Prevalence and sociodemographic correlates of mental and behavioural disorders in Pakistan: findings from the first nationally representative cross-sectional survey
Raza ur Rahman, David V Sheehan, Afzal Javed, Syed Haroon Ahmed, Kashif Shafique, Uzma Kanwal, Mohammad Iqbal Afridi, Asad T Nizami, Ghulam Rasool, Rizwan Taj, Moin Ahmed Ansari, Mohammad Naim, Saeed Farooq, Mehtab S Karim, Hana Mehmood, Mohammad Ayub, Anjum MemonIntroduction
Comprehensive population-based nationally representative data on the prevalence of mental and behavioural disorders in Pakistan (population 247 million) have been lacking—hindering the development of prevention policies and responsive mental health services. We conducted the National Psychiatric Morbidity Survey to ascertain the prevalence and sociodemographic correlates of these disorders to inform the development of mental healthcare policies to reduce stigma, disability and morbidity associated with these disorders.
Methods
We conducted a cross-sectional household survey using a stratified multistage cluster sampling design across the four provinces of Pakistan between 2019 and 2022. A total of 17 773 adults aged ≥18 years were interviewed in-person by trained researchers using the Mini International Neuropsychiatric Interview (V.7.0.2). Current (point) and lifetime precise and weighted prevalence was determined according to the International Classification of Diseases ICD-10 classification of mental and behavioural disorders. Functional impairment was measured using the Sheehan Disability Scale. Weighted prevalence estimates and multivariable logistic regression were used to assess associations with sociodemographic variables. National Bioethics Committee of Pakistan granted ethical approval for the survey.
Results
The overall current and lifetime weighted prevalence of all mental and behavioural disorders (ICD-10 codes, F10–F60) was 32.3% (95% CI 31.6 to 32.9) and 37.9% (95% CI 37.2 to 38.6), respectively. The highest current prevalence (24.5%) was observed for neurotic/stress-related disorders (F40–F48), followed by post-traumatic stress disorder (PTSD) (F43.1, 19.9%) and mood disorders (F30–F39, 11.6%)—which was essentially due to the high prevalence of episodic/recurrent depressive disorders (F32–F33, 10.6%). About 6% of the participants reported suicidality in the past month and 1% had made a lifetime suicide attempt. The highest prevalence was observed in people who were aged 40+ years, females, lived in urban areas, separated, divorced or widowed, had no formal education and were retired or categorised as homemakers. In the multivariable logistic regression analyses, the likelihood of psychiatric morbidity significantly increased with increasing age (p value for trend <0.001), being separated, divorced or widowed (p value for trend <0.01) and being unemployed, homemaker, student or retired (p value for trend <0.01) and decreased with increasing level of education and income (p value for trend <0.01) and residence in rural area.
Conclusion
This first nationally representative survey of psychiatric morbidity in Pakistan showed that one in three adults in the country is living with a diagnosable mental and behavioural disorder. The relatively high prevalence of PTSD (1 in 5) may be associated with broader contextual factors, although the cross-sectional design does not permit attribution to specific events or exposures. These findings inform the development of national mental health prevention strategy, healthcare services and community support programmes to reduce the burden of psychiatric morbidity in Pakistan.