above 60). Higher prevalence was
amongst females (5.79% 95 CI 5.46–6.14), those with lesser
education (illiterate [6.03%, 95% CI 5.54–6.55] and primary
education [5.68%, 95% CI 5.13–6.28]), being unemployed
(5.09%, 95% CI 4.78–5.42), married (4.93%, 95% CI 4.67–5.20)
and those residing in metro urban areas (8.11%, 95% CI
7.32–8.96).
The current prevalence of depressive and anxiety
disorders (including PTSD and OCD) is 2·68% and 2·94%,
respectively. The current prevalence was higher among
females in both depressive (female: 3.01% vs. male: 2.4%) and
anxiety disorders (female: 3·69% vs. male: 2·14%) [Table 1].
Table 2 shows the multiple logistic regression analysis for
various sociodemographic factors associated with CMDs.
Among the sociodemographic variables, gender, age and
residence were found to be significantly associated with
CMDs. The risk of CMDs among females was found to be
Table 1: The current prevalence of common mental disorders (n=34,802)
Total
n (%) 95% CI
Any CMD 1683 (5.1) 5.06‑5.13
Depressive disorders 881 (2.68) 2.65‑2.71
Anxiety disorders (with PTSD and OCD) 959 (2.94) 2.92‑2.97
PTSD – Posttraumatic stress disorder; OCD – Obsessive‑compulsive disorder; CMD – Common mental disorder; CI – Confidence interval
Indian Journal of Psychiatry Volume 64, Issue 1, January-February 2022
1.53 times higher than males. Furthermore, people residing
in metro urban cities had 1.86 times higher risk than those
living in rural areas.
Nearly two‑third of individuals had reported disability
either at work or family or social life due to CMDs. Of
which, almost 50% had moderate or more disability due to
CMDs [Table 3].
Socioeconomic impact assessment [Table 4] showed that
nearly one out of 2 patients had difficulties with activities
of daily life and thus “could not do as usual” and quantified
that they had either inability/reduced ability to work at
least 10 days in a month. Family members, on average,
2 days/month, had to forgo work to take care of patients
with CMDs, which points out the social impact of CMDs.
Median monthly expenditure incurred due to health
and treatment‑related costs were estimated at around
₹1500/month.
Overall the treatment gap of CMD was estimated to be
around 80·4% and was slightly greater amongst females
81·5%. The treatment gap at urban nonmetro (87·4%)
is surprisingly higher than rural (79·7%) and urban
metro (77·7%) populations [Table 5].
DISCUSSION
This NMHS is the first nationwide epidemiological survey
with a large population sample and rigorous methodology
which estimated the prevalence, disability, and treatment
gap of psychiatric disorders across different states in India
from the representative general population. Of the 39,532
individuals surveyed, the response rate was 88%. The
sample size was large and representative compared to the
earlier survey (24,371 individuals in Sagar et al., 2017) with
a similar response rate. The inclusion of agoraphobia, social
phobia, OCD, and PTSD in the estimation of CMDs is a value
addition.
While earlier Indian data estimated the prevalence of
neurotic disorders to be in the range of 5.8%–7.3%,[15,16] the
overall weighted current prevalence of CMDs in the present
study was 5.1% (95% CI: 5.06–5.13). These numbers translate
to 70 million Indian adults suffering from CMDs. Consistent
with the literature, CMDs were higher in females[17,18] and
those above 40 years. This result brings the need for more
research into the impact of CMDs on work productivity and
Male Female
n (%) 95% CI n (%) 95% CI
628 (3.79) 3.50‑4.08 1055 (5.79) 5.46‑6.14
350 (2.4) 2.39‑2.47 531 (3.01) 2.96‑3.04
336 (2.14) 2.11‑2.18 623 (3.69) 3.65‑3.74
15
 Jayasankar, et al.: Common Mental Disorders in India’s National Mental Health Survey, 2016

