The model uses PHQ-2, a two-question screening tool, followed by PHQ-9, a more detailed nine-question assessment for those who screen positive.
Published Dec 05, 2025 | 7:00 AM ⚊ Updated Dec 05, 2025 | 7:00 AM
Mental Health. Representative Image. (iStock)
Synopsis: A study said screening adults for depression, using a two-step tool, could prevent more than 18,000 deaths and generate savings between ₹2.91 lakh crore and ₹4.82 lakh crore each year. It also said screening adults aged 30 and above would reduce the annual prevalence of depression by 2.4 percent.
Meena walked into her village health centre in rural Karnataka for a routine check-up. The community health worker pulled out a simple two-question form. Within minutes, the screening revealed what Meena had hidden for months: She struggles to find joy in daily tasks and feels down most days. The health worker referred her for further assessment. Three months later, Meena returned to work at the local textile unit, her productivity restored.
This scene could repeat millions of times across India if the government rolls out population-level depression screening at Ayushman Arogya Mandirs, the country’s frontline health facilities.
A study published in The Lancet Regional Health – Southeast Asia now provides the numbers to back this vision: Screening adults using a two-step tool could prevent more than 18,000 deaths and generate savings between ₹2.91 lakh crore and ₹4.82 lakh crore each year.
Researchers from PGIMER-Chandigarh, NIMHANS-Bengaluru and the National Health Systems Resource Centre built an economic model to evaluate the government’s plan. They compared what happens when health workers screen everyone against the current system, where only people who present with symptoms are diagnosed.
The model uses PHQ-2, a two-question screening tool, followed by PHQ-9, a more detailed nine-question assessment for those who screen positive. Think of it as a funnel: The first questions catch potential cases, the second confirms them.
Screening adults aged 30 and above would reduce the annual prevalence of depression by 2.4 percent. Incidence rates would drop by 5.1 percent. Extend the programme to people aged 20 and above, and those numbers climb to 3.59 percent and 6.6 percent, respectively.
The study projected that screening could reduce depression-related deaths by 15 percent annually. Over a lifetime, the programme would save 12,826 lives in the cohort aged 30 years and above. For those aged 20 and above, that figure jumps to 18,340 lives saved.
Each person screened gains between 0.0273 and 0.0295 quality-adjusted life years (QALYs), depending on their age group. The researchers noted that these gains in quality of life run five times higher than the gains in life years alone, showing how early intervention transforms daily functioning.
“The intervention results in QALY gains that are five times higher (ranging from 0.028 to 0.030 per person) than the gains in life years, highlighting the impact of early intervention on quality of life,” the authors wrote.
The economic case builds on two pillars: Direct healthcare costs and productivity losses. Depression drains the economy through both channels, but the indirect costs tower over direct spending on treatment.
From a societal perspective, which counts both direct and indirect costs, the screening programme becomes cost-saving. The benefits outweigh the expenses of training health workers, supplying medicines and running community-based screening.
The researchers found that screening people aged 20 and above proves more cost-effective than limiting it to those over 30. Depression often strikes earlier in life, so catching it sooner yields greater returns.
The study estimated that the programme would generate net savings equivalent to 0.19 percent to 0.32 percent of India’s GDP. The indirect cost savings alone would equal 0.7 percent to 1.15 percent of GDP, driven by reductions in premature mortality and productivity losses.
“Mental disorders have a considerably larger macroeconomic impact with associated savings in indirect costs equivalent to 0.7–1.15 percent GDP,” the study stated.
The programme’s success hinges on two factors. First, the screening tools must work accurately. If the sensitivity of PHQ-2 drops below 26 percent, or if the combined sensitivity of the two-step approach falls under 35 percent, the programme fails to deliver net health benefits compared to standard care.
The researchers stressed this point: Training quality and supervision determine whether the tools identify enough cases without overwhelming the system with false positives.
Second, at least 60 percent of people who screen positive must seek treatment in public health facilities. Currently, only 43 percent do. If that share rises to 60 percent, the intervention becomes cost-saving even from a narrower perspective that considers only direct healthcare costs.
The study also finds cost savings if all patients with sub-threshold depression and at least 75 percent of those with mild depression use government primary healthcare facilities.
India faces a shortage of mental health workforce. The country has relatively few psychiatrists compared to its population. However, the study argued that the existing primary healthcare infrastructure can absorb this work through task-shifting.
ASHAs (Accredited Social Health Activists) would conduct the initial PHQ-2 screening. Community Health Officers would handle the PHQ-9 assessments and manage mild cases. Time-motion studies showed these officers operate at 43 percent of their capacity, suggesting room to take on more work without major staffing increases.
The researchers estimate the annual incremental budgetary requirement at ₹16.68 lakh per million population for screening those aged 30 and above, and ₹22.12 lakh per million population for the expanded programme covering those aged 20 and above. These figures cover medicines, consumables, training, information campaigns and overhead costs.
Depression hits certain groups harder: Women, older adults, rural communities, people with lower education and income, and those from marginalised castes. These same groups face the highest barriers to accessing treatment.
Distance, lack of awareness and stigma all deter people from seeking care. The researchers argued that bringing screening to primary healthcare facilities addresses all three barriers at once.
“Beyond the considerations of efficiency, the intervention is likely to fare well on the equity scale, given the disproportionate burden of depression among vulnerable sub-groups,” the authors note.
The model used data from the National Mental Health Survey to capture care-seeking patterns and productivity losses. It drew on the National Sample Survey for cost calculations. The researchers also collected primary data from 259 patients to measure quality of life across different health states.
The model validated well against existing epidemiological data. It estimated a four percent prevalence and 1.5 percent annual incidence in the usual care scenario, matching published literature. The lifetime risk of 36 percent falls within the reported range of 20 percent to 40 percent.
Current guidelines create an awkward gap. The Rastriya Kishor Swasthya Karayakram (National Adolescent Health Programme) covers screening for 11 to 19-year-olds. The comprehensive primary healthcare guidelines focus on those aged 30 and above. The 20-29 age group slips through.
The researchers pushed for closing that gap. Screening people aged 20 and above would deliver higher QALY gains and lower cost-utility ratios than the narrower approach.
“Our findings suggest that extending the screening program to include individuals aged 20 years and above would be a more cost-effective strategy,” the study stated.
(Edited by Muhammed Fazil.)
