Mental Health & Society
The Quiet Epidemic: Anxiety is the World’s most common Mental Health Condition and India is falling behind in addressing it.
470 million people worldwide live with anxiety disorder. In India, the number of people affected has more than doubled in just over three decades. Only one in four who need treatment actually receive it. Anxiety is still widely dismissed as a mood, not a medical condition. That needs to change.
Anxiety, in common usage, is the word we use for a pre-exam flutter or the nervous energy before a job interview. It is something people are expected to manage, push through, and move on from. The cultural assumption is that anxiety is temporary, normal, and largely a matter of mindset.
The science says something different. Anxiety disorder is a recognised, diagnosable medical condition. It is the most prevalent mental health condition in the world. It has measurable physical consequences on the heart and metabolism. It significantly raises the risk of depression, substance abuse, and suicide if left untreated. And in India, the number of people living with it has more than doubled over the last three decades.
This is not a story about being stressed. It is a story about a public health emergency that is hiding in plain sight.
First: What is Anxiety Disorder?
Anxiety vs. Anxiety Disorder
The Difference Between Normal Worry and a Medical Condition
Feeling anxious about a difficult situation is normal and healthy. Fear before danger, worry before a hard decision, nervousness before an important moment: these are the body’s natural responses. They help us prepare and perform.
Anxiety disorder is different. It is when anxiety becomes persistent, excessive, and disproportionate to the actual situation. It is when the nervous system remains in a state of heightened alert even when there is no real threat. It interferes with daily life, work, relationships, and sleep. It does not go away on its own. And it is not a character flaw or a weakness of will. It is a pathology: a medical condition with identifiable causes, measurable effects on the body, and effective treatments.
The types of anxiety disorder include Generalised Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, Specific Phobias, and Post-Traumatic Stress Disorder (PTSD), among others. Each has its own pattern of symptoms but shares the core feature of persistent, unmanageable anxiety that disrupts normal functioning.
The Scale of the Problem
According to the World Health Organization, approximately 470 million people worldwide suffer from anxiety disorder. This makes it the single most common mental health condition on earth. More common than depression. More common than schizophrenia. More common than any other mental health diagnosis.
Anxiety in India: The Numbers
- Anxiety disorder prevalence in India in 1990: 2,591.9 cases per 1,00,000 people
- Anxiety disorder prevalence in India in 2023: 5,792.8 cases per 1,00,000 people
- Increase over 33 years: 123.5% — more than double
- Source: Global Burden of Disease Study, published in The Lancet
- People in need of treatment who actually receive it globally: only 27.6% (about 1 in 4)
- Mental health issues affecting women in India: 20% — twice the rate seen in men (NIMHANS, 2019)
Let that 123.5% figure sit for a moment. In the span of one generation, the number of Indians affected by anxiety disorder per 100,000 people has more than doubled. This is not simply a statistical artefact of better diagnosis. The drivers of this rise are real, well-documented, and deeply embedded in the structure of Indian society and its recent transformation.
What is Driving the Rise?
Mental health conditions rarely have a single cause. Anxiety disorder is no different. The factors driving its increase in India are multiple and interconnected.
Academic and Economic Pressure
India’s education system is intensely competitive. Millions of students compete for a shrinking number of desirable seats in colleges and government jobs. The pressure on young people during exam seasons is documented and measurable. Coaching institutes in cities like Kota attract students from across the country, and the psychological toll of this environment has been well-reported. This competition does not end at education. The formal job market has been shrinking relative to the number of educated young people entering it, meaning the anxiety of the exam does not resolve after graduation but continues into professional life.
Breakdown of Social Support Networks
The joint family system, for all its constraints, provided a natural network of social support. Urbanisation, nuclear family structures, migration for work, and the individualisation of modern urban life have reduced the availability of these informal support networks. People are physically closer together in cities and more isolated in practice. Mental health research consistently shows that the quality of social relationships is one of the strongest predictors of psychological wellbeing. As social support structures have thinned, anxiety has grown.
Climate and Environmental Stress
This is a driver that is still emerging in public consciousness but increasingly documented in research. Extreme weather events, floods, droughts, heatwaves and the disruptions they cause to livelihoods, homes, and communities have measurable effects on the mental health of affected populations. Farmers who lose crops to unexpected rainfall, coastal communities threatened by rising sea levels, families displaced by floods: all carry psychological burdens that research increasingly classifies as anxiety disorders. WHO has formally established links between climate stress and mental health outcomes.