absenteeism.[19] That metro had a higher prevalence of CMDs The overall treatment gap of CMDs was 80.4%, more significant
adds to the growing evidence of the impact of urbanization in nonmetros and amongst females. This is the first time that
in the development of mental disorders.[20] disability has been enquired in India in a community‑based
survey. The present study found that around two‑third (60%)
reported disability, underscoring the urgent need for
Table 2: Multiple logistic regression analysis for factors
planning services. Substantive disability compounded with
associated with current common mental disorders
a huge treatment gap increases disability‑adjusted life years
(n=1683)
and YLD and adds to higher economic costs.[21] As most CMDs
Adjusted OR 95% CI P
affect one’s productive years, it can lead to absenteeism
Gender
leading to less productivity and increased job strain, etc.[22]
Male (reference) 1.0
Female 1.53 1.41‑1.72 <0.001
Age The Portugal‑WMHS estimated disability among CMDs
18‑29 (reference) 1.0 to be only 14.6%.[23] The reason for this vast difference
30‑39 0.72 0.59‑0.85 <0.001 between Portugal‑WMHS and NMHS samples has to be
40‑49 0.89 0.74‑1.05 0.18
interpreted carefully. WMHS study has used WHODAS 2.0
50‑59 1.04 0.87‑1.23 0.64
>60 1.06 0.89‑1.26 0.49 to measure disability, including cognition and self‑care
Education components, which are less likely to be affected in CMDs.
Illiterate 1.0 Indian sites WMHS in 2005 showed that the treatment gap
Primary 1.05 0.91‑1.21 0.48 for CMDs was around 95%.[8] This change in the treatment
Secondary 0.96 0.82‑1.13 0.67
gap can be taken on a positive note that the treatment
High school 0.76 0.65‑0.90 0.001
Preuniversity 0.75 0.60‑0.91 0.006 gap has improved over a decade, which could be due to
Graduate 0.57 0.46‑0.71 <0.001 improved healthcare services over time. However, caution
Others* 0.96 0.41‑2.23 0.93 is the inclusion of SUDs in this considerable treatment
Occupation gap. Conventionally, a large treatment gap is attributed to
Employed (reference) 1.00 stigma, lack of human and financial resources, accessibility,
Unemployed 0.96 0.44‑2.06 0.91
Others* 0.89 0.41‑1.90 0.75
awareness among the public, etc.[24] The treatment gap
Marital status for CMDs in NMHS was higher in the urban area (87·7% in
Single (reference) 1.0 nonmetro urban). Although nonintuitive, huge treatment
Married 1.18 1.18‑0.54 0.67 gaps are also due to unevenly distributed resources, leaving
Divorced/separated 1.15 1.15‑0.53 0.71 the transition location of urban areas “orphans” compared
Residence
Rural (reference) 1.0
to metro and rural areas.[25]
Nonmetro urban 0.84 0.73‑0.97 0.02
Metro urban 1.86 1.64‑2.11 <0.001 Are the prevalence of the CMDs on the rise in last decade?
OR – Odds ratio; CI – Confidence interval, *Means missing data Sagar et al.[8] reported the 12‑month prevalence of CMDs was

Table 3: Disability in various domains in patients with common mental disorders (n=1509)

Self‑reported No disability, Any disability, n (%*)
disability n (%) Mild Moderate Severe Extreme
Disability at work 598 (39.7) 471 (51.7) 247 (27.2) 132 (14.6) 60 (6.6)
Disability at social life 572 (37.9) 465 (49.6) 273 (29.1) 140 (15) 59 (6.3)
Disability at family life 568 (37.6) 442 (47) 281 (29.9) 139 (14.8) 79 (8.3)
Disability is assessed using Sheehan Disability Scale, *The percentage of grading of any disability is calculated with denominator of any disability as a total.
Missing data (n=174) has been excluded from analysis

Table 4: Socioeconomic impact of current common mental disorders

Difficulties with activities of daily life (n=1509)* n (%)
Could do as usual 871 (57.7)
Could do but not everything 353 (23.4)
Could do only something 179 (11.9)
Extreme or could do nothing 92 (6.1)
Socioeconomic impact Median days/monthly expenditure
Unable to carry out usual activities in the past 30 days (n=742) 10
Reduction of usual activities in the past 30 days (n=721) 10
Family members were not able to go to work in the past 3 months for care of patient 6
Family leisure or social activities was missed 10
Median monthly expenditure (INR) 1500
*Difficulties with activities in daily life - 14 (0.9%) status not known

