Pakistan Survey Finds Mental Disorders in One in Three Adults as Care Shortages Persist

A national survey puts numbers to Pakistan's mental health needs

Pakistan's first nationally representative psychiatric survey found that 32.3 per cent of adults had a current mental or behavioural disorder, with post-traumatic stress disorder affecting 19.9 per cent and depressive disorders affecting 10.6 per cent. The findings give health planners a national measure of needs in a country where specialist care is concentrated in cities.

Researchers interviewed 17,773 adults across Punjab, Sindh, Khyber Pakhtunkhwa and Balochistan. Their published survey paper in BMJ Public Health puts lifetime prevalence at 37.9 per cent, meaning that more than one in three adults had experienced a disorder at some point.

The Pakistan Psychiatric Society led the National Psychiatric Morbidity Survey with collaborating institutions. Lead investigator Professor Raza-ur-Rahman heads the psychiatry department at Hamdard University in Karachi. Partners included Brighton and Sussex Medical School, the University of South Florida and psychiatric institutions across Pakistan.

Raza-ur-Rahman described how the findings could guide decisions about where to put staff, services and money:

This survey provides the evidence needed to develop effective mental health policies and services in Pakistan. It identifies who is most at risk, where support is most needed, and the scale of the unmet need for care,

The findings arrive as the Ministry of National Health Services, Regulations and Coordination begins work on a National Mental Health Policy for 2026 to 2035. They also give provincial governments evidence for decisions about care closer to homes, rather than relying mainly on hospitals and specialists.

How the researchers reached households

The published paper dates fieldwork to 2019 through 2022, rather than the 2018 start cited in initial public descriptions of the project. Interviews paused during COVID-19 lockdowns in 2020 and 2021 before resuming with safety measures.

The Pakistan Bureau of Statistics helped select areas and calculate the sample size. Researchers used three stages of random selection: choosing geographic blocks, selecting households within them and then selecting one eligible adult from each household. Participants were aged 18 or older.

Teams approached 20,833 households and completed 17,773 interviews. The researchers reported an 86.2 per cent response rate. Interviews took place in homes, with teams including a male and a female interviewer to improve acceptance in communities where some households were uncomfortable admitting male interviewers.

Trained researchers used the Mini International Neuropsychiatric Interview, or MINI, translated into Urdu and checked through translation back into English. This structured interview uses a set sequence of questions and diagnostic rules to identify disorders. Findings were classified using the International Classification of Diseases, known as ICD-10.

Important dates in the survey and policy process include:

• November 11, 2017: Pakistan's National Bioethics Committee approved the survey.
• 2019: Fieldwork began across the four provinces.
• 2020 to 2021: COVID-19 lockdowns temporarily interrupted interviews.
• 2022: The survey's fieldwork period ended.
• July 2024: An early research manuscript appeared on medRxiv.
• 2026 to 2035: The period covered by the national mental health policy now under development.

What the main percentages mean

The survey's 32.3 per cent current prevalence means that roughly 32 out of every 100 adults met diagnostic criteria for at least one disorder covered by the study. Lifetime prevalence, at 37.9 per cent, includes disorders experienced earlier in life.

The difference between those two measures is 5.6 percentage points. Both are useful for planning: current prevalence describes needs around the time of assessment, while lifetime prevalence shows how widely these conditions have touched people's lives.

Neurotic and stress related disorders were the largest current diagnostic group, at 24.5 per cent. PTSD falls within that group and accounted for much of its prevalence. PTSD can involve distressing memories, avoidance of reminders and a continuing sense of threat after traumatic experiences.

Mood disorders affected 11.6 per cent of adults currently, mostly through depressive disorders, which affected 10.6 per cent. Depression involves persistent changes in mood and interest that can interfere with ordinary activities, sleep, concentration and relationships.

The researchers' earlier survey manuscript also reported lifetime prevalence of 19.62 per cent for mood disorders and 24.81 per cent for neurotic and stress related disorders. Those lifetime measures cover a longer period than the current figures. People can experience more than one disorder, so diagnostic categories can overlap.

Suicidal distress calls for a clear route to care

About 6.2 per cent of participants reported suicidality during the previous month. The interview module covered several experiences, including suicidal thoughts, intent, plans and behaviour. The headline figure therefore describes a broader range of distress than suicidal thoughts alone.

Approximately 1.1 per cent reported a suicide attempt at some point in their lives. The researchers assessed these experiences separately because identifying people in danger is central to prevention and clinical care.

Survey teams arranged referral information for local mental health services. Participants with a suicidal plan or intention, or an acute disorder, were referred for clinical assessment and management under arrangements made with district or local government services.

For health planners, this part of the survey connects detection with a practical responsibility: a person identified as needing urgent help must have somewhere to go. Training a community worker to recognise distress requires a working connection to clinicians who can assess and treat it.

Age, income and education shape the pattern

Older adults, people with lower incomes and those with less education had higher levels of psychiatric morbidity. The published analysis also found associations with being separated, divorced or widowed, and with being unemployed, a homemaker, a student or retired.

Adults aged 50 to 59 had a current prevalence of 60.67 per cent in the earlier manuscript, compared with the national estimate of about 32.3 per cent. Among adults aged 60 or older, current prevalence was 56.73 per cent. These figures identify older adults as an important group for service planning.

Urban residents had a current prevalence of 33.84 per cent, compared with 31.51 per cent in rural areas, a difference of 2.33 percentage points. Rural communities still face the practical difficulty of reaching specialists who are concentrated in cities.