Genetic and Biological Factors
Anxiety disorder also has biological roots. Genetics plays a role: people with family histories of anxiety are at higher risk. Neurological factors, including the functioning of the autonomic nervous system and the regulation of stress hormones like cortisol, mean that some individuals are constitutionally more vulnerable. Environmental triggers act on a biological substrate that varies between people.
What happens to the body when anxiety goes untreated
Anxiety is not only a psychological condition. It has direct physical consequences that make it a public health concern in the full sense of the term.
What Does Anxiety Do to the Body?
The Physical Toll of a Hyperactive Nervous System
Anxiety triggers the body’s “fight or flight” response, a system designed to help us respond to immediate danger. In the short term, this is useful. But when the nervous system remains hyperactivated over long periods because of chronic anxiety disorder, the same mechanism becomes harmful.
Cardiovascular risk: A chronically stressed nervous system keeps blood pressure elevated, increases heart rate variability, and raises long-term risk of heart disease and stroke.
Unhealthy coping: People with untreated anxiety frequently turn to alcohol, tobacco, and other substances as coping mechanisms. These habits worsen metabolic health and create additional medical conditions.
Mental health cascades: Untreated anxiety significantly raises the risk of clinical depression, substance use disorders, and suicidal ideation. The WHO has documented these connections clearly. Anxiety is often the entry point into a broader mental health crisis.
The Treatment Gap: Three in Four People Get No Help
Here is one of the most striking facts in this space. Anxiety disorder has highly effective treatments. Cognitive Behavioural Therapy (CBT), a structured form of talk therapy, has strong evidence behind it. Medication, where appropriate, can significantly reduce symptoms. Community support and lifestyle interventions also make a measurable difference. This is not a condition for which medicine is helpless.
And yet, worldwide, only 27.6% of people who need treatment actually receive it. Nearly three in four get nothing.
Why Do Most People Not Get Help?
Three Barriers That Keep People from Treatment
1. Low funding: Mental health services are chronically underfunded globally and in India. India’s public mental health spending is less than 1% of the total health budget. There are simply not enough psychiatrists, psychologists, or counsellors, especially outside major cities.
2. Shortage of trained providers: India has approximately 0.3 psychiatrists per 1,00,000 people. The recommended number is at least 3. This is a tenfold gap. In rural areas, the shortage is far more acute.
3. Stigma: This is perhaps the most powerful barrier. In Indian society, mental health conditions are widely associated with weakness, “madness,” or supernatural causes. Seeking help for anxiety or depression still carries significant social stigma, particularly in smaller towns and rural areas. People hide their symptoms. Families discourage treatment. The cultural framing of mental illness as a character failing, rather than a medical condition, stops millions of people from accessing help that exists.
The Gender Dimension: Women Bear a Disproportionate Burden
Mental health in India is not gender-neutral. A 2019 report by the National Institute of Mental Health and Neuro Sciences (NIMHANS) found that mental health issues affect 20% of women in India. That is twice the prevalence seen in men.
Women in India suffer disproportionately from depression, anxiety, and somatic symptoms, which are physical complaints like headaches, stomach pain, or fatigue that have no clear medical cause but are rooted in psychological distress. The reasons are not difficult to understand in a structural sense. Women in India face a unique combination of pressures: domestic responsibilities that are socially non-negotiable, limited economic independence in many households, vulnerability to gender-based violence, restricted mobility, and reduced access to healthcare and social support on their own terms.
Yet women seeking mental health help face a double stigma: the general stigma around mental illness, and the additional social pressure to be seen as stable, capable caregivers who manage their families without complaint. The result is that women are both more affected by anxiety and less able to access help for it.
The Research Gap: Anxiety is the least studied major Mental Health Condition
For a condition this widespread, anxiety disorder receives surprisingly little research attention. It is vastly under-researched compared to schizophrenia and bipolar disorder, which have been the dominant focus of psychiatric research for decades.
Part of this is the legacy of how mental health research was structured in the 20th century, when the most severe and visible conditions attracted the most funding. Part of it reflects the cultural tendency to dismiss anxiety as not serious enough to warrant the same scientific investment as conditions that cause obvious incapacitation.
This gap matters practically. Without adequate research, we have fewer evidence-based treatment protocols suited to India’s specific cultural and economic context. We have less data on which interventions work best in low-resource settings. And we have limited understanding of how the specific drivers of anxiety in India, from climate stress to caste-based discrimination to the pressures of aspirational urban life, interact with biological vulnerability
What Needs to Change
A Policy Agenda for Mental Health in India
- Significantly increase public mental health funding. India’s mental health budget is a fraction of what is needed. Integrating mental health care into primary health centres, training frontline health workers in basic counselling, and expanding the supply of psychologists and counsellors in Tier 2 and Tier 3 cities are immediate priorities.
