Introduction

Occupational mental health is an essential aspect of overall well-being, impacting individuals, broader workforce and workplace productivity. In India, as in many other countries, there is a growing recognition of the importance of mental health at work. As per S&P Global Ratings, the Indian economy, the fastest-growing among major economies, grew at 7.2% in 2022-23 and is likely to grow at 6.7% for the next three years(1). As a fast-growing economy with a diverse and rapidly changing work environment, India faces several challenges and opportunities in promoting occupational mental health. The World Health Organization suggests that the worldwide economy loses approximately 1 trillion dollars in productivity each year due to mental health issues(2). Another WHO forecast predicts economic losses related to mental health conditions to reach approximately dollar 1.03 trillion between 2012 and 2030 in India alone(3).

Characterized by rapid industrialization, urbanization, and technological advancement, occupational mental health space in fast-developing economies presents unique challenges driven by rapid economic growth, cultural factors, and changing work dynamics. Addressing these issues requires a comprehensive and culturally sensitive approach, involving governments, employers, and healthcare providers to ensure the well-being of the workforce. Occupational mental health in India is a serious issue, with a substantial body of literature highlighting wide prevalence of workplace-related stress.

Methodology:

A comprehensive review of the literature was carried out by initially searching for related studies and topics across various databases, predominantly from PubMed, Google Scholar, Scopus, and websites. The subjects covered the common occupational mental issues in the fast-developing economy countries, Occupational mental health scenario, the existing interventions and the suggested remedial/ policy measures specifically in Indian workspace. A total of 237 records were reviewed. Among these, 37 duplicate records were removed, and 138 records that didn't pertain to the study, for instance, those unrelated to mental health, occupational workers, or specific to the Indian or fast developing economy context, were excluded. Finally, the most pertinent 38 works were included in this review. It is important to note that academic work on similar lines in disadvantaged section of the workforce viz. unorganized sector is not readily available. Barring few, almost all literature in peer reviewed journals is available from more urban background, organized background or industry background. Literature on mental health issues and stress in healthcare workers is a treatise in itself and therefore has not been included in the subsequent discussion.

Fig.1: Prisma(4) Flow Diagram of the Study

The Common Mental Issues with the Fast-Developing Economies:

Work Intensity and Pressure:

Researchers have explained that the intensity of work is one of the major dimensions deciding job quality. It is sin qua non that a manageable intensity of work and emphasising its implications for physical and mental health, as well as for opportunities to have a satisfying personal and family life.(5) Fast-developing economies often witness increased work intensity and pressure due to the demands of economic growth and globalization. This can lead to high levels of stress and burnout among workers(6). For instance, in China, the concept where employees are expected to work from 9 a.m. to 9 p.m., six days a week, commonly known as "996" work culture, has garnered attention for its detrimental effects on mental health(7). The demands placed on employees to consistently excel can create excessive stress, resulting in heightened workloads, extended hours, increased anxiety, and emotional burnout. In the absence of adequate support, mental disorders and other mental health issues can have a detrimental impact on an individual's self-esteem, work performance, attendance, and their ability to secure or maintain employment. Depression and anxiety alone result in the loss of a staggering twelve billion working days annually

Employment Uncertainties:

The gig economy, where temporary roles are prevalent, and companies engage independent workers for brief projects within a free-market framework, is fast expanding phenomenon of most developing economies. As per a Boston Consulting Group report, India boasts a gig workforce of 15 million individuals, active across sectors like software, shared services, and professional services and holds the fifth position globally in flexible staffing, trailing behind only the US, China, Brazil, and Japan(8). Precarious employment, characterized by job insecurity and lack of social protections, can contribute to anxiety and depression.(9). Studies do show an impact of employment uncertainty on mental health. Job uncertainty and psychological distress goes hand in hand to affect the value or the image of the employee organisation proportionally(10).

Technostress:

Technostress was initially defined as a “modern disease of adaptation caused by an inability to cope with the new computer technologies in a healthy manner”(11,12). It is now recognised as the negative psychological relationship between people and the introduction of new technologies as a result of altered habits of work and collaboration due to the use of modern information technologies at office and home situations(8).The technostress in fast-developing economies is leading to a situation where employees feel overwhelmed by constant connectivity and information overload due to rapid adoption of technology and rapid digitalization in workspace(13). In addition due to digitization of many processes workers feel susceptible to being replaced in case of non-satisfactory work performance(14). This issue is particularly pertinent in countries like India and Brazil, which have seen a quick surge in digitalization.

