Building a Case for Addressing
the Issue of Mental Health in Rural Tamil Nadu

Nicholas De Vito, Amudha Panneerselvam,
Kavya Vaghul, Juhi Sutaria,
Ravikumar Chockalingam

Global burden of mental illness

Mental illness is a nontrivial contribution to the global burden of disease. The burden of illness is analyzed quantitatively by disability-adjusted life years (DALYs). It is the sum of the years of life lost (YLL) and the years lived with disability (YLD) due to the illness or injury. The YLL value is calculated by the number of deaths at each age multiplied by the global standard life expectancy for each age. The YLD value is calculated by multiplying the number of incident cases of a disease or injury in one year, by the average duration of the disease, and a weight factor between 0 (perfect health) and 1 (death), that reflects the severity of the disease. In this way, the DALY is a measurement that combines morbidity and mortality in one value, estimating the chronic effects of an illness not just by deaths that are caused but also by time spent disabled by the disease. Neuropsychiatric conditions comprise 13.1% of the total global DALYs. They also contribute to over a quarter of the DALYs due to non-communicable diseases, both globally and for low income countries. Currently, unipolar depressive disorders are the third leading cause of burden of disease, and it is projected that by 2030, they will be the leading cause of burden of disease, comprising 6.2% of the total DALYs(Global Burden of Disease Report 2004).

How does mental illness compare with other global health concerns? For developing countries, particularly, the prevalence of infectious diseases and maternal health gaps seem like more pressing issues, and in the face of these issues how important can a topic like mental health really be? It is true that infectious disease, and maternal, child, and reproductive illnesses are issues that account for a large portion of the years of life lost (YLL). Lower respiratory infections were the number one cause of YLL in low-income countries, according to the WHO Global Burden of Disease Report (2005). Neglected, however, are the conditions that produce the most years lost due to disability (YLD), such as mental disorders, dementia, and stroke (Prince et al. 2007). Neuropsychiatric conditions make up one third of all YLD for adults aged 15 years and over, and unipolar depressive disorders alone are the leading cause of YLD in low and middle-income countries, as well as in high-income countries (GBD Report 2004). The argument that mental illnesses are more prevalent in developed countries has been shown to be invalid; mental illness is a global concern that is prevalent in developing countries as well as in developed countries, and is a problem that is often not well addressed in developing countries (Das et al. 2005, Saxena et al. 2007).

In addition, studies have shown a correlation between mental illness and comorbidities with other physical illnesses. An article entitled “No Health Without Mental Health”, published in 2007 by the Lancet as part of a series on global mental health, reviews comorbidities of mental illness and many other illnesses. These include non-communicable diseases such as cardiovascular diseases and diabetes, as well as communicable diseases such as HIV/AIDS, tuberculosis, and malaria (Prince et al. 2007, Coehlo et al. 2009, Lacovides and Siamouli 2008). A study of a rural population in Tamil Nadu found that body pains were the most frequently reported symptoms of the mentally ill, representing a major somatic manifestation of mental illness (Badrakalimuthu 2009). A mental illness can make it more difficult for a person to recover from a somatic illness; for example a depressed person may show lower adherence to a treatment plan than a mentally healthy person, as has been seen with adherence to HIV and tuberculosis (Prince et al. 2007).

With all of these factors to consider, it is evident that mental illness is a pressing global issue, for developed and developing countries alike. The next section will review the burden of mental illness in India.

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