- Invest in research specifically on anxiety. India needs anxiety-specific research that reflects its own context: the pressures of its education system, the climate stresses faced by farming communities, the experience of women, and the psychological effects of rapid urbanisation.
- Run sustained anti-stigma campaigns. Changing cultural attitudes toward mental illness is a long process. It requires sustained public communication that normalises help-seeking, presents mental health conditions accurately, and challenges the framing of anxiety as a character weakness.
- Build community support networks. Formal healthcare alone cannot address the scale of this problem. Peer support groups, community health workers trained in mental health first aid, and school-based counselling programmes can reach people who will never visit a psychiatrist.
- Address the structural drivers. Reducing academic pressure, expanding formal employment, strengthening social protection systems, and addressing the environmental crises that generate psychological stress are not mental health policies in the narrow sense. But they are essential to reducing the burden of anxiety disorder in the long term.
Anxiety is not a mood. It is not a personality type. It is not something you can solve by being more positive or working harder. It is a medical condition affecting nearly 6,000 people per 1,00,000 in India today, double what it was in 1990, and it is leaving lasting damage on the hearts, the relationships, and the lives of the people who carry it without support.
The treatments work. The research exists. The funding and the political will do not yet match the scale of the problem. The first step toward closing that gap is to stop calling this a mood, and start calling it what it is: a public health emergency.
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On March 31, the World Economic Forum (WEF) released its annual Gender Gap Report 2021. The Global Gender Gap report is an annual report released by the WEF. The gender gap is the difference between women and men as reflected in social, political, intellectual, cultural, or economic attainments or attitudes. The gap between men and women across health, education, politics, and economics widened for the first time since records began in 2006.
[wptelegram-join-channel link=”https://t.me/s/upsctree” text=”Join @upsctree on Telegram”]No need to remember all the data, only pick out few important ones to use in your answers.
The Global gender gap index aims to measure this gap in four key areas : health, education, economics, and politics. It surveys economies to measure gender disparity by collating and analyzing data that fall under four indices : economic participation and opportunity, educational attainment, health and survival, and political empowerment.
The 2021 Global Gender Gap Index benchmarks 156 countries on their progress towards gender parity. The index aims to serve as a compass to track progress on relative gaps between women and men in health, education, economy, and politics.
Although no country has achieved full gender parity, the top two countries (Iceland and Finland) have closed at least 85% of their gap, and the remaining seven countries (Lithuania, Namibia, New Zealand, Norway, Sweden, Rwanda, and Ireland) have closed at least 80% of their gap. Geographically, the global top 10 continues to be dominated by Nordic countries, with —Iceland, Norway, Finland, and Sweden—in the top five.
The top 10 is completed by one country from Asia Pacific (New Zealand 4th), two Sub-Saharan countries (Namibia, 6th and Rwanda, 7th, one country from Eastern Europe (the new entrant to the top 10, Lithuania, 8th), and another two Western European countries (Ireland, 9th, and Switzerland, 10th, another country in the top-10 for the first time).There is a relatively equitable distribution of available income, resources, and opportunities for men and women in these countries. The tremendous gender gaps are identified primarily in the Middle East, Africa, and South Asia.
Here, we can discuss the overall global gender gap scores across the index’s four main components : Economic Participation and Opportunity, Educational Attainment, Health and Survival, and Political Empowerment.
The indicators of the four main components are
(1) Economic Participation and Opportunity:
o Labour force participation rate,
o wage equality for similar work,
o estimated earned income,
o Legislators, senior officials, and managers,
o Professional and technical workers.
(2) Educational Attainment:
o Literacy rate (%)
o Enrollment in primary education (%)
o Enrollment in secondary education (%)
o Enrollment in tertiary education (%).
(3) Health and Survival:
o Sex ratio at birth (%)
o Healthy life expectancy (years).
(4) Political Empowerment:
o Women in Parliament (%)
o Women in Ministerial positions (%)
o Years with a female head of State (last 50 years)
o The share of tenure years.
The objective is to shed light on which factors are driving the overall average decline in the global gender gap score. The analysis results show that this year’s decline is mainly caused by a reversal in performance on the Political Empowerment gap.
Global Trends and Outcomes:
– Globally, this year, i.e., 2021, the average distance completed to gender parity gap is 68% (This means that the remaining gender gap to close stands at 32%) a step back compared to 2020 (-0.6 percentage points). These figures are mainly driven by a decline in the performance of large countries. On its current trajectory, it will now take 135.6 years to close the gender gap worldwide.
