Universal screening for depression at the primary healthcare level could result in significant public health benefits and economic savings for India, according to a new modelling study published in The Lancet Regional Health – Southeast Asia.
The study examined the feasibility and cost-effectiveness of integrating population-based depression screening into India’s comprehensive primary healthcare system, in line with the Centre’s proposal to introduce routine screening at Ayushman Arogya Mandirs.
Conducted jointly by researchers from the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, NIMHANS in Bengaluru, and the National Health Systems Resource Centre, the study was funded by the Union Department of Health Research.
The researchers compared universal screening of adults aged 30 and above and an expanded option covering those aged 20 and above with the current practice of diagnosing only symptomatic individuals.
Two-step screening
The analysis found that a two-step assessment approach using depression screening tools (PHQ-2 and PHQ-9) could reduce the annual prevalence of depression by 2.4% and incidence by 5.1% among adults aged 30 and above. Screening individuals aged 20 and above was associated with greater health gains and improved cost-effectiveness.
Girish N. Rao, professor of Epidemiology at NIMHANS and one of the authors, said this was the first such study in India to quantify the economic and health impact of depression screening using modelling techniques.
“Until now, discussions around depression have largely been qualitative. This study demonstrates that the tools to address depression already exist and shows how they can be systematically applied within the healthcare system,” he told The Hindu.
Dr. Rao said depression contributes significantly to social and economic losses, including suicide risk. “Nearly half of suicide risk is linked to mental health disorders, particularly depression. Untreated depression also worsens outcomes in chronic conditions such as diabetes, where adherence to medication and lifestyle advice is often poor,” he said.
He underscored the importance of integrating mental health screening into routine care. “Most patients first present at primary healthcare facilities. Screening for depression whenever individuals seek care would be more effective than waiting for severe symptoms to develop,” he said.
Data from many sources
The study drew up data from multiple national sources, including the National Mental Health Survey and the National Sample Survey, along with quality-of-life data, to model outcomes under routine care versus systematic screening.
The findings show that gains in quality-adjusted life years (QALYs) per person ranged from 0.0273 to 0.0295, while the intervention could avert between 12,826 and 18,340 deaths over a lifetime horizon.
From a societal perspective, the programme is projected to generate savings of ₹291 billion to ₹482 billion- equivalent to 0.19% to 0.32% of India’s GDP- largely due to reduced productivity losses. Both screening strategies were found to be cost-effective.
The study also found that the programme becomes cost-saving from the health system’s perspective if at least 60% of patients identified through screening seek care in public health facilities.
The authors cautioned that benefits depend on maintaining diagnostic accuracy and adequate training of frontline health workers. The study also noted that individuals aged 20 to 29, currently outside universal screening frameworks, stand to benefit significantly.
Published – December 27, 2025 09:17 pm IST
