Mapping the burden of mental health issues in rural India through house-to-house surveys: Insights from the NAMAN program

Abstract

Mental health disorders in rural India remain substantially under-identified, with treatment gaps exceeding 70%. Population-level data from rural regions are limited under real-world programmatic conditions. This study provides this information from two geographically and socio-culturally contrasting rural blocks (taluks; sub-district administrative areas) of India, viz., Belur (Karnataka) and Munsyari (Uttarakhand). To estimate population-level screen-positive rates for mental health disorders through Community Health Workers (CHWs)-led house-to-house screening and to compare these with specialist assessments. Trained CHWs conducted assessments using MERIT Plus (Mental HEalth ScReenIng Tool for Community Health Workers of India), covering all households in Belur and Munsyari. Screening outcomes were compared using embedded quality-monitoring interviews conducted by mental health professionals, and apparent sensitivity, apparent specificity and inter-rater agreement were estimated. In Belur, 3,191 individuals (2.0%) out of 157,614 screened positive, with an adult screen-positive rate of 2.4%. Tobacco use (0.82%), alcohol abuse (0.62%), anxiety (0.48%) and sadness/somatoform symptoms (0.51%) were most frequent. Apparent Sensitivity was 45.3% and apparent specificity 98.2%; quality monitoring estimated the screen-positive rate at 9.5%, with the highest agreement for psychosis ( κ  = 0.75). In Munsyari, 474 individuals screened positive out of 44,315 (1.07%), with an adult screen-positive rate of 1.3%, dominated by anxiety (0.58%). Sensitivity was 19.2% and specificity 100%; the estimated screen-positive rate was 8.2%, with psychosis again showing the highest agreement ( κ  = 0.80). CHW-led screening for mental health disorders at scale is practical and can be expanded in real-world settings.