The Growing Burden of Mental Disorders in Nepal: Trends, Prevalence, and Disability-Adjusted Life Years (1990–2019)

Created at 2025, Jan 12

Impact Statement
Nepal has endured a decade-long internal armed conflict and continues to grapple with the aftermath of the devastating 2015 earthquake, alongside numerous personal, social, cultural, economic, political, and environmental adversities. Despite these challenges, there is a lack of systematic analysis on the trends and burden of mental disorders in the country. This study bridges that gap by providing estimates of the prevalence and disability-adjusted life years (DALYs) associated with mental disorders in Nepal from 1990 to 2019. It highlights the rising burden of mental health issues over the past three decades, with significant variations across sex and age groups. In 2019, approximately 3.9 million people in Nepal were living with mental disorders, with major depressive and anxiety disorders being the most prevalent. The contribution of mental disorders to the total disease burden has tripled since 1990. These findings underscore the urgent need for effective programs and policies to address the growing mental health crisis in Nepal and guide stakeholders in preparing the health system for future challenges.

Introduction
Mental disorders are a leading global health concern, contributing significantly to the disease burden worldwide. Between 1990 and 2019, the proportional contribution of mental disorders to total DALYs increased by 58% globally, making them the seventh leading cause of DALYs in 2019 and affecting approximately 970 million people (Institute of Health Metrics and Evaluation, 2019). Beyond the health implications, mental disorders impose a substantial economic burden through increased healthcare costs and productivity losses (Doran & Kinchin, 2019). Low- and middle-income countries (LMICs), including Nepal, bear a disproportionate share of this burden.

Several adversities—chronic health conditions, poverty, social exclusion, gender inequality, conflict, disasters, and migration—can increase the risk of developing mental disorders (Lund et al., 2018). Nepal has faced unique challenges, including a decade-long internal conflict (1996–2006), the catastrophic 2015 earthquake (Kane et al., 2018), high unemployment rates, significant out-migration (Dhungana et al., 2019), domestic violence, alcohol abuse, and persistent poverty. These factors collectively exacerbate the country’s mental health crisis (Luitel et al., 2013).

A recent national mental health survey found that 10% of Nepalese adults have experienced a mental disorder at some point in their lives (Nepal Health Research Council, 2021). Other studies have highlighted the prevalence of anxiety and depression (Upadhyaya & Pol, 2003; Kohrt et al., 2009; Risal et al., 2016). However, these studies often focused on specific populations, employed self-reported tools with limited validity, and did not estimate DALYs or analyze temporal trends, leading to variability in reported mental health statistics (Steel et al., 2009).

Given the limited availability and accessibility of mental health services in Nepal, a systematic analysis of the trends and burden of mental disorders is crucial. This study aims to provide a comprehensive assessment of the prevalence and DALYs of mental disorders in Nepal from 1990 to 2019, using data from the Global Burden of Disease (GBD) Study 2019. These insights are vital for planning effective prevention and management strategies in the country.

Methods
Study Design and Data Sources
This study utilized estimates from the GBD 2019, a comprehensive multinational study assessing health loss for 369 diseases and injuries across 204 countries from 1990 to 2019 (Roth et al., 2020). Data were extracted using the GBD Compare visualization tool available on the Institute for Health Metrics and Evaluation (IHME) website. The GBD study integrates data from diverse sources, including vital registration systems, health surveys, disease registries, and healthcare facilities, and employs sophisticated statistical techniques to estimate disease incidence, prevalence, deaths, and DALYs.

For Nepal, GBD 2019 utilized 402 data sources, including household surveys, hospital records, and disease registries, to estimate the burden of mental disorders.

Study Outcomes
This study focused on various mental disorders, including major depressive disorders (major depressive disorder and dysthymia), anxiety disorders, developmental intellectual disabilities (idiopathic), dysthymia, attention deficit hyperactivity disorder (ADHD), conduct disorder, bipolar disorder, autism spectrum disorders, schizophrenia, bulimia nervosa, anorexia nervosa, and other mental disorders. These conditions were classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD-10) criteria (Vos et al., 2020).

The findings provide a detailed understanding of the magnitude and distribution of mental disorders in Nepal, offering critical data for health system planning and intervention development.