Cultural Factors:

Cultural factors influence understanding, presentation, diagnosis, management, course and outcome of mental illnesses. (15). Cultural factors, such as the stigma associated with mental health issues including the sexual orientation, play a significant role in fast-developing economies. In many Asian countries, there is a reluctance to discuss mental health problems openly, which can hinder early intervention(16). Along with social stigma attached with mental health problems and their treatments, low levels of awareness and lack of support from peers hamper timely and proper help-seeking in India(17). It may come in the way of the employee with a mental health condition from seeking timely help or none at all. This can lead to further deterioration, depression, loss of self-esteem and other poorer psychosomatic health outcomes. Furthermore, this stigma of being a mental or psychological case, may lead workers to hide or ignore risks to their mental health for the fear of negative consequences in the workplace, such as differential treatment or loss of job. Cultural sensitivity is crucial when designing mental health programs.

Inadequate Occupational Health Services:

Many fast-developing economies face challenges in providing accessible and effective occupational health services. This can limit the availability of mental health support for workers(18). Strengthening healthcare infrastructure is vital for addressing mental health issues. A holistic approach or the total worker health concept for the employee wellness has occupational mental health as one of the core ingredients is still catching up in developing economies(19). Workers in these countries often have to cope-up with the workplaces that have poor overall health and safety policies, poor employer employee communications and management policies, and no or negligible mental well-being programs which may affect their mental health adversely. For numerous decades, both international and national laws have been established to safeguard the human rights of employees in the workplace. Despite this, the implementation of these policies varies and frequently falls short of being optimal. Additionally, in low- and middle-income countries—where the largest working-age population resides—there remains a persistent lag in executing or identifying appropriate interventions. Furthermore, these regions often lack sufficient policies to prevent discrimination against employees dealing with mental disorders(20,21).

The Indian Occupational Mental Health Scenario:

The prevalence of mental health issues in the Indian workforce is a growing concern. India’s workforce comprises nearly 92 per cent in the unorganised segment, with the entire farm sector falling under the informal category, while only one-fifth of the non-farm workers are found in the organised segment.(22) Numerous studies and surveys have documented the high prevalence of occupational stress and mental health issues among Indian workers. According to a study conducted by global consulting firm McKinsey, four out of every 10 working in corporate India are showing high levels of burnout, distress, anxiety, and depression(23). Literature reviews do indicate the impact of stress in the post COVID period(24). Deadlines, burdensome and demanding workloads, poor team cultures, lack of recognition, and poor job satisfaction were found to be the usual contributors. Job insecurity, poor work life balance, gender bias, poor workplace mental health services, cultural factors including stigma attached with mental illness, and peer pressure are other significant factors impacting occupational mental health in India. A cross-sectional study encompassing 35 countries, India included, reveals that approximately two-thirds of employees experiencing depression encountered discrimination either in their current workplace or during job applications (20). Table 1 presents the number of references for leading contributors to occupational mental health disorders in India. Figure 2 depicts the same in pie diagram. It may be noted that many references had listed more than one contributor.

Fig.2: Relative proportions of references of major contributors to occupational mental health disorders in Indian workplaces.

A Deloitte "Mental health in the workspace 2022" survey, with 3,995 subjects across 12 key industries and demographics found the workplace to be a top stressor, with 47 percent respondents undergoing workplace related stress(25). It also concluded that the COVID-19 pandemic heightened and introduced new mental health factors by obscuring the boundaries between work and home, posing mental health challenges such as longer work hours, the isolation associated with virtual working environment, and job security concerns. About 76% of Indian workers indicate that stress has a negative impact on work performance with 49% expressing similar sentiments about their mental health, according to a survey by ADP Research Institute(26)

Recent survey studies in India revealed that more than a quarter of Indian employees (36%) were experiencing mental health problems, and half of the sample (50%) were worried about job uncertainties(27). A study conducted by ASSOCHAM in 2015 found that 43% of employees in the private sector experienced signs of general anxiety disorder or depression.(28) A poll of 3000 corporate employees from 8 cities across India and from 10 diverse sectors that included e-commerce, FMCG & Hospitality, to name a few, showed that 8 in 10 employees had skipped work for a period of 14 days due to mental fatigue in the preceding year(29). The National Mental Health Survey of India revealed that workplace stress was a significant contributor to mental health problems, affecting both urban and rural employees(30). A study by Yardi and Adsule found sleeping disorder in a group of corporate workers (day shift) to be at 13.8%. Insomnia is a known medical comorbidity with anxiety disorders, depression and hypertension(31). Some have reported that the prevalence of anxiety disorders among Indian employees was around 21.1%, while the prevalence of depression was 13.9%. Research has emphasized the mental health challenges workers face in the informal sector in India(32,33). These findings highlight the substantial burden of mental health conditions in the workplace. Furthermore, stress and burnout are common among Indian professionals, driven by factors such as heavy workloads, job insecurity, and the pressure to meet performance target. Studies in factory workers elucidate a clear presence of multiple psychiatric morbidities including substance use. These groups also carry many associated risk factors and psychosocial factors that increases their vulnerability to poorer health outcomes.(34,35). Authors have also reported need for further research to get a complete picture of the problem.

