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The article “Mental ill health and fitness for work” by Glozier1 focused on work related mental ill health issues and discussed various topics such as screening, safety, and legal issues. However, as work environments differ with respect to biopsychosocial factors and different levels of exposure, which are known to increase vulnerability for psychiatric disorders in workers,2 it would be better to specify the work environments while considering the prevalence of mental ill health.
Data in the article has mostly come from developed countries. It may be relevant here to give similar perspective from developing countries such as India. It would also be interesting to note similar morbidity in specific populations of industrial employees, as they are known to be more vulnerable for mental ill health.2
The available information on the prevalence of psychiatric morbidity in industrial workers shows that it is considerably higher than that in the general population.3 The reported 20–35% prevalence of psychiatric morbidity in working populations in Western countries as reported by Glozier1 is comparable with that from Indian industrial sites (14–37%).4 However, comparison would be meaningful if the working environments are similar.
The types of mental illness reported to be common in the Western countries are similar to those observed in various industrial set-ups in India.4 They are basically anxiety disorders, adjustment disorders, mood disorders (especially depression), somatoform disorders, alcohol and tobacco use, and dependence. As reported by Glozier,1 comorbidies are also commonly noted in the Indian studies. The most common comorbidities are with substance abuse disorders.
An important observation is that screening for common mental disorders is probably pointless because of the rapid change in illness status, the numbers of persons having problems may overwhelm the occupational health service, and the predictive value is low.1 In addition, different assessing instruments will give different figures. It was observed in an epidemiological survey that even if around 36.2% of employees had psychiatric problems, only 9.7% of them came for psychiatric services (Kar et al, unpublished data). It suggests that various factors influence psychiatric service utilisation, such as unawareness and stigma. Although the clinic population reflected realistically the magnitude of the felt need of the workers for mental health services, periodic screening with standardised and reliable instruments may elucidate the mental health needs of the population, based on which optimum care programmes can be planned.
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