Regional Differences in the Mental Health Burden among Indian States: A Global Burden of Disease 2021-based Analysis

Background: Mental disorders are a major contributor to the burden of disease in India, with regional differences in prevalence, severity, and coverage of services. The need for planning at the national level based on standardized disease metrics remains unsatisfactory. Aim: The aim of this study was to assess and compare the prevalence and severity of major mental health disorders across Indian states and union territories (UTs) utilizing data from the Global Burden of Disease (GBD) 2021. Methods: We performed a cross-sectional ecological study of GBD 2021 data focusing on four primary disorders (depression, anxiety, bipolar disorder, and schizophrenia) throughout 36 states and UTs. Disability-adjusted life years (DALYs) and prevalence rates were standardized for every 100,000 individuals using estimates from the 2021 census. We introduced an innovative Per-Case Disability Index (DALYs/prevalence) to evaluate disability on a per-case basis. Correlation analyses and regional comparisons were carried out, incorporating analysis of variance and a Gender Disparity Index (GDI). Results: Depressive disorders showed the highest average burden (mean DALY: 827.7/100,000), followed by anxiety (474.5), schizophrenia (213.2), and bipolar disorder (77.4). Schizophrenia had the highest Per-Case Disability Index (mean: 0.637). There was a significant relationship ( r > 0.99) between DALYs and prevalence. High Per-Case Disability Index values were found in smaller states such as Tripura, Manipur, and UTs (apart from Delhi). Conclusion: Prevalence and severity of mental health disorders differ significantly across various regions in India. DALY, prevalence data along with Per-Case Disability Index, can help in developing equitable policy. Integrating Per-Case Disability Index and GDI into planning may enable more equitable resource distribution.