Practices and Attitude of General Physicians in Pakistan Regarding Post-Traumatic Stress Disorder: A Cross-Sectional Study

Abstract

Background: Mental health illnesses contribute to 7.4% of global disability-adjusted life years and make up 22.9% of years lived with disability. With the ongoing COVID-19 pandemic, the risk of post-traumatic stress disorder (PTSD) and suicide has notably increased, particularly in developing countries as individuals face tremendous economic loss and fear of poverty. Aims: To assess post-traumatic stress disorder (PTSD) screening, diagnostic, referral, and management practices of general practitioners in Karachi, Pakistan along with one-time attitudes regarding the same. Methods: 151 general physicians, from three tertiary care hospitals and several private clinics participated in this survey, in Karachi from 2017-2019. Data was collected via an adapted and pretested questionnaire. The number of general practitioners adhering to good screening, diagnostic, and referral practices has been reported along with one-time attitudes regarding PTSD management in GP care. Results: The response rate for the survey was 64% and the mean age of the participants was 38 (±10) years. 70% of physicians showed interest in mental health however, only 30% reported having any previous formal training in the subject. Good practices regarding PTSD included screening trauma patients for PTSD (57%), using DSM-5 criteria for diagnosing PTSD (13%), screening PTSD patients for risk of suicide, and prescribing SSRIs and referrals as part of management (64%, 34% respectively). It was seen that these practices differed significantly among males, females, graduates, postgraduates, and those who had formal training in mental health. The majority of the physicians (95%) are of the attitude that patients should be screened for PTSD following a recent traumatic event. Conclusion: Overall practices of general physicians in Karachi are lacking in skills concerning common mental health issues like PTSD. A positive attitude should be taken advantage of, and further skills enhancement should be considered as the next step for improvement of our general practice to decrease mental health-related morbidity.