Mental health disorders are a significant public health concern globally, contributing substantially to the overall burden of disease. Psychiatric morbidity, encompassing a wide range of mental disorders, has become increasingly recognized as a critical aspect of health care requiring systematic attention (1). Despite growing awareness and advancements in psychiatric care, disparities in access, awareness, and cultural perceptions of mental health continue to shape patterns of psychiatric morbidity, particularly in resource-limited settings such as Kashmir (2, 3).

Kashmir, located in the northernmost region of India, has long been marked by socio-political instability, natural disasters, and limited health infrastructure, all of which contribute to a high prevalence of mental health issues. The region’s unique sociocultural and geopolitical context has compounded the psychological burden among its population. Reports from international and national agencies suggest elevated rates of anxiety, depression, post-traumatic stress disorder, and other psychiatric conditions in Kashmir (4, 5). These findings highlight the need for region-specific studies to understand the nature and extent of psychiatric morbidity in this population. However, comprehensive research on this topic remains sparse, especially in clinical settings (6).

Psychiatry outpatient departments (OPDs) often serve as the primary point of contact for individuals seeking mental health care in resource-constrained regions like Kashmir. They provide a unique opportunity to assess the prevalence and pattern of psychiatric disorders in individuals presenting with mental health concerns. Understanding these patterns is crucial for developing targeted interventions, optimizing resource allocation, and tailoring treatment protocols to address the specific needs of the population.

Studies conducted in other parts of India have demonstrated diverse patterns of psychiatric morbidity, with common diagnoses including mood disorders, anxiety disorders, psychotic disorders, substance use disorders, and somatoform disorders (7, 8). However, the prevalence and presentation of these conditions can vary significantly depending on the demographic, cultural, and environmental factors unique to a region. For instance, sociocultural beliefs, stigma, and access to care play pivotal roles in shaping help-seeking behaviour and the clinical presentation of psychiatric disorders (9, 10).

In Kashmir, these factors are further influenced by prolonged exposure to stressors such as armed conflict, forced migration, unemployment, poverty, and frequent natural calamities like floods and earthquakes. These adversities have not only heightened the risk of developing psychiatric conditions but have also perpetuated barriers to seeking timely and adequate care. Moreover, the stigma associated with mental illness and a lack of awareness about available services often delay treatment, leading to chronicity and increased morbidity.

This study aims to address the existing gap in knowledge by examining the pattern of psychiatric morbidity among patients attending the psychiatry outpatient department of a government medical college in Kashmir.

This cross-sectional study approached 1430 patients out of whom 933 consented to participate. Thus, data of 933 patients attending over a period of 6 months to the Psychiatry Outpatient Department (OPD) at Government Medical College, Anantnag, Kashmir was analysed on the sociodemographic, occupational, and clinical characteristics.

The mean age of participants was 32.9 years (SD = 17.6), with a majority being female (61.3%) compared to males (38.7%). Most participants were married (55.3%), while 44.3% were unmarried, and a minority (0.4%) were divorced or separated. 36.7% of participants had completed secondary education, and 21.4% were graduates, however 18.2% were illiterate. Participants from Nuclear families predominated over joint families (62.6% vs 37.4%) (Table 1).

The most frequent occupation among participants was homemaking (37.9%), followed by students (30.3%). Other occupations included business (5.1%), labour (5%), and self-employment (3.8%). Professionals and teachers constituted 1.5% and 1.2% of the sample, respectively, reflecting limited professional engagement among patients. The prevalence of unemployment in the sample was 5.1% (Table 2).

Major depressive disorder (MDD; 23.7%) was the most prevalent observed condition, followed by obsessive-compulsive disorder (OCD), affecting 19.3% of patients, and bipolar affective disorder (BPAD; 10.5%). Panic disorder, vascular headache, and personality disorders each accounted for 5.4% of cases. Schizophrenia was diagnosed in 2.6% of participants, while PTSD and acute stress reaction affected 0.8% each. Notably, anxiety-related disorders (generalized anxiety, phobic anxiety, and panic disorder) collectively constituted a significant portion of diagnoses. Substance use disorder, intellectual disability, and dementia also emerged as notable concerns, albeit with lower prevalence (Table 3).