A study by Bhagat et al. highlighted the detrimental impact of job insecurity on the mental well-being of Indian IT professionals. Several other determinants contribute to the mental health challenges faced by Indian workers.(36) Work-related stressors, inadequate work-life balance, and a lack of social support at the workplace have been identified as significant factors. The nature of employment, including precarious work arrangements and job insecurity, also plays a role in the mental health of workers. Gender disparities in the workplace also have implications for occupational mental health. Women in India often face workplace harassment and discrimination, which can lead to mental health problems. A study by Vartak et al. (2019) examined the association between workplace harassment and depression among female employees in India and found it to be a significant concern. A cross-sectional study spanning 35 countries, including India, found that approximately two-thirds of employees who experienced depression encountered discrimination either within their current workplace or during their job application processes(20).

Additionally, the stigma associated with mental health issues in India can discourage individuals from seeking help, further exacerbating the problem(34). Stigma around mental illness remains a substantial barrier to seeking help. Research by Raguram et al. explored the impact of cultural factors on mental health stigma and help-seeking behavior(37). Another study brought out an alarming statistic that stigma in India prevents nearly 80 percent of afflicted persons from receiving treatment(38,39). As per a study, however, employee silence in India has been found to be negatively related to job burnout in contrast to Western countries where employee silence was positively related to undesirable work outcomes and relationship between employee silence and job burnout was mediated by Emotional Intelligence(40).

Existing Interventions for the Occupational Mental health issues in India:

Efforts have been made to address occupational mental health issues in India. Various interventions and policies have been proposed and implemented to address mental wellness in Indian workplaces. Companies are increasingly implementing Employee Assistance Programs (EAPs) and mental health awareness campaigns. The Indian government has launched initiatives like the National Mental Health Program (NMHP) to promote mental well-being. To address the mental health needs of the Indian workforce, various interventions and policies have been proposed and implemented. Workplace stress management programs, employee assistance programs, and mental health awareness campaigns are gaining traction in the corporate sector(41,42). The Mental Healthcare Act of 2017 is a significant step forward, emphasizing the importance of mental health rights and services, including at the workplace(43). Acknowledging the pandemic's effect on individuals' mental health and overall well-being, the Indian government made it a priority by allocating investments in the 2022 Union budget to improve access to quality mental health counselling and also care services(44) However, challenges remain in the effective implementation of these policies and interventions. A study by Sagar et al. highlighted the need for a more comprehensive approach, integrating mental health into occupational health programs and ensuring accessibility to mental health services for all workers, including those in the informal sector(45).

It is also important that mental health wellbeing mechanisms are broadly aligned with the particular organization’s policies(27). More careful observations and proper feedback could help reduce the level of burnout and increase job satisfaction and mental health quality in certain professional segments(46). Prominent Indian multinational corporations have actively utilized the workplace to encourage sustainable behavioural changes for long-term mental health goals, resulting in tangible benefits for the companies, their employees, and the surrounding communities. These encompass corporate wellness initiatives, such as work-life balance strategies (like well-being-related leaves, 'no meeting Fridays' policy, etc.), wellness sessions including yoga, meditation, and stress management. Additionally, they incorporate employee assistance programs, such as outsourced counselling services, mobile application-based counselling, and a 24/7 telephone helpline. Employee well-being programs encompass provisions for physical healthcare services and mental health services. Moreover, peer support programs involve the availability of mental health advocates, peer support, and peer-to-peer counselling.(47-49) Unfortunately, there are no interventions or systemic efforts for the employees’ mental well-being in the unorganised sectors. In Government establishment the mental well-being of employees is mostly a neglected component of overall occupational health curriculum of the organisations.

It is essential to recognize that cultural factors play a substantial role in shaping the perception and management of mental health issues in India. Stigma, family expectations, and the influence of traditional healing practices can impact an individual's willingness to seek help(50) Tailored interventions that consider these cultural nuances are vital for the success of mental health programs in India. Cultural and societal factors play a significant role in shaping perceptions of mental health in India. Despite extensive global research on workplace stress, stigma, and attitudes toward individuals facing stress or mental health issues, along with the development of interventions to address these issues more effectively, this aspect remains significantly overlooked across various industries and nations, including India. However, only a small fraction of the insights gained from these studies have been put into practice(39,51).

