Psychiatric Morbidity Among Medical Clinic Attendees at a Tertiary Care Hospital in Sri Lanka During the Economic Crisis

Background Chronic physical illnesses such as diabetes and hypertension are risk factors for psychiatric morbidity among medical clinic attendees. Failure to identify psychiatric morbidity results 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 (depression, anxiety, and stress) among medical clinic attendees at a tertiary care hospital in Sri Lanka, and explore associated sociodemographic and medical factors. Methods Conducted at the North Colombo Teaching Hospital, Ragama, this descriptive cross-sectional study involved 350 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. Data analysis was performed using SPSS, employing descriptive statistics, Chi-square tests, and Pearson correlation. Results Of 350 participants 203 (58%) were females; 195 (55.7%) were aged 60 years or more. Anxiety was present in 10.0%(95%CI:6.9%-13.1%), depression in 22.6%(95%CI:18.2%-26.9%) and stress in 9.7%(95%CI:6.6%-12.8%). Patients with anxiety had a higher number of comorbidities than those without (P=0.011), as did patients with stress (P=0.038). Patients with hypertension were more likely to have depression than those without (26% vs 17%, P=0.041). Participants with anxiety and depression were likely to have higher monthly expenses for medications and to be on medications for psychiatric illnesses. Those with inadequate income, not living in their own house and unable to pay debts were likely to have depression. For every additional comorbidity, odds ratio (OR) of having anxiety increased by 1.45(95%CI:1.09–1.96). Females had OR of having anxiety 2.83(95%CI:1.24-7.19). For every additional comorbidity, OR of having stress increased by 1.51(95%CI:1.14–2.03). For every Rs.1000 increase in monthly expenditure, OR of having depression increased by 1.06(95%CI:1.01–1.12). Conclusion The study highlights a concerning prevalence of psychiatric disorders among medical clinic attendees, particularly among those with multiple comorbidities and socio-economic challenges. There is an urgent need for effective mechanisms to identify and address these mental health issues within this vulnerable population.