Females were disproportionately affected by OCD (19.9% vs. 18.3% for males) and major depressive episodes (15.4% vs. 11.4% for males). Conversely, BPAD, panic disorders and dementia were more prevalent among males. Statistically significant associations were found between gender and certain diagnoses, such as acute stress reactions and PTSD (p < 0.001) (Table 4).

The mean age of participants varied significantly by diagnosis. Acute stress reactions and phobic anxiety disorders were more prevalent among younger patients, with mean ages of 33.4 and 33.6 years, respectively. Older age groups exhibited higher rates of dementia (mean age = 65.8 years) and mild cognitive impairment (mean age = 57.5 years). Mood disorders such as MDD and BPAD were observed across a broader age spectrum, reflecting their pervasive nature (Table 5).

Significant associations were noted between sociodemographic variables and psychiatric diagnoses. For example, younger participants were more likely to present with anxiety disorders, while older individuals demonstrated higher rates of neurocognitive disorders. Gender differences in the prevalence of OCD, depression, and PTSD underline the need for gender-sensitive mental health interventions (Tables 4 and 5).

The study offers significant insights into the patterns of psychiatric morbidity in the Kashmir region, highlighting the profound impact of socio-political instability, cultural stigma, and inadequate healthcare infrastructure on mental health. In the present study, major depressive disorder (MDD, 23.7%), followed by obsessive-compulsive disorder (OCD) emerged as the most prevalent diagnosis (19.3%), bipolar affective disorder (BPAD; 10.5%). Major depressive disorder has been widely reported to be one of the most prevalent conditions among patients of psychiatry in the Kashmiri population (11, 12). However, where the present study stands out is in the observation of a prevalence of OCD which is higher than that reported in these studies. A probable cause for this might be the fact that while the other studies on the topic assessed general patient population, the present study assessed only patients presenting to the psychiatry department with apparent symptoms of psychiatric disorders. These observations indicate that symptoms of OCD are distressing enough to warrant a visit to the hospital for treatment, much more so than other psychiatric disorders. In the present study, anxiety disorders, including generalized anxiety disorder, panic disorder and phobic anxiety disorder made up 8.7% of the diagnoses, similar to that reported by authors like Bailam et al. and Wani et al., pointing to generally higher levels of stress experienced by the population living in this region, which has historically seen much socio-political turmoil (2, 13).

Sociodemographic factors such as education, occupation, and family structure showed important insights into the profile of the patients presenting to the study institution. The high prevalence of mental health issues among homemakers and students reflects the dual burden of academic/household responsibilities and limited social support networks (14, 15). This finding aligns with regional studies reporting similar trends in populations facing economic and educational disparities (16, 17). Furthermore, the predominance of nuclear families among participants (62.6%) suggests a potential erosion of traditional support systems, which has been identified as a key determinant of mental health (18). The study also highlights the underrepresentation of certain groups, such as professionals and skilled workers, which may point to barriers in accessing mental health care, including stigma and lack of awareness (19, 20).

On assessment of risk factors for psychiatric morbidities, the study revealed significant gender disparities in psychiatric diagnoses. Females were disproportionately affected by OCD and major depressive episodes, a trend observed globally where women exhibit higher vulnerability to affective disorders due to both biological and sociocultural factors (21, 22). In contrast, panic disorders and dementia were more prevalent among males, which could be linked to differences in help-seeking behaviour or exposure to specific stressors like substance abuse and occupational hazards (23).

Age also played a crucial role in the distribution of diagnoses. Anxiety-related disorders were more common in younger individuals, while neurocognitive disorders like dementia were prevalent among older participants (24, 25). This pattern underscores the need for age-specific mental health interventions, as suggested by studies emphasizing developmental and life-course perspectives in psychiatric care (26, 27). The broad age spectrum for mood disorders, such as major depressive disorder, further highlights their pervasive impact across different life stages.

This study provides a crucial foundation for understanding psychiatric morbidity in Kashmir, emphasizing the urgent need for targeted interventions to mitigate the region’s mental health crisis. Policymakers and healthcare providers must prioritize culturally adapted, gender- and age-specific strategies to address the diverse mental health needs of this vulnerable population.