Psychiatric morbidity among medical clinic attendees at a tertiary care hospital in Sri Lanka during the economic crisis

Chronic physical illnesses such as diabetes and hypertension are risk factors for psychiatric morbidity among medical clinic attendees. Failure to identify psychiatric morbidity may result in a significant financial burden on the healthcare system and on individuals by increasing hospital visits and needless investigations. The Sri Lankan population has been undergoing unprecedented health, political and economic issues since 2019, potentially worsening the mental health of many individuals. This study aims to detect the prevalence of psychiatric morbidity (symptoms of anxiety, stress, and depression) among medical clinic attendees at a tertiary care hospital in Sri Lanka, and explore associated sociodemographic and medical factors. Conducted at the North Colombo Teaching Hospital in Ragama, this descriptive cross-sectional study enrolled 350 consecutive participants who provided informed consent. An interviewer-administered questionnaire collected sociodemographic and medical data, complemented by DASS-21 scale for screening depression, anxiety, and stress. Descriptive statistics were used to summarize the study population. Group comparisons were done using Chi-square tests, Fisher's exact test, and Wilcoxon rank sum test. Independent predictors associated with psychiatric morbidity were identified using binary logistic regression. Of 350 participants, 203 (58%) were females; 195 (55.7%) were aged 60 years or more. 10.0% of participants screened positive for anxiety symptoms (95%CI 6.9-13.1%), 9.7% for stress symptoms (95%CI 6.6-12.8%), and 22.6% for depression symptoms (95%CI 18.2-26.9%). Participants who screened positive for anxiety had a higher number of comorbidities (P = 0.01), as did those who screened positive for stress (P = 0.025). Participants with hypertension (P = 0.04) and asthma (P = 0.01) were more likely to screen positive for depression symptoms. Multiple variable logistic regression revealed that clinical and socioeconomic factors were independent predictors of psychiatric morbidity. The odds of anxiety and stress increased with each additional physical comorbidity (OR 1.45, 95% CI 1.09-1.96 and OR 1.51, 95% CI 1.14-2.03, respectively). Females had nearly three times higher odds of screening positive for anxiety (OR 2.83, 95% CI 1.24-7.19). Depressive symptoms were primarily associated with economic indicators; for every 1000 LKR increase in monthly medication expenditure, the odds of depression rose by 6% (OR 1.06, 95% CI 1.01-1.12). The study highlights a concerning prevalence of symptoms of anxiety, stress and depression among medical clinic attendees, particularly among those with multiple comorbidities and socio-economic challenges. There is a need for effective mechanisms to identify and address these mental health issues within this vulnerable population.