Epidemiology in teh context of mental disorders refers to the study of the distribution of mental conditions within specific populations. This ppt covers the data on India.

1. Epidemiology and
Social demographic
correlates of Mental
disorders
S o n a m M a n o j
1 s t Y e a r M P h i l C l i n i c a l P s y c h o l o g y
M o d e r a t e d b y : M s . F a t h i m a B . P

2. What is Epidemiology ?
• Epidemiology is the study of patterns of diseases in human
population
• Epidemiologic studies are concerned with understanding the patterns
of disease in human population and to plan prevention and treatment
on the basis of this understanding.

3. Goals of Epidemiology
Agent
Host
Environment
• Epidemiologists investigate the interactions that may occur among the host, agent,
and environment (the classic epidemiologic triangle) to produce a disease
state.
• Identify the etiology of a disease in order to prevent or intervene
in the progression of the disorder

4. Goals of Epidemiology
• Epidemiologic studies generally proceed from studies that specify
the prevalence and distribution of a disease within a population by
person, place, and time (that is, descriptive epidemiology) to more
focused studies of the determinants of disease in specific groups
(that is, analytic epidemiology).
• Descriptive epidemiologic studies are important in specifying the
rates and distribution of disorders in the general population.

5. Terms to remember
• Rates and ratio
• Prevalence
i . Point,
i i . period,
i i i . lifetim e,
iv . treated or untreated,
• Inception (Incidence)
• Attributable risk- (difference between 2 incidence rates (exposed –
not exposed)
• Relative risk – ratio of incidence rates (exposed and non exposed)

6. Identifying Stages
Outcome
Disorder
Exposure
• Exposure, dealing with the course
• Disorder, dealing with the manifestation of a disease in clinical signs and
symptoms
• Outcome, examining what leads to different outcomes for different patients.

7. Preventive measures
• Primary or Universal, prevention tries to reduce the risk of
exposure to agents promoting the disease
• Secondary or Targeted, prevention is directed at saving those who
have been exposed from developing the disease
• Tertiary or Indicated, prevention focuses on reducing the damage
caused in those who actually become ill.

8. How do we carry
out Epidemiology
in Psychiatry
setting

9. Base population
• General population or population subgroup
• Primary care population
• Mental health service population
• Psychiatric Case Registers

10. Research Design
Experimental studies
Clinical trials
– Randomization
– Placebo
– Blinding (Single, double, triple)

11. Types of Epidemiology Studies
• Observational studies
– Cross-Sectional Studies
– Longitudinal Studies
Prospective
Retrospective
• Case-Control Studies – Establish risk factors, not rates of disorder
• Case Register Studies

12. Applications of Epidemiology to Psychiatry
• Methodological developments
• Introduction of structured and semi-structured diagnostic interviews
• Statistical methods for estimating prevalence and correlates of mental
disorders
• Patterns of comorbidity within and between classes of disorders,
• Sociodemographic and environmental correlates and risk factors for
mental disorders, and
• Service patterns in general population samples.

13. Prevalence of Epidemiology studies in India
• Journey started six decades ago ( 1950-60)
• First published epidemiological study in India was in 1961, Agra By
Dr.K. C. Dubey
• Development of PSE
• Development of Indian Psychiatric Survey Schedule (IPSS)
Prevalence of psychiatric disorders - 9.5 to 370 per 1000 population

14. What does W.H.O say?
In 2019, 1 in every 8 people, or 970 million people around the world
were living with a mental disorder, with anxiety and depressive
disorders the most common
In 2020, the number of people living with anxiety and depressive
disorders rose significantly because of the COVID-19 pandemic.
Initial estimates show a 26% and 28% increase respectively
for anxiety and major depressive disorders in just one year

15. W.H.O’s bird eye view – Global Prevalence -
2022
Disorder Prevalence
Anxiety Disorders 301 million people were living with an
anxiety disorder including 58 million
children and adolescents
Depression 280 million people were living with
depression, including 23 million children
and adolescents
Bipolar Disorder 40 million people experienced bipolar
disorder
Schizophrenia Schizophrenia affects approximately 24
million people or 1 in 300 people

16. W.H.O’s bird eye view – Global Prevalence -
2022
Disorder Prevalence
Eating disorders 14 million people experienced eating disorders
including almost 3 million children and
adolescents
Disruptive behaviour and dissocial
disorder
40 million people, including children and
adolescents, were living with conduct-dissocial
disorder in 2019
Substance Abuse About 270 million people (or about 5.5% of global
population aged 15-64) had used psychoactive
drugs in the previous year and about 35 million
people are estimated to be affected by drug use
disorders (harmful pattern of drug use or drug
dependence).

17. National Mental Health
Survey- NMHS
(NIMHANS)
The NMHS was undertaken as a large scale, multi -centred
national study on the various dimensions and
characteristics of mental health problems among individuals
aged 18 years and above across 12 Indian states during
2014 - 16.
•North : Punjab and Uttar Pradesh
• South : Tamil Nadu and Kerala
• East : Jharkhand and West Bengal
• West : Rajasthan and Gujarat
• Central : Madhya Pradesh and Chhattisgarh
• North-East : Assam and Manipur

18. National Mental Health Survey- NMHS
(NIMHANS)
Epidemiological study in India is carried out by NIMHANS
Objectives: (NMHS)
•Estimate the prevalence and pattern of various mental disorders in a
representative Indian population.
• Identify treatment gap, health care utilization, disabilities and impact.
• Assess the current mental health services and systems in the surveyed states .

19. National Mental Health Survey- NMHS
(NIMHANS)
Objectives: (SMHSA)
•Assessment of available health and health related resources for mental health
activities / programmes in the 12 surveyed states.
• Examining the status of mental health services and programmes in the surveyed
states through a systems assessment framework.

