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.

Burnout, depression, anxiety, and stress are overlapping, yet distinct constructs. Mental health problems like depression and anxiety can occur as a consequence of burnout. Resilience, on the other hand, can potentially protect against burnout as well as its mental health consequences. This study aimed to explore the relationship between burnout, depression, anxiety, stress, and resilience among healthcare workers (HCWs), and to investigate the moderating role of resilience against the mental health correlates of burnout. For this purpose, using a cross-sectional design, 318 HCWs from various categories (nurses, midwives, doctors, etc.) recruited from hospital and community settings in two Districts of Sri Lanka during the COVID-19 pandemic were surveyed using the Copenhagen Burnout Inventory (CBI), Depression, Anxiety and Stress Scale (DASS-21), and the Brief Resilience Scale. CBI assessed three domains: personal burnout, work burnout and client burnout. The prevalence of personal, work, and client burnout were 26.4

The high prevalence of psychological problems observed among healthcare workers (HCWs) during the COVID-19 pandemic called for interventions to safeguard their mental health. We assessed the effectiveness of a 6-week online mindfulness-based intervention in improving well-being and reducing stress among HCWs in Sri Lanka. Eighty HCWs were recruited and randomised into two groups: waitlist-control (WLC) and intervention groups. In the intervention, 1-hour online sessions were conducted at weekly intervals and participants were encouraged to do daily home practice. Stress and well-being were measured pre- and post-intervention using the Perceived Stress Scale and WHO-5 Well-being Index, respectively. One-way analysis of covariance was used to evaluate the effectiveness, in both intention-to-treat (ITT) and complete-case (CC) analyses. A significantly greater improvement in well-being occurred in the intervention arm compared to WLC on both ITT (p = .002) and CC analyses (p < .001), with medium-to-large effect sizes (partial η2 = .117-.278). However, the reduction in stress following the intervention was not significant compared to the WLC group on both ITT (p = .636) and CC analyses (p = .262). In the intervention arm, the median number of sessions attended by participants was 3. Low adherence to the intervention may have contributed to the apparent non-significant effect on stress.

A wide range of medications are being misused by people the world over and Sri Lanka is no exception. Reasons for this misuse are manyfold. Regulatory bodies, prescribers, dispensers, as well as the general public, have significant roles to play in mitigating the misuse of prescribed medications and their harmful consequences.

When compared with other Asian countries, psychiatric education and training in Sri Lanka has made significant developments during the past two decades, such as introducing psychiatry as a separate final year subject in the undergraduate medical curricula. However, further developments in psychiatric training in medical education are needed.

Mental health legislation protects the rights of people with mental illnesses. However, despite major social, political and cultural changes, Sri Lankan mental health services still operate on laws enacted mostly during the British rule more than a century ago, in the pre-psychotropics era, and focusing more on the detention of people with mental illnesses than on their treatment. It is high time all stakeholders made efforts for the much-awaited new Mental Health Act to pass through parliament urgently to meet the needs and protect the rights of patients, their caregivers and service providers.

To the Editor, Resilience is the capacity for adaptation and “bouncing back” in the face of adversity.1,2 It protects against mental health problems such as depression, anxiety, and stress and improves well-being.3 During the COVID-19 pandemic, there was a growing need for studies on protective factors in mental health, such as resilience, particularly among healthcare workers.4 Psychometric assessment of resilience is a prerequisite for research in this area. A review of 19 resilience scales found a wide variation in their psychometric properties, with all of them posing some challenges.5 However, the authors noted that the Resilience Scale for Adults, Brief Resilience Scale (BRS), and the Connor-Davidson Resilience Scale had the finest psychometric ratings. BRS may have an exceptional place in behavioral research because other resilience scales tend to assess resources that promote resilience rather than resilience itself. BRS is probably the only measure to assess resilience in its most basic meaning—the ability to “bounce back.”2 Furthermore, among resilience scales, BRS is short and, therefore, would generate better response rates in research. As BRS was not available in local languages, its validation into Sinhalese and Tamil languages was needed to enable research on resilience in Sri Lanka.