16 Indian Journal of Psychiatry Volume 64, Issue 1, January-February 2022

 Jayasankar, et al.: Common Mental Disorders in India’s National Mental Health Survey, 2016
Table 5: Treatment gap and care characteristics of adult common mental disorders
Variable
Treatment gap (%)
Median duration of illness in months
Median interval between onset of illness and consultation in months
Median duration of being on treatment in months
5·52% which included SUDs but excluded PTSD, OCD, social
phobia, and agoraphobia. However, our study, undertaken
almost a decade later (2003–2005 vs. 2015–2016), has
observed an increase in the prevalence of CMDs. Similar
to our findings, WMHS estimated the 12‑month prevalence
of mood and anxiety disorders to be in the range of 4.1%–
5.7%[26] in other low‑ and middle‑income countries (LAMIC).
However, the 12‑month prevalence of mood and anxiety
disorders in higher‑income countries was estimated
to be around 9.6%–27.8%. In a large meta‑analysis, the
12‑month global prevalence of CMDs was estimated to
be 17.6%.[27] Hence, our findings are comparable to other
LAMIC countries and are much lesser than estimates from
higher‑income countries.
Although the lower prevalence of CMDs in India is
comparable with LAMIC, it is lower than in Western
countries. This lower prevalence rate of CMDs in the
Indian sample is not exclusive to CMDs; it is also observed
in schizophrenia.[28] Both International Pilot Study on
Schizophrenia[29] and Determinants of Outcome of
Severe Mental Disorders (DOSMED)[30] studies reported
that the course and outcome of schizophrenia in India
were more favorable than in developed countries. This
lower prevalence of CMDs in India (though comparable
with LAMIC) can be attributable to varying degrees of
psychosocial, cultural, and economic reasons. In addition,
the contribution of individual variabilities such as
resilience, alexithymia, and “trait” markers of individuals
towards the threshold of mental illness needs to be
considered.[31,32]
Limitations
The current prevalence in this study is a more reliable point
estimate and avoids potential recall bias. This study is not
ruling out the possibilities of under‑estimation of CMDs
in the country because of under‑reporting due to stigma,
exclusion of somatoform disorders (under detection as
depressive symptoms may have subsumed under somatic
symptoms), specific phobia and dysthymia, and missing of
more disabled sub‑threshold or subsyndromal disorders.
Implications
The current study was conducted in the largest representative
sample with a uniform methodology that provides critical
insights to planners and practitioners. We require a
DOSMED type study[33] which includes higher income and
LAMIC countries, to study the differences in prevalence and
Indian Journal of Psychiatry Volume 64, Issue 1, January-February 2022
Overall Male Female Rural Urban nonmetro Urban metro
80.4 78.5 81.5 79.7 87.4 77.7
36 36 36 36 48 36
4 6 3 4 5.5 4
36 38 36 36 48 36
its correlations of CMDs (including sub‑threshold) across
the countries.
Given the higher sufferings of CMDs compounded with
its higher treatment gap and lower accessibility to mental
health care and services, there is an urgent need to improve
psychiatric care in India through its National Mental Health
Programme[34] NMHPS operational arm, the District Mental
Health Programme[35] should focus more on CMDs apart from
traditional SMDs.[36] The need is also on the task‑shifting
to primary care in general healthcare settings with
impactful, innovative telemedicine on‑consultation training
methods.[37,38] There is also a need for national guidelines
of the management of CMDs in primary, secondary, and
tertiary healthcare delivery systems.
From a larger public health point of view, the present
estimates of 1 in 20 persons with CMDs in India need to be
seen in context within the spectrum of the noncommunicable
disease.[39] Given the higher prevalence of CMDs among
NCDs.[40] It is recommended to include CMDs in the
management of NCDs for a better course and prognosis.
Future epidemiological studies should address culturally
sensitive psychiatric illnesses, i.e., somatization and
dysthymic disorder. The bigger takeaway from this study is
that mental health planners should now target risk factors
such as urbanization, vulnerable populations (women and
elderly), etc.
CONCLUSIONS
The NMHS data on the current prevalence estimate of
CMD provides ample evidence to recognize CMDs as a
significant public health problem in India. Considering its
impact on disability and potential economic loss, a major
shift should focus on task‑shifting. Interventions should
focus on early detection in primary care, appropriate
pharmacological and nonpharmacological interventions,
greater accessibility to the community, and lesser health
care costs to the public.
Acknowledgments
“NMHS India National Collaborators Group include Pathak
K., Singh L. K., Mehta R. Y., Ram D., Shibukumar T. M.,
Kokane A., Lenin Singh R. K., Chavan B. S., Sharma P.,
Ramasubramanian C., Dalal P. K., Saha P. K., Deuri S. P., Giri
A. K., Kavishvar A. B., Sinha V. K., Thavody J., Chatterji R.,
Akoijam B. S., Das S., Kashyap A., Ragavan V. S., Singh S. K.,
17
 Jayasankar, et al.: Common Mental Disorders in India’s National Mental Health Survey, 2016
Misra R. and investigators as listed in the report: National
Mental Health Survey of India, 2015‑2016: Prevalence,
Patterns, and Outcomes.”
The data used for analysis in this publication is from
the National Mental Health Survey (NMHS) funded by
the Ministry of Health and Family Welfare, Government
of India, and was implemented and coordinated by
NIMHANS, Bengaluru, INDIA in collaboration with state
partners. NMHS phase 1 (2015‑2016) was undertaken in
12 states of India across the six regions and interviewed
39,532 individuals (http://indianmhs.nimhans.ac.in). The
funder had no role in implementation, data acquisition,
data analysis, and interpretation and write‑up of the
paper.
The authors would also like to sincerely thank Professor
David V. Sheehan, Distinguished University Health Professor
Emeritus at College of Medicine, University of South Florida,
USA, for his guidance and valuable inputs for the smooth,
scientific, and efficient conduct of the survey.
Financial support and sponsorship
The data used for analysis in this publication is from the
National Mental Health Survey (NMHS) funded by the
Ministry of Health and Family Welfare, Government of
India and was implemented and co‑ordinated by National
Institute of Mental Health and Neurosciences (NIMHANS),
Bengaluru, INDIA in collaboration with state partners.
NMHS phase 1 (2015‑16) was undertaken in 12 states
of India across the 6 regions and interviewed 39,532
individuals (http://indianmhs.nimhans.ac.in). Funder had no
role in implementation, data acquisition, data analysis and
interpretation and write up of the paper.
Conflicts of interest
There are no conflicts of interest.
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