Depression in India: Let's talk

Depression manifests in different ways depending on its severity, the individual’s socio-cultural context and his or her age. This, the report says, makes recognising it challenging. For instance, children with depression have different symptoms compared to adults.

Depression can be diagonsed using the ICD-10 criteria. (ICD or the International Classification of Diseases is the global health information standard maintained by the WHO.) Symptoms of depression include feelings of sadness, reduced interest in most activities, fatigue, loss of self-esteem, unreasonable guilt, recurrent thoughts of death or suicide, a diminished ability to think or concentrate, disturbed sleep, a gloomy perception of the future, and fluctuations in appetite and/or weight.

The National Mental Health Survey (NMHS) 2015-16 by the Ministry of Health and Family Welfare shows that rates of depression are higher among women than among men across all age groups. The difference reaches its peak in the 40-49 age group – 4.19 per cent of women and 3.04 per cent of men have depressive disorders.

According to the report, poverty and mental health are part of a ‘vicious cycle’. People with common mental disorders like anxiety and depression are more likely to become poor due to increased health expenditure, loss of productivity, reduced social support and the stigma associated with their mental illness. Poverty, on the other hand, exposes individuals to social exclusion, malnutrition, obstetric risks and a higher risk of violence, among other factors, that could lead to depression. A lack of access to good-quality and continued mental healthcare contributes to this ‘vicious cycle’.

The NMHS 2015-16 found over 50 per cent of peope who had depression said that their condition interfered with daily activities. The survey also spoke to people caring for those with depression, such as family members and relatives. Of these, 77 per cent reported problems with finances, and their family’s leisure, routine and interaction.

A mental health ‘treatment gap’ refers to a situation in which individuals with psychiatric disorders remain untreated although effective treatments exist for them. The World Health Survey (2002-04) says that, in India, there is a treatment gap of 86 per cent for depression and 80 per cent for any ‘suicidal risk behaviour’.

India has an acute shortage of mental health professionals – there are only 0.07 psychiatrists and 0.12 psychiatric nurses for every 1,00,000 people. Often, these professionals have insufficient or no training in dealing with depression. The country also doesn’t have an uniterrupted supply of essential psychotropic drugs, efficient referral systems, counselling services and continued care for patients.

The report recommends educating the public to improve its mental health, helping patients with ‘social participation’, educating and supporting caregivers, improving awareness in the workplace, and training healthcare providers.

Focus and Factoids by Nioshi Shah.

PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.