Women had a higher current prevalence in the direct comparison, at 33.46 per cent against 31.07 per cent for men. In the earlier manuscript, however, the statistical model that considered several demographic factors together found lower adjusted odds among women. The simple comparison describes the two groups as surveyed; the adjusted model examines sex alongside factors such as age, income and marital status.

Disability extends beyond a diagnosis

The researchers also measured how mental disorders affected family life, responsibilities at home, work and social relationships. They used the Sheehan Disability Scale, which asks people to rate interference with daily activities.

Alcohol use disorders had the highest mean current disability score, at 23.7, followed by manic episodes or bipolar disorder at 23.5 and schizophrenia at 23.3. These results show why planning services requires attention to how much help people need, as well as how common a condition is.

A less common disorder can place heavy demands on a household if it disrupts employment, relationships or the ability to manage everyday tasks. Depression and PTSD, meanwhile, create a large need for accessible care because they affect substantial shares of the adult population.

Professor Anjum Memon, chair in epidemiology and public health medicine at Brighton and Sussex Medical School and the study's senior co-author, described the change in the evidence available to decision makers:

This is a landmark moment for mental health research in Pakistan. For decades, policymakers have had to rely on fragmented local studies or international estimates. We now have robust national evidence showing, for the first time, the true scale of mental and behavioural disorders across the country.

Specialist shortages leave large gaps in access

The published paper cites about 470 certified psychiatrists nationally, equivalent to 0.19 per 100,000 people, with most based in urban centres. It also states that mental health receives less than 0.5 per cent of total healthcare spending.

Dr Fauziah Rabbani, a professor at Aga Khan University's Brain and Mind Institute, has cited another workforce estimate of 0.24 psychiatrists and 1.30 psychologists per 100,000 people. Her assessment also puts the share receiving no formal care in a year at more than 80 per cent. Both workforce estimates describe a limited pool serving a very large population.

Sindh illustrates how geography affects access. Dr Karim Khawaja, honorary chairman of the Sindh Mental Health Authority, puts Pakistan's broader mental health workforce at roughly 600 professionals, including about 140 in Sindh. He says specialists in the province are available in only 10 districts.

Khawaja described the position outside those districts:

The remaining districts do not have these specialists,

Families outside the main service centres may therefore need to travel for diagnosis and treatment, adding transport costs and time away from work. Sindh has also faced a reported absence of a provincial mental health policy for five years, making decisions about prevention, referrals, staffing and data collection more urgent.

A community programme offers a practical model

Aga Khan University's Brain and Mind Institute and the Government of Sindh have developed mPareshan, a programme that gives Lady Health Workers six short educational audio and video materials in local languages. Workers can play them through an Android application during household visits.

The programme adapts the World Health Organization's mental health Gap Action Programme guidance for workers already serving communities. Its materials use familiar language about distress, worry and sleep problems, while workers provide support, coping advice and referrals.

Rabbani describes an approximately 60 per cent reduction in anxiety and depression scores among participating men and women. Her account also describes the programme as acceptable and feasible in communities affected by flooding, where an application that works without an internet connection is useful.

Sindh has endorsed the mPareshan training manual for the Lady Health Worker curriculum and approved expansion across all 30 districts. That creates a route for broader community contact alongside the much narrower distribution of specialists.

The model shares tasks across the health system: community workers recognise distress and arrange referrals, primary care clinicians manage common disorders, and specialists support more complex care. The survey researchers similarly recommend integrating mental health into primary healthcare, investing in community support, training frontline workers and reducing stigma.

What the evidence can guide next

The Ministry of National Health Services' work on the policy for 2026 to 2035 offers an opportunity to connect national findings with provincial delivery. No adoption or implementation date has been given. Staffing, medicine supplies, supervision and referral arrangements will determine whether people can obtain care after a problem is recognised.

The survey also has boundaries that matter for planning. It measures adults living in households, and excludes people whose severe cognitive or physical disabilities prevented them from understanding the interview. Children require separate evidence and services; their needs sit outside these adult prevalence estimates.

The researchers applied sampling weights to account for differences in selection and provincial representation. However, identifiers for the original sampling units and clusters were unavailable for the statistical analysis. The paper says the full sampling design therefore could not be incorporated into estimates of uncertainty, which affects how precisely the percentages can be interpreted.

The study also provides a picture collected across 2019 to 2022, with an interruption during the pandemic. Further surveys could track changes over time. PTSD research would benefit from detailed information on traumatic exposures, while service planning needs district information about staffing, access and treatment.

Pakistan now has a shared national starting point for those decisions: almost one in three adults met criteria for a current disorder, common conditions affected large numbers, and some disorders were associated with substantial disruption of daily life. Bringing care closer to households is the concrete task linking those findings to the policy work.

Key Points

• The survey interviewed 17,773 adults across Pakistan's four provinces between 2019 and 2022.
• Current mental and behavioural disorders affected 32.3 per cent of adults; lifetime prevalence was 37.9 per cent.
• PTSD affected 19.9 per cent and depressive disorders affected 10.6 per cent.
• About 6.2 per cent reported suicidality in the previous month; approximately 1.1 per cent reported a lifetime suicide attempt.
• Older age, lower income, less education and disrupted marital relationships were associated with higher psychiatric morbidity.
• Specialist shortages and concentration in cities limit access, while Sindh has approved expansion of mPareshan across 30 districts.
• A national mental health policy covering 2026 to 2035 is under development.