Potential Solutions and Future Directions:

Despite research and the development of interventions aimed at addressing workplace stress, stigma, and attitudes toward employees dealing with stress or mental illness, this aspect continues to be frequently overlooked on a global scale, spanning various industries and countries, India included, and only a handful of the insights gained from these efforts are effectively put into practice(39,51). Moving forward, addressing occupational mental health in India requires a multi-faceted approach. It involves creating supportive work environments, improving access to mental health services, and raising awareness about mental health issues. Addressing these issues requires a concerted effort from various stakeholders such as employers, policymakers, and mental health professionals to create a healthier and more supportive work environment(52). A concerted approach for suicide prevention among younger workforce in consonance with the prevailing policies and programs is extremely warranted (53, 54). Biswas et al. in all in their small study population comparing government and private sector employees have noted that private sector jobs to be more stressful in following domains viz. role overload, role ambiguity, role conflict, poor participation, powerlessness, intrinsic improvement, low status and strenuous working condition(55). There has been no systematic study about the occupational workers in different occupational settings except the big corporates and to some extent the government sectors. Other sectors such as, unorganised sector which employs a very substantial percentage of total Indian workforce, the government and public sector undertakings and the small and micro, small and medium enterprises. Small and medium-sized enterprises (MSMEs) play a pivotal role in driving economic growth within today's rapidly evolving and dynamic business landscape. As these MSMEs prepare to confront forthcoming challenges, it's crucial to emphasize the importance of providing mental health support and wellness programs for their workforce(26).

Policymakers must strive to enact labour reforms that protect workers' rights, promote job security, and regulate work hours in the unorganised and private sectors. For example, China has started enforcing labour laws to address the "996" culture(56). Governments and organizations should invest in expanding mental health services, ensuring that they are accessible and affordable for all workers(18). Employers should invest in mental health awareness programs and training for managers to recognize and support employees facing mental health challenges(57). Establishing clear policies on remote work and telecommuting can help mitigate technostress and create a healthier work-life balance (58).

As cultural factors play a substantial role in management of mental wellness in Indian workplaces, mental health campaigns should be tailored to the cultural context of the region to reduce stigma and encourage help-seeking behaviour(59). Stigma, family expectations, and the influence of traditional healing practices can impact an individual's willingness to seek help.(50) Cultural sensitivity is vital when designing and implementing mental wellness programs. Awareness and information campaigns are required to enhance trust, responsibility, enrolment, and active engagement in existing programs(60). Organizational social programmes, such as outings and competitions, in addition to digital mental health apps and technology have been proposed to improve workplace mental well-being in Indian scenario.

Conclusion

India faces unique challenges in the realm of occupational mental health due to a combination of various factors that emanate from fast economic growth, rapid industrialization and digitization, fast changing employment patterns, and cultural factors. Several occupational factors contribute to mental health problems in India. Long working hours, job insecurity, lack of work-life balance, and limited access to mental health support services are commonly cited issues with job insecurity as the predominant contributor to the occupational mental health cases in India. In Indian settings another domain that cannot be disregarded is the stigma towards mental illness which affects both initial help seeking behavior and also leads to poor compliance(61). Mental wellness in Indian workplaces has been recently acknowledged as a critical aspect of employee well-being that has implications for both individuals and the broader workforce. While there has been progress in recognizing and addressing mental health concerns in the workplace, there is still much work to be done. A multi-layered approach that seeks to improve the work culture and work environment to make it more conducive for employees’ mental wellbeing, easy and unhindered access to mental health services, awareness and de-stigmatization of mental and psychological disorders can go a long way to improve the state of occupational mental health in India. This however, requires concerted and integrated efforts from all the stakeholders including the policy makers, employers, mental health professionals, psychiatrists, and the labour organizations. It is strongly recommended that sector specific comprehensive mental health surveys across unorganised, government and private sectors be conducted to ascertain the wider extent of occupational mental health in India so that necessary interventions can be designed accordingly and the corresponding policy tweaks, if required, can be worked out.

Acknowledgement

The author is grateful to Dr D.K. Aswal, Director, Health, Safety & Environment Group, Bhabha Atomic Research Centre, Mumbai for his keen interest and guidance in this work.

Competing Interests: The author declares no competing interests.

Funding: No funding was obtained for this study.

Data Availability Statement: The data that support the findings of this study are available from the corresponding author, [Vyom Saxena], upon reasonable request.

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