Published Jul 11, 2026 | 7:00 AM ⚊ Updated Jul 11, 2026 | 7:00 AM
(Representational image/Creative Commons)
Synopsis: A new national study has found stark regional inequalities in India’s mental health burden, with Tamil Nadu, Manipur and Telangana recording the highest burden of depression, while smaller states such as Goa, Mizoram and Tripura show the greatest disability per patient. Researchers say India must move beyond case counts and allocate mental health resources based on illness severity and gender disparities.
India’s mental health crisis does not spread evenly. A new study using Global Burden of Disease 2021 data has mapped how depression, anxiety, bipolar disorder and schizophrenia distribute across all 36 states and union territories, and the results expose a system that counts cases but misses suffering.
The study, published in Annals of Indian Psychiatry, introduces a metric called the Per-Case Disability Index, calculated by dividing disability-adjusted life years (DALYs) by prevalence per 100,000 population. It measures how severely each diagnosed patient suffers, not just how many exist.
Tamil Nadu records the highest depression-related DALYs in the country at 1,331 per 100,000 population. Manipur follows at 1,169. Telangana ranks third at 1,015.
On prevalence, the order holds. Tamil Nadu leads with 7,404 cases per 100,000, Manipur at 6,540, and Telangana at 5,724.
The co-occurrence of high DALYs and high prevalence in these states signals something beyond detection alone. Researchers note this pattern points to “a combination of systemic and epidemiological factors”, meaning both the true burden and the ability to record it run high here simultaneously.
Depression carries the largest national average burden of any disorder studied: 827.7 DALYs per 100,000 population.
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For anxiety disorders, Manipur records the highest DALYs at 813 per 100,000, followed by Kerala at 678 and Mizoram at 585.
Kerala’s position demands attention. The state combines high literacy, accessible healthcare and rapid social change, conditions the study links to rising anxiety detection and help-seeking behaviour.
Researchers point to urbanisation, academic pressure, media overload and economic insecurity as factors driving anxiety rates in South India. Kerala’s infrastructure may surface cases that other states leave unrecorded.
Anxiety carries a national average burden of 474.5 DALYs per 100,000, the second largest among the four disorders studied.
Telangana ranks among the top three states for depression across both DALYs and prevalence. The state also shows female predominance in schizophrenia-related burden, according to the study’s Gender Disparity Index analysis.
This places Telangana in a category where both volume of cases and gender-specific suffering require separate policy attention, not a single blanket response.
Goa records the highest schizophrenia-related Per-Case Disability Index at 0.643. Mizoram follows at 0.642. Tripura records 0.638.
For bipolar disorder, the union territories excluding Delhi top severity at 0.268, followed by Tripura at 0.260 and Sikkim at 0.215. These states do not carry the largest caseloads. They carry the largest suffering per patient.
Researchers conclude this reflects “limited early intervention, chronicity, or stigma-related delays in care”, a compounding failure where patients reach services late, deteriorate further and require more intensive support that the system does not provide.
“Fewer patients in high-index states such as Tripura and Mizoram experience disproportionately greater impairment,” the authors write.
The study finds a near-perfect correlation between DALYs and prevalence across all disorders, with r (Pearson correlation coefficient) greater than 0.99. States that detect more cases record a higher total burden. The internal logic holds.
However, for schizophrenia and bipolar disorder, the Per-Case Disability Index shows almost no correlation with either DALYs or prevalence, with r below 0.15.
This breaks the assumption that drives current resource allocation. A state can record low caseloads and still concentrate severe, disabling, long-duration illness among its patients. The current system, built on population and prevalence counts, does not see this.
“High-index, low-population states currently risk underallocation of resources despite elevated individual suffering,” the authors state. “Goa and Mizoram, with relatively small populations but high Per-Case Disability Index, require expanded mental health workforces and rehabilitative infrastructure.”
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The study’s Gender Disparity Index (GDI) reveals distinct regional patterns.
Kerala records a GDI of 1.24 for depression, meaning women carry 24 percent more burden than men. Mizoram matches this at 1.24. West Bengal records 1.19.
States with higher female literacy and healthcare access surface more female cases, the researchers suggest. Greater help-seeking among women in these states may explain part of the pattern.
Bihar and Punjab show the opposite. Male-predominant burden dominates for bipolar disorder and anxiety, a pattern the study links to stigma, externalising behaviour and substance use among men, combined with underreporting among women.
“Mental health services must take into account the ways that gender affects family support networks, stigma, and access,” the authors write.
The National Mental Health Survey of 2015-16 established that nearly 150 million Indians require active psychiatric care. Treatment gaps exceed 70 percent for most conditions.
The study argues that national programmes, including the National Mental Health Programme, have produced uneven implementation across states precisely because the federal structure leaves delivery to states, and states receive resources based on population and prevalence, not severity.
“A decentralised and severity-sensitive approach to mental health planning is urgently needed,” the authors conclude.
The study calls for integrating the Per-Case Disability Index and the Gender Disparity Index into national health planning frameworks, alongside, not instead of, existing prevalence and DALY data.
The authors argue this composite approach would redirect attention toward states where patients suffer most intensely, even when case numbers stay low.
They also recommend scaling mobile psychiatry units, task-shifting through ASHAs and auxiliary nurse midwives, telepsychiatry services and school-based mental health support in high-severity, low-resource states.
Global frameworks have already moved in this direction. The study points to quality-adjusted life years and treatment responsiveness as metrics already guiding investment decisions internationally, tools India’s mental health programmes have not yet adopted at scale.
“This all-encompassing strategy is necessary to build a mental health system that is genuinely responsive and equitable,” the authors write.
(Edited by Muhammed Fazil.)
