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World Mental Health Day: What do genes have to do with mental health?

World Mental Health Day

How prevalent are psychiatric disorders in India and why should we be concerned about them?

Psychiatric illnesses are a diverse group of complex disorders including autism, anxiety disorders, schizophrenia, affective disorders such as depression and bipolar disorder, and other related conditions. Serious mental illnesses such as schizophrenia and bipolar disorder cumulatively affect approximately 1–4% of the population worldwide. The prevalence of mental health illness has been on the rise owing to multiple reasons. Some positive contributing factors include better diagnosis, more awareness and negative contributing factors such as high stress levels, lesser social connections, and increasing competition.

The estimated prevalence of mental health illness in India remains wide. It ranges from 10 to 370 per 1000 across the country. Some studies have estimated the prevalence of mental health illness in the rural population to be about 49 per 1000 individuals compared against 80 per 1000 in urban population. Women and children are at a higher risk of developing psychiatric diseases. Factors such as gender discrimination, social exclusion, and domestic violence predispose women to an increased risk of developing psychiatric illnesses.

Despite a rise in the number of people diagnosed with mental health illness, compared against worldwide estimates, the prevalence of mental health illness in the South Asian population is lower. This may be attributed to many factors such as under-reporting of symptoms, disease classification and better cultural, social support and better coping strategies that may lead to lower incidences of psychiatric disorders compared against the West.

Multifactorial nature of diseases

Psychiatric illnesses are complex disorders with multiple genetic variants, environmental and lifestyle risk factors. Psychiatric conditions such as schizophrenia and bipolar disorders are highly heritable. A family history of psychiatric illnesses increases the risk of developing such conditions. In certain cases, psychiatric illness can present as a part of a syndromic genetic condition such as autism, Fragile X syndrome, or 22q11.2 deletion syndrome (DiGeorge Syndrome).

Many studies have reported the risk of developing a psychiatric illness; however, the risk estimates may vary between studies.

 

Disease Risk to first-degree relative
Bipolar disease 5-30%
Autism (idiopathic) 3-8%
Attention deficit hyperactivity disorder (ADHD) 20-65%
General anxiety 20%
Obsessive compulsive anxiety disorder 10-25%
Schizophrenia 1-11%

What are the challenges in diagnosis and treatment of mental health conditions in India?

Many factors have been identified to be challenges contributing to delayed diagnosis and treatment of psychiatric illness in India:

1. Stigma related to mental disorders
2. Low awareness among common people
3. Delayed treatment seeking behavior
4. Lack of easily available treatment

Misconceptions about the biology of the disease, belief in cultural myth such as possession of demons, prevalent use of alternative medicine are additional barriers to early diagnosis and treatment. There is strong evidence to suggest that the onset of mental illnesses begin at an early age. Improving child development services, improving access to psychological interventions at an earlier age and community building activities can reduce the burden of psychiatric illnesses in children.

Mental health isn't all of me, but it's a massive part of my journey and a massive part of my whole being.

 

Why and how can genetic counseling help?

Individuals with a personal or family history of psychiatric diseases may seek genetic counseling for multiple reasons:

  1. Individuals may be interested in a quantitative risk assessment based on the most updated information
  2. Interest in understanding the underlying biology of the disease
  3. Individuals may be seeking support to address their concerns regarding risk for children and siblings

The process of genetic counseling can help in accurate risk assessment and addressing concerns about the impact on family members. At this time we cannot prevent psychosis; however, following a high standard of self-care such as balanced diet, regular exercise, adequate sleep, and symptom awareness may be protective for at-risk family members. Studies have also shown that cognitive behavioral therapy can help in effective ways to cope with stress and strategies to develop healthy coping mechanisms. For individuals who are at risk of developing psychiatric diseases, therapy may be considered prior to the onset of symptoms to help develop healthy coping strategies.

 

A family history of psychiatric disorder is a risk factor for developing the disease. Risk assessment by genetic counselors is based on the presence of family history and existing information on risk estimates for psychiatric diseases. Genetic testing may be recommended in some cases when the disease may present along with other features suggestive of a genetic syndrome. Prior studies have shown that genetic counseling is effective for individuals and family members and has documented favorable outcomes for an increase in knowledge and as well improved psychological impact.

 

Genetic testing and counseling are not limited to risk assessment of mental health illness for an unaffected individual. People who have been diagnosed with psychiatric diseases can benefit from genetic testing. Pharmacogenomics is a branch of genetics that allows us to improve the selection of favorable medications by predicting responses to drugs. Individuals with a diagnosis of psychiatric illness often receive multiple medications to identify the right treatment. While some people may have a favorable response to medications, some individuals may have negative reactions to medications they receive in such a trial-and-error process. Learn more about pharmacogenomics here.

 

A genetic counselor is a specialized health care professional who has expertise in medical genetics and psychological counseling. If you would like to set up a genetic counseling appointment as you have a personal or family history psychiatric disease CALL US on 1800 102 4595 (toll-free) or 040-66986700 or WRITE TO US at info@mapmygenome.in

 


About the author

neerajaNeeraja Reddy is a board-certified genetic counselor (American Board of Genetic Counseling). She is a genetic counselor at Mapmygenome. Neeraja completed her Masters in Genetic Counseling from Brandeis University, Waltham, MA. She had earlier worked with University of Pennsylvania, Telegenetics Program.

 

 


 

Selected references

Austin, J. C., Palmer, C. G. S., Rosen-Sheidley, B., Veach, P. M., Gettig, E., & Peay, H. L. (2008). Psychiatric Disorders in Clinical Genetics II: Individualizing Recurrence Risks. Journal of Genetic Counseling, 17(1), 18–29. https://doi.org/10.1007/s10897-007-9121-4

Moldovan, R., Pintea, S., & Austin, J. (2017). The Efficacy of Genetic Counseling for Psychiatric Disorders: a Meta-Analysis. Journal of Genetic Counseling, 26(6), 1341–1347. https://doi.org/10.1007/s10897-017-0113-8

Jay Kumar Ranjan and Hari Shankar Asthana, 2017. Prevalence of Mental Disorders in India and Other South Asian Countries. Asian Journal of Epidemiology, 10: 45-53.
Math, S. B., & Srinivasaraju, R. (2010). Indian Psychiatric epidemiological studies: Learning from the past. Indian Journal of Psychiatry, 52(Suppl1), S95–S103. http://doi.org/10.4103/0019-5545.69220

Malhotra, S., & Patra, B. N. (2014). Prevalence of child and adolescent psychiatric disorders in India: a systematic review and meta-analysis. Child and Adolescent Psychiatry and Mental Health, 8(1), 22. https://doi.org/10.1186/1753-2000-8-22

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