‘Mental disorder burden highest among 15- to 19-year-olds’: What this means for young India

*Anxiety disorders in India rose significantly by 123 per cent between 1990 and 2023.

*The prevalence of dysthymia, a chronic low-grade depression,  per lakh population was 902 in 1990, rising to 948 in 2023.

*The prevalence rate of 316 cases of schizophrenia per lakh population climbed to 321 per lakh in 2023.

* The prevalence of major depressive disorders increased from 2,147 per lakh in 1990 to 2,799.6 per lakh.

It’s called a “silent health emergency”, and India is in the throes of it. The data tells us a worrying story: the mental health crisis is spiralling.

A new analysis from the “Global Burden of Disease Study”, published in The Lancet, has found that mental disorders have surged dramatically across the globe over the past three decades, with India witnessing some of the sharpest increases.

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According to the study, nearly 1.2 billion people worldwide are living with mental health conditions, which is nearly double the number compared to 1990. While population growth and ageing partly explain the rise, researchers say the increase is also linked to the lingering impact of the Covid-19 pandemic, growing social inequality, conflict, economic stress, digital isolation, and changing attitudes toward mental health reporting.

Particularly alarming is the sharp rise among adolescents aged 15 and 19 years, signalling a long-term structural shift in global mental wellbeing that countries like India may be ill-equipped to handle.

The Covid-19 pandemic was one contributing factor, particularly for anxiety and depressive disorders. File photo/Reuters

Speaking to Firstpost, the lead author of the study, Dr Damian Santomauro, an associate professor at the Queensland Centre for Mental Health Research, Australia, said the prevalence and burden of mental disorders will increase over time.

Dr Santomauro said South Asia saw one of the biggest increases in the mental health burden in the world, with the highest increase in DALY (Disability-Adjusted Life-Year) counts and age-standardised DALY rates for mental disorders between 1990 and 2023. [DALY is a health metric used to measure the overall burden of disease. One DALY represents the loss of exactly one year of full, healthy life.] Among women and girls, the impact was especially severe: the mental health burden rose by 44.2 per cent even after adjusting for population growth and ageing.

The excerpts from the interview:

Q. Around 1.2 billion people live with mental health conditions. Your study shows a sharp rise in mental disorders globally since 1990. What are its key findings?

Dr Santomauro: We observed a 95·5 per cent increase in prevalent cases of mental disorders globally between 1990 and 2023. A large proportion of this increase was driven by population growth and ageing. As countries have become more successful at reducing mortality from various communicable, maternal, nutritional, and neonatal diseases, more people are living to ages when chronic and disabling conditions, including mental disorders, are more common.

Additionally, we observed a 24.2 per cent increase in the global age-standardised prevalence rate of mental disorders between 1990 and 2023, indicating that the rise cannot be explained by population growth and ageing alone.

Q. What do you believe are the biggest drivers behind this increase? How much of the rise reflects a true increase in mental illness, and how much is due to better diagnosis, awareness, and reporting?

Dr Santomauro: Our study did not directly assess the drivers of this increase, so we cannot provide a definitive explanation. The Covid-19 pandemic was clearly one contributing factor, particularly for anxiety and depressive disorders. However, we also observed rising prevalence before the pandemic in some high-income countries, suggesting broader underlying trends.

Multiple factors are contributing. These may include changes in epidemiological data collection and reporting practices over time, evolving attitudes toward mental health and survey participation, and increased exposure to risk factors such as childhood maltreatment, domestic violence, poverty, rising inequality, war and conflict, climate-related stressors, and the effects of living in an increasingly digital world where real-world social connectedness may be declining. More research into the risk factors of mental disorders and their distribution over time is required for more definitive answers.

The shift of mental disorders to a younger age group is concerning. Pixabay

Q. Did any findings surprise you while analysing trends across more than three decades?

Dr Santomauro: We expected the burden of mental disorders to increase over time; however, we were surprised by the magnitude of this rise. We were also surprised by the finding that prevalence peaked among adolescents aged 15 to 19 years, largely driven by higher and increasing rates of major depressive disorder and anxiety disorders.

Historically, the burden of mental disorders has tended to peak later in life, around middle age. The shift toward younger age groups is particularly concerning, as it places a substantial long-term burden on all countries, especially those with large youth populations.

Q. Are we witnessing a temporary post-pandemic mental health crisis, or a long-term structural shift in global mental wellbeing?

Dr Santomauro: While the Covid-19 pandemic likely explains a substantial component of the increase in mental disorder prevalence between 1990 and 2023, it is unlikely to account for the entire rise.

As mentioned earlier, mental health surveys from several high-income countries were already showing increasing trends in mental disorders before the pandemic occurred. That said, we will not have a definitive answer to this question until more epidemiological data from mental health surveys across a broader range of countries become available, particularly in low- and middle-income countries, where data remain limited. Consistent and comparable data collection methods will be essential for accurately assessing trends over time and understanding the underlying drivers of these increases.

Q.What trends stood out specifically for India and South Asia?

Dr Santomauro: South Asia was among the regions with the highest increase in DALY counts and age-standardised DALY rates for mental disorders between 1990 and 2023. This was especially true for females, where we observed an increase of 44.2 per cent in age-standardised DALY rates for mental disorders between 1990 and 2023. This was among the highest increases in age-standardised DALYs recorded regionally among females, following Australasia (49.6 per cent), Western Europe (44.3 per cent), and Western sub-Saharan Africa (54.5 per cent). These findings highlight the need for not just age but also sex-specific mental health policies, targeting support for women and girls in South Asia.

In women and girls, the mental health burden has risen by 44.2 per cent between 1990 and 2023. File photo/AFP

Q: India has a large youth population but a limited mental health infrastructure. What risks does this create over the next decade?

Dr Santomauro: Mental disorder burden is already highest among adolescents aged 15 to 19 years, which is a global concern, but especially concerning in countries where young people make up a substantial proportion of the population. This, coupled with increasing mental disorder burden over time, is and will continue to place long-term pressures on health systems in India and around the world.

Mental disorders lead to considerable health loss and human suffering. They also have broader social, economic, and public health consequences, which would only exacerbate if the burden for mental disorders is not matched by proportional expansion in mental health services, workforce capacity, or accessible support systems. The challenge extends beyond mental health systems alone.

Mental disorders are closely linked to a higher risk of chronic diseases, injuries, and poorer management of physical health conditions. These trends highlight the urgent need for stronger surveillance systems, early intervention programs, school- and community-based mental health services, and more coordinated, inclusive public health strategies.