Mental health

From trauma to genetic predisposition, there are dozens of risk factors for mental health conditions. Indeed, researchers are looking deeply into which life events (like the death of a family member and financial difficulties) can trigger psychological and mental problems, and how.

Here’s a look at some of the global risk factors for mental health conditions:

• Familial factors: This includes
  • A family history of any mental illness or genetic predisposition to mental health conditions like anxiety or depression. Research shows that in people with bipolar disorder there is a 60-80% chance that the disorder was inherited from a family member.
  • Family discord or poor relationships with family members
  • Domestic abuse is also a major cause of mental health disturbance. Research shows that people who have suffered domestic abuse may even develop post-traumatic stress disorder (PTSD)
• Environmental factors: This may include factors like air pollution and noise pollution, but also things you may have been exposed to in the womb. For example, medicines or alcohol. Scientists have also found links between an increase in temperature and mental health visit to hospitals.
• Financial factors: Research has found that there is a greater likelihood of mental health problems in families and people with financial problems than those who don’t have money problems. 
• Lifestyle factors: These could include little or no exercise, poor diet with lots of processed foods, smoking, stressful job, not taking time out for yourself and loved ones or the choices you make that lead to disengagement from community and friends, loneliness and social isolation. Recreational drugs, alcohol and other stimulants can also affect mental health temporarily.
• Health factors: Having a serious (possibly terminal) illness, a chronic ailment like diabetes, being in an accident or sustaining brain injury can affect one’s state of mind. In addition to these, certain medicines used to treat health conditions may affect mental health also. Of course, having a mental illness—especially an undiagnosed or untreated one—can have a huge impact on mental health. During the COVID-19 pandemic, people reported feeling anxious about the new disease—this is quite apart from the neurological symptoms of COVID-19 such as headaches, dizziness, reduced alertness and confusion.
• Major life events: Events such as a separation or a death in the family, job loss, being in an accident, a breakup, life stages like pregnancy or menopause can also have a profound impact on mental health.
• Other factors: War, conflict, migration, physical or sexual abuse, fearing for your safety or that of loved ones, bullying and being in a constant state of alertness like during a global pandemic can all take a toll on mental health, too (read more: How to deal with the anxiety of living through a pandemic).
  Your gender may have a bearing on mental health. For example, women are more prone to depression than men. Research shows that financial difficulties have a greater impact on women than men’s health.
  Studies also show that your age can also be a contributing factor: neglect and mental health disturbances at an early age have a much larger impact than they would on an adult. On the other end of the age spectrum, degenerative mental illnesses like Alzheimer's are much more like to affect senior citizens rather than children.
  That said, some mental health factors like loneliness affect the young as well as the old.

National Mental Health Survey on risk factors in India specifically

In 2016, NIMHANS published the findings of the first-ever National Mental Health Survey of India (NMHS). According to the survey, the biggest risk factors for mental health problems in India are:

• General risk: 10.6% of India’s population has some form of mental morbidity (or problems due to mental health) currently, and 13.7% of the participants reported experiencing mental morbidity at some point in their lives.
• Gender: Males have a higher prevalence of mental morbidity in India compared to females, both at the time of the survey (13.9% for men and 7.5% for women) and at some point in their lives (16.7% for men, compared with 10.8% in women).
• Age: People aged 40-49 are the highest risk (14.5%).
• Place of residence: Residents of urban metros have a higher current prevalence (14.7%) of mental morbidity, compared with people living in the non-metro cities and towns (9.73%) and villages of India (9.57%).
• Education level: Education, too, seems to have a role in this: the survey showed higher mental morbidity rates for those who had primary schooling compared with those who had no schooling. However, the mental morbidity rates reduced as “education status” or the person’s qualifications increased. People with a high school diploma had a lower prevalence of mental morbidity than people with no education—and people with still higher education were better off than people with a matriculation certificate.
• Socioeconomic status: People from the working class had a higher prevalence of mental health problems than people in higher income brackets.
• Marital/relationship status: Those who are widowed or separated from their spouse or partner had higher mental morbidity rates than people who were married (11.16% current and 14.38% lifetime) and those who had never married (7.66% and 9.58%, respectively).

As can be seen from this list, while some of the risk factors for poor mental health are within our control, others are not. Some tend to be temporary, while others cast a long shadow on our well-being. The important thing is to remember that asking for help is the first step towards improving mental health.

It is natural to be distressed for short periods in some situations. However, it is important to keep an eye out for some common signs of mental health disturbances. These include, in no particular order:

• Feeling hopeless or worthless
• Feeling anxious or worried often
• A noticeable change in behaviour
• Having negative thoughts
• Thinking about harming oneself (self-harm) or others
• Suicide ideation
• Difficulty sleeping or sleeping too much
• Loss of appetite or eating much more than usual
• Avoiding friends, family, social gatherings
• Finding little or no joy in activities that used to be fun before
• Low energy levels
• Low libido or sex drive
• Confusion
• Having delusions, hallucinations or hearing voices
• Becoming dependent on substances that change one’s mood (uppers and downers) such as alcohol, nicotine or drugs
• Difficulty performing everyday tasks like getting dressed for work or taking care of yourself

In some ways, the brain is the final frontier in medicine. Scientists are still trying to figure out the complex chemical interactions within the central nervous system and the body which regulate how we feel, think, behave.