20. • The overall study design of the NMHS was multi-stage, stratified,
random cluster sampling.
• A multi-stage sampling was adopted in each state and each
selected state of India constituted the sampling frame.
• The districts and talukas within the states constituted the Primary
and Secondary Sampling Units, respectively.
• Each named inhabited village as per the Census 2011 constituted
a rural cluster, while a census enumeration block represented an
urban cluster and individuals within the identified households formed
the unit of analysis.
• The numbers of rural, urban metro and urban non -metro clusters
were selected based on their respective proportions for the state.
Within each cluster all eligible members (>=18 years) within the
households selected using systematic random sampling method were
interviewed.
• Thus, in total 34802 adults and about 1191 adolescents drawn
from 12 states were interviewed.

21. • The study instruments collected sociodemographic information including
completed age, gender, education, occupation, income (house -hold and
individual) and marital status.
• For assessment of mental morbidity, the Mini International Neuro -
Psychiatric Inventory (MINI) adult version and the MINI-Kid version were
used for adults and, older children and adolescents, respectively.
• In addition, additional questionnaires for tobacco use (Fagerstrom
questionnaire) and to screen for Epilepsy, Intellectual Disability (ID) and
Autism Spectrum Disorders (ASD) were also incorporated.
• Further, questionnaires on health care utilisation, assessment of
disability (modified Sheehan’s scale) and socioeconomic impact of illness
were used in the study.
• All data collection instruments were translated into the local languages
of each of the surveyed states.
Study Instruments

22. Quality Assurance
To maintain quality assurance, several steps were built into the protocol
(i) monitoring of activities on daily, weekly and fortnightly intervals,
(ii) certification of training for data collectors to ensure high levels of inter -rater reliability,
(iii) fortnightly e-communications between teams,
(iv) regular data checks and feedback and
(v) 5% validation re-interviews by Field Data Collector supervisors and PIs of the respective
states.
(vi) Strict protocols were established for data transfer and management with access -
controlled mechanisms.
(vii)Data received from all states was examined for errors and after checks, was used for
analysis.

23. Qualitative Research
In addition to the household surveys, a total of 57
Focused Group Discussions (FGDs) and 69 Key
Informant Interviews (KIIs) were undertaken in
the states to provide qualitative information
especially regarding certain areas, where it was
felt that the survey method may not be
adequately informative.
These areas included patterns of
substance abuse (both licit–alcohol
& tobacco, and illicit substances),
issues relating to mental illness and
homelessness, the perceived
treatment gap, stigma experienced
around mental health and the
barriers / challenges to mental
health care delivery.

24. Analysis
• The International Classification of Disease, 10th revision, Diagnostic Criteria for Research (ICD
10 DCR).
• Current (Point) prevalence is reported for all diagnostic groups (ICD categories F10 -19, F40-
48), and both current and life-time prevalence (ever in the life of an individual in the past) is
reported for select conditions under F20-29, F30-39 and panic disorders.

25. National Mental
Health Survey-
NMHS
(NIMHANS)

26. National Mental Health Survey- NMHS
(NIMHANS)
Rural urban differentials in prevalence of mental disorders(%)
Prevalence of mental disorders in rural and urban area (%)

27. National Mental Health Survey- NMHS
(NIMHANS)
Current Prevalence : Common and Severe Mental Disorders (%)
Prevalence of common and severe mental disorders

28. National Mental Health Survey- NMHS
(NIMHANS)
Prevalence of MDD. Socio-demographic differentials
(highest prevalence category displayed)
Prevalence of major depressive disorders

29. National Mental Health Survey- NMHS
(NIMHANS)
Prevalence of Substance Use Disorders (%)
Prevalence of psychoactive substance use

30. National Mental Health Survey- NMHS
(NIMHANS)
Prevalence of Substance Use Disorders by Gender (%)
Prevalence of psychoactive substance use

31. National Mental Health Survey- NMHS
(NIMHANS)
Prevalence of High Suicidal Risk : Socio-demographic
differentials
Prevalence of high suicidal risk

32. National Mental Health Survey- NMHS
(NIMHANS)
Prevalence of Mental disorders (%) in 13-17years by
age and residence
Prevalence of mental disorders (%) in adolescents

33. National Mental Health Survey- NMHS
(NIMHANS)
Prevalence of mental disorder in different States (%)
Prevalence of mental disorder in different States (%)

34. National Mental Health Survey- NMHS
(NIMHANS)
Extreme disability (%) among persons with mental
disorders
Disability associated with mental disorder

35. National Mental Health Survey- NMHS
(NIMHANS)
Disability proportion among subjects with mental
disorders (%)
Disability associated with mental disorder

36. National Mental Health Survey- NMHS
(NIMHANS)
Prevalence of mental disorders by income quintiles
Economic burden of mental disorders

37. Lets Analyse

38. In a nutshell
One fourth of youth experience a mental disorder during the past year,
and about one third across their lifetimes.
Low income plays a big role in the occurrence of Mental health
condition
Usage of Psychoactive substances is a chief catalyst of increasing the
burden of mental health disorders.

39. Future of Epidemiology
• Molecular genetics and epidemiology
• Risk factors and dimensional measures of psychopathology Cross-
national differences in the prevalence of disorder
• Changes over time (secular)
• Changes in the pattern and prevalence of disorders

40. References
Books:
Maddux, J. E., & Winstead, B. A. (2015). Psychopathology: Foundations for
a Contemporary Understanding. Routledge.
Website:
http://indianmhs.nimhans.ac.in/nmh
https://www.who.int/data