Prevalence of common mental disorders (CMDs) in Bhutan was found to be higher, at 29.3 percent, 19 percent more than the Gross National Happiness Study, 2015 found.

This was according to a cross-sectional secondary analysis of data of the same GNH study.

The secondary data analysis by Gyambo Sithey et al published in the BMJ open, a weekly peer-reviewed medical journal in February last year, aimed to identify factors associated with symptoms of CMDs in Bhutan. BMJ open is one of the world’s oldest general medical journals.

While CMDs were a major cause of the global burden of disease, Gyambo Sithey said that CMDs affected a substantial proportion of the Bhutanese population. The study states that CMDs lead to disability and reduced work participation and productivity.

CMD, according to the World Health Organisation, is a range of anxiety and depressive disorders that impact on the mood or feelings of the affected person.

“Our estimate was higher compared with the estimate in the GNH Survey report (10.3%) because we used a lower GHQ-12 threshold score (≥12vs ≥16),” he said. “Our threshold score was selected based on findings from the Goldberg et al and the Lundin et al studies.”

He said that Bhutan was the first country in the world to focus on happiness as a state policy, but little was known about the prevalence and risk factors of CMDs in this setting. “We aim to identify socioeconomic, religious, spiritual and health factors associated with symptoms of CMDs.”

Data from the second GNH survey, conducted between January and May 2015 by the Centre for Bhutan Studies and GNH Research were analysed using a hierarchical analytical framework and generalised estimating equations.

“Our findings confirm the importance of established socio-economic risk factors for CMDs, and suggest a potential link between spiritualism and mental health,” he said.

The GNH survey surveyed 7,041 male and female respondents aged 15 years and above.

The GNH survey measured symptoms of CMDs using the embedded 12-item General Health Questionnaire (GHQ-12) which is a screening tool to detect minor psychological distress in the general population or in a non-clinical setting.

The study states that a participant was classified as having a CMD if he or she has a total GHQ-12 score of 12 or more.

The findings from this study highlight the importance of established socio-economic factors of CMDs in Bhutan and suggest that religious involvement and spirituality may be protective factors for mental health in this setting.

While older age, being female, being divorced or widowed, illiteracy, occupation, low income, poor self-reported health status and having a disability were found to be the potential risk factors for CMD in Bhutan, the study did not find any association between residence (rural and urban) and CMDs.

This, he said could be due to the massive rural to urban migration in Bhutan over the years, masking any potential association. “It could also be due to the inclusion of other markers of socioeconomic status in the model, such as income and occupation.

He said that his findings support existing evidence that social and economic factors are independently associated with CMDs.

It was found that spirituality was associated with higher GHQ-12 scores. He said that this was consistent with findings from other studies suggesting that spirituality is associated with mental health.

“Increased spirituality and belief in Karma were found to be protective factors for CMDs,” he said.

It was also found that respondents who occasionally and never considered karma in their daily lives reported higher GHQ-12 scores compared with respondents who regularly considered karma.

More than 90 percent of Bhutan’s population report that they are spiritual, according to the GNH survey.

In this setting, he said that spirituality and religious involvement may promote mental health through supportive faith-based community networks. Religious involvement was found to be associated with a better ability to cope with stress, and depression, suicide, anxiety and substance abuse.

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The limitation of the study was that data on other established risk factors of CMDs, such as alcohol, substance abuse and history of mental illness were not collected.

“Further studies are needed to understand causal pathways to CMDs and to provide evidence to support mental health policy decisions and investments,” he said.

Dechen Tshomo