– The gender gap in Political Empowerment remains the largest of the four gaps tracked, with only 22% closed to date, having further widened since the 2020 edition of the report by 2.4 percentage points. Across the 156 countries covered by the index, women represent only 26.1% of some 35,500 Parliament seats and 22.6% of over 3,400 Ministers worldwide. In 81 countries, there has never been a woman head of State as of January 15, 2021. At the current rate of progress, the World Economic Forum estimates that it will take 145.5 years to attain gender parity in politics.
– The gender gap in Economic Participation and Opportunity remains the second-largest of the four key gaps tracked by the index. According to this year’s index results, 58% of this gap has been closed so far. The gap has seen marginal improvement since the 2020 edition of the report, and as a result, we estimate that it will take another 267.6 years to close.
– Gender gaps in Educational Attainment and Health and Survival are nearly closed. In Educational Attainment, 95% of this gender gap has been closed globally, with 37 countries already attaining gender parity. However, the ‘last mile’ of progress is proceeding slowly. The index estimates that it will take another 14.2 years to close this gap on its current trajectory completely.
In Health and Survival, 96% of this gender gap has been closed, registering a marginal decline since last year (not due to COVID-19), and the time to close this gap remains undefined. For both education and health, while progress is higher than economy and politics in the global data, there are important future implications of disruptions due to the pandemic and continued variations in quality across income, geography, race, and ethnicity.
India-Specific Findings:
India had slipped 28 spots to rank 140 out of the 156 countries covered. The pandemic causing a disproportionate impact on women jeopardizes rolling back the little progress made in the last decades-forcing more women to drop off the workforce and leaving them vulnerable to domestic violence.
India’s poor performance on the Global Gender Gap report card hints at a serious wake-up call and learning lessons from the Nordic region for the Government and policy makers.
Within the 156 countries covered, women hold only 26 percent of Parliamentary seats and 22 percent of Ministerial positions. India, in some ways, reflects this widening gap, where the number of Ministers declined from 23.1 percent in 2019 to 9.1 percent in 2021. The number of women in Parliament stands low at 14.4 percent. In India, the gender gap has widened to 62.5 %, down from 66.8% the previous year.
It is mainly due to women’s inadequate representation in politics, technical and leadership roles, a decrease in women’s labor force participation rate, poor healthcare, lagging female to male literacy ratio, and income inequality.
The gap is the widest on the political empowerment dimension, with economic participation and opportunity being next in line. However, the gap on educational attainment and health and survival has been practically bridged.
India is the third-worst performer among South Asian countries, with Pakistan and Afghanistan trailing and Bangladesh being at the top. The report states that the country fared the worst in political empowerment, regressing from 23.9% to 9.1%.
Its ranking on the health and survival dimension is among the five worst performers. The economic participation and opportunity gap saw a decline of 3% compared to 2020, while India’s educational attainment front is in the 114th position.
India has deteriorated to 51st place from 18th place in 2020 on political empowerment. Still, it has slipped to 155th position from 150th position in 2020 on health and survival, 151st place in economic participation and opportunity from 149th place, and 114th place for educational attainment from 112th.
In 2020 reports, among the 153 countries studied, India is the only country where the economic gender gap of 64.6% is larger than the political gender gap of 58.9%. In 2021 report, among the 156 countries, the economic gender gap of India is 67.4%, 3.8% gender gap in education, 6.3% gap in health and survival, and 72.4% gender gap in political empowerment. In health and survival, the gender gap of the sex ratio at birth is above 9.1%, and healthy life expectancy is almost the same.
Discrimination against women has also been reflected in Health and Survival subindex statistics. With 93.7% of this gap closed to date, India ranks among the bottom five countries in this subindex. The wide sex ratio at birth gaps is due to the high incidence of gender-based sex-selective practices. Besides, more than one in four women has faced intimate violence in her lifetime.The gender gap in the literacy rate is above 20.1%.
Yet, gender gaps persist in literacy : one-third of women are illiterate (34.2%) than 17.6% of men. In political empowerment, globally, women in Parliament is at 128th position and gender gap of 83.2%, and 90% gap in a Ministerial position. The gap in wages equality for similar work is above 51.8%. On health and survival, four large countries Pakistan, India, Vietnam, and China, fare poorly, with millions of women there not getting the same access to health as men.
The pandemic has only slowed down in its tracks the progress India was making towards achieving gender parity. The country urgently needs to focus on “health and survival,” which points towards a skewed sex ratio because of the high incidence of gender-based sex-selective practices and women’s economic participation. Women’s labour force participation rate and the share of women in technical roles declined in 2020, reducing the estimated earned income of women, one-fifth of men.