There are dozens of conditions that can affect the brain and our mental health. The following is a list of the common mental health problems today, as per India’s National Mental Health Survey 2015-16 (NMHS 2016, the latest such data available):

• Substance use disorders (SUDs): Alcohol, opioids, cannabinoids, sedatives and hypnotics, cocaine, other stimulants, hallucinogens, volatile solvents and tobacco are all psychoactive substances that can affect the brain and multiple systems in the body—plus, they can be highly habit-forming or addictive.
  According to the NMHS 2016, more than one in five people in India use at least one of these substances. The prevalence of tobacco use is nearly 21%, alcohol 4.6% and drugs 0.6%.
  Research shows that substances like cigarette chemicals cause “brain changes” and can make things worse for people who already have a psychiatric illness like attention deficit hyperactivity disorder (ADHD) or Alzheimer’s.
• Schizophrenia and other psychotic disorders: Several mental health conditions can cause psychosis, such as schizophrenia, schizoaffective disorder, catatonia and bipolar disorder. Use of psychoactive substances can also cause psychosis sometimes (read more: What is ayahuasca?). Schizophrenia is a mental health disorder that distorts the patient’s sense of reality—it may be linked to delusions (delusional disorders), hallucination, and difficulty functioning normally on a day-to-day basis.
  According to the NMHS 2016, the prevalence of schizophrenia and other psychotic disorders in the country was 0.5% at the time of doing the survey, and 1.4% of respondents said they had had a psychotic disorder at some point in their lives.
  Globally, 20 million people are living with schizophrenia, according to the WHO.
• Mood disorders: Depression, bipolar disorder, seasonal affective disorder, premenstrual dysphoric disorder and drug-induced or illness-related depression are all examples of mood disorders.
  According to the NMHS 2016, mood disorders as a whole had a prevalence of 2.84% at the time of doing the survey and 5.61% at some point in the respondents’ lives.
  Globally, 264 million people are living with depression, according to the WHO.
• Neurotic and stress-related disorders: Neuroses include obsessive and anxiety disorders such as obsessive-compulsive disorder and phobias—phobic anxiety is an example of phobia (fear) while stress-related disorders include post-traumatic stress disorder and acute stress disorder (which can last for three days to a month).
• Suicide risk: Self-harm and suicide are extreme fallouts of negative thoughts and low mental health. India has a prevalence of 10.6 suicides per 100,000 population, according to the NMHS 2016. The prevalence is highest in the 30-44 age group (17.24 per 100,000) followed closely by people aged 18-29 (17.15). The suicide incidence rate in India is significantly higher among men than women. Globally, 1.4% of all deaths each year are because of suicide. Research shows that adverse childhood experiences and mental health problems are linked to higher risk of suicide.

India has a National Mental Health Programme to fight mental illness and promote mental health. In addition to reaching out to medical health professionals and helplines, there are many avenues available to improve your mental health. Here are some ideas to get you started:

• Psychotherapy: Therapies such as cognitive behaviour therapy, talk therapy, grief counselling can help some people get to the root of what they are feeling and equip them with some strategies to cope with it.
• Drug therapy: Medicines like antidepressants and antipsychotics may be prescribed for mental health issues.
• Lifestyle changes: Making healthier choices in terms of the food we eat, how much we exercise, how much we socialise and whether we consciously try to maintain a positive outlook can have a bearing on our mental health. Research shows that simply smiling can improve people’s mood whereas griping or complaining can worsen the mood.
• Relaxation: In addition to the above, meditation, yoga, tai chi and deep breathing exercises can help you relax and feel good.

As you know, mental health is not just the absence of mental illness, it is about taking a 360-degree view of mental well-being. For this reason, doing things that relax you (like going on holiday or to the movies), keep you fit (exercise and diet mostly, but also regular checkups by a doctor) and make you happy are important here. Something as small as a vitamin D deficiency can tip the scales ever so slightly. It is important to pay attention to self-care and happiness.

Finally, it's impossible to talk about mental health today without considering the wide-ranging impact of social media on our perception of our selves and our lives and on interpersonal relationships. FOMO, social anxiety, infodemic and body image issues are all deeply linked with this medium. As with other things, it helps to reach out for help if you feel distressed by any aspect of your life online.

Read more: 7 simple but effective tips for self-care

According to the WHO "Mental Health: Strengthening Our Response" fact sheet, “multiple social, psychological, and biological factors determine the level of mental health of a person at any point in time. For example, violence and persistent socio-economic pressures are recognized as risks to mental health. The clearest evidence is associated with sexual violence.”

Other risk factors for mental health disturbances, according to the WHO, are:

• Inability to keep up with really fast-paced social changes
• Poor or stressful work conditions. This could include bullying at work, brutal competition and pressure or an unsustainable work-life equation
• Gender discrimination: This may include discrimination against people with non-heteronormative sexual preferences and non-binary gender and non-Cisgender identities
• Social exclusion: There are many forms of social exclusion, starting from exclusion from the group of popular kids at school to exclusion based on caste or religion
• Unhealthy lifestyle
• Physical health problems
• Human rights violations
• Psychological and personality factors
• Biological risks include genes

Although there are many different types of mental health disturbances and disorders, each with their own signs and symptoms, there are some red flags we should keep an eye out for. Among these are feelings of hopelessness, sleep disturbances, a sudden change in appetite, thoughts of self-harm or suicide.

Mental health isn’t just the absence of mental illness, it involves mental wellness as well. India has a National Mental Health Programme to promote mental well-being. In addition to this, there is growing infrastructure and expertise in India in terms of psychiatrists, psychologists, therapists and counsellors to help people deal with their issues.

It’s important to keep a lookout for signs of mental health problems—in yourself and in loved ones (including in children)—and reach out for help from a professional or by taking up guided self-help steps. It is also very important to break the taboo surrounding mental health issues, so we can all take better care of our mental health.