Pakistan is the most urban country in South Asia, and its urban population is growing at an alarming average annual rate of over 4 per cent. Major cities such as Karachi, Lahore, and Faisalabad are located within the Indus Basin and are growing rapidly. This urban growth is accompanied by undesirable impacts on both ecological and socioeconomic systems.

Urban growth in the Indus Basin is largely a result of rural-urban migration of people for improving their livelihood. This mass movement of people has a profound effect on the characteristics of the epidemiological disease profile. Besides the impacts of congestion and overcrowding, noise, and environmental pollution, the more obvious ill effect of rapid urbanisation is emotional stress which has far-reaching socioeconomic implications. As such, among the many manifestations of urban decay in these cities is the high prevalence of mental disorders among citizens.

Research has shown that many symptoms of morbidity such as headaches and lethargy are in fact caused by psychological stress, which has far-reaching socioeconomic implications at both individual and community levels. This presentation reviews this aspect of the Indus Basin in light of the results of our own study in the city of Lahore which showed that the citizens of all socioeconomic groups in Lahore were disturbed by numerous urban annoyances associated with congestion and environmental degradation, and those disturbed were also depressed, had low self-esteem, low resilience, and an external locus of control. Depression was strongly affected by education, population density, and household congestion. Consistent with similar studies in other parts of the world, our results showed that the degraded urban environment causes psychological morbidity as reflected in the prevalence of depression, loss of self-esteem, and low resilience.

Globally, the annual cost of psychological morbidity has been estimated into billions of dollars. In Pakistan, direct and indirect per capita costs of morbidity relating to mental disorders in urban population have been estimated to be more than 3,000 Pak Rupees per month, which amounts to a loss of approximately 20 days of work by an agricultural worker. This presentation, therefore, argues that there is an urgent need for strategic planning in urban centres of the Indus Basin aimed at checking the unbridled urban growth, improving civic services, and ensuring better mental health of citizens in urban areas.