Learning from the Nordic region, noteworthy participation of women in politics, institutions, and public life is the catalyst for transformational change. Women need to be equal participants in the labour force to pioneer the societal changes the world needs in this integral period of transition.
Every effort must be directed towards achieving gender parallelism by facilitating women in leadership and decision-making positions. Social protection programmes should be gender-responsive and account for the differential needs of women and girls. Research and scientific literature also provide unequivocal evidence that countries led by women are dealing with the pandemic more effectively than many others.
Gendered inequality, thereby, is a global concern. India should focus on targeted policies and earmarked public and private investments in care and equalized access. Women are not ready to wait for another century for equality. It’s time India accelerates its efforts and fight for an inclusive, equal, global recovery.
India will not fully develop unless both women and men are equally supported to reach their full potential. There are risks, violations, and vulnerabilities women face just because they are women. Most of these risks are directly linked to women’s economic, political, social, and cultural disadvantages in their daily lives. It becomes acute during crises and disasters.
With the prevalence of gender discrimination, and social norms and practices, women become exposed to the possibility of child marriage, teenage pregnancy, child domestic work, poor education and health, sexual abuse, exploitation, and violence. Many of these manifestations will not change unless women are valued more.
[wptelegram-join-channel link=”https://t.me/s/upsctree” text=”Join @upsctree on Telegram”]2021 WEF Global Gender Gap report, which confirmed its 2016 finding of a decline in worldwide progress towards gender parity.
Over 2.8 billion women are legally restricted from having the same choice of jobs as men. As many as 104 countries still have laws preventing women from working in specific jobs, 59 countries have no laws on sexual harassment in the workplace, and it is astonishing that a handful of countries still allow husbands to legally stop their wives from working.
Globally, women’s participation in the labour force is estimated at 63% (as against 94% of men who participate), but India’s is at a dismal 25% or so currently. Most women are in informal and vulnerable employment—domestic help, agriculture, etc—and are always paid less than men.
Recent reports from Assam suggest that women workers in plantations are paid much less than men and never promoted to supervisory roles. The gender wage gap is about 24% globally, and women have lost far more jobs than men during lockdowns.
The problem of gender disparity is compounded by hurdles put up by governments, society and businesses: unequal access to social security schemes, banking services, education, digital services and so on, even as a glass ceiling has kept leadership roles out of women’s reach.
Yes, many governments and businesses had been working on parity before the pandemic struck. But the global gender gap, defined by differences reflected in the social, political, intellectual, cultural and economic attainments or attitudes of men and women, will not narrow in the near future without all major stakeholders working together on a clear agenda—that of economic growth by inclusion.
The WEF report estimates 135 years to close the gap at our current rate of progress based on four pillars: educational attainment, health, economic participation and political empowerment.
India has slipped from rank 112 to 140 in a single year, confirming how hard women were hit by the pandemic. Pakistan and Afghanistan are the only two Asian countries that fared worse.
Here are a few things we must do:
One, frame policies for equal-opportunity employment. Use technology and artificial intelligence to eliminate biases of gender, caste, etc, and select candidates at all levels on merit. Numerous surveys indicate that women in general have a better chance of landing jobs if their gender is not known to recruiters.
Two, foster a culture of gender sensitivity. Take a review of current policies and move from gender-neutral to gender-sensitive. Encourage and insist on diversity and inclusion at all levels, and promote more women internally to leadership roles. Demolish silos to let women grab potential opportunities in hitherto male-dominant roles. Work-from-home has taught us how efficiently women can manage flex-timings and productivity.
Three, deploy corporate social responsibility (CSR) funds for the education and skilling of women and girls at the bottom of the pyramid. CSR allocations to toilet building, the PM-Cares fund and firms’ own trusts could be re-channelled for this.
Four, get more women into research and development (R&D) roles. A study of over 4,000 companies found that more women in R&D jobs resulted in radical innovation. It appears women score far higher than men in championing change. If you seek growth from affordable products and services for low-income groups, women often have the best ideas.
Five, break barriers to allow progress. Cultural and structural issues must be fixed. Unconscious biases and discrimination are rampant even in highly-esteemed organizations. Establish fair and transparent human resource policies.
Six, get involved in local communities to engage them. As Michael Porter said, it is not possible for businesses to sustain long-term shareholder value without ensuring the welfare of the communities they exist in. It is in the best interest of enterprises to engage with local communities to understand and work towards lowering cultural and other barriers in society. It will also help connect with potential customers, employees and special interest groups driving the gender-equity agenda and achieve better diversity.