Background: Despite being the third most prevalent psychiatric disorder, social anxiety disorder remains under-diagnosed due to multiple reasons. Although many screening instruments are available in the English language, to date no instrument has been translated into Tamil. Objective: To translate and validate the Liebowitz Social Anxiety Scale (LSAS-SR) into Tamil among a group of Sri Lankan university students whose mother tongue is Tamil. Method: The process of translation and validation involved standard procedures. DSM-5 was used as the gold standard to diagnose social anxiety disorder. As part of the psychometric study, test-retest reliability and analysis of items for internal consistency of the instrument were assessed. Results: A cut off of 55.5 had the optimum sensitivity and specificity for the Tamil version of the LSAS-SR. The Cronbach's alpha between the avoidance subscale, total and the fear subscale total was 0.860 while the figures for Cronbach's alpha between the total score and fear subscale total score and the avoidance subscale total score were 0.880 and 0.855, respectively. The test-retest reliability correlation coefficients for the fear subscale, avoidance subscale and the total score were 0.890, 0.925 and 0.918, respectively (p<0.001 for all). Conclusions: The cut off score of 55.5 had the optimum sensitivity and specificity for the LSAS-SR Tamil version. It had good internal consistency and test-retest reliability. Further studies will enable the assessment of the prevalence of social phobia and investigation of cultural and environmental factors associated with social phobia in Sri Lanka.

The Journal of the Postgraduate Institute of Medicine (JPGIM) is an open access, peer-reviewed, biannual journal published by the Postgraduate Institute of Medicine (PGIM) of the University of Colombo (UOC), Sri Lanka. The JPGIM aims to publish articles relevant to clinicians, policymakers, and researchers on topics relating to the practice of medicine, medical education, professionalism, integrity, and ethics of the research enterprise. The JPGIM has been in publication since 2014 and publishes accepted manuscripts online immediately after copy-editing, enabling rapid dissemination of scientific knowledge. The published articles are compiled into two issues in June and December.The Journal practices a double-blind peer review policy. The JPIGM does not charge any article processing or publication fee.We recommend that you review the About the Journal page for the journal's section policies, as well as the Submission Guidelines. Authors need to register with the journal prior to submitting or, if already registered, can simply log in and begin the five-step process.

Official journal of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.Interested in submitting to this journal? We recommend that you review the About the Journal page for the journal's section policies, as well as the Author Guidelines. Authors need to register with the journal prior to submitting or, if already registered, can simply log in and begin the five-step process.

Introduction Healthcare workers (HCWs) are at risk of mental health problems during a pandemic. Being stationed at the frontline or not may have implications on their mental health. Objectives The aims of this study were to assess depression, anxiety and stress among HCWs, to explore differences between frontline and non-frontline workers, and to investigate associated factors. Methods In this cross-sectional study, frontline and non-frontline HCWs were recruited from a COVID-19 screening hospital in Sri Lanka. Mental health impact was assessed using Depression, Anxiety and Stress Scale (DASS-21). Sociodemographic data and perceptions of social and occupational circumstances were gathered. Categorical variables were analyzed using Chi square and logistic regression. Odds ratios were calculated for the effect of different perceptions on psychological morbidity. Results A total of 467 HCWs participated, comprising 244 (52.2%) frontline and 223 (47.8%) non-frontline workers, with female preponderance (n=341, 77%). Prevalence of depression, anxiety and stress among HCWs were 19.5%, 20.6%, 11.8%, respectively. Non-frontline group showed a higher prevalence of depression (27% vs. 11%, p<0.001), anxiety (27% vs. 14%, p=0.001) and stress (15% vs. 8%, p=0.026). Being married, having children, living with family and higher income were associated with better psychological outcomes. Perceived lack of personal protective equipment, inadequate support from hospital authorities, greater discrimination, and lack of training to cope with the situation predicted poor mental health outcomes, and non-frontline HCWs were more likely to hold such perceptions. Conclusion Addressing factors leading to negative psychological outcomes in HCWs should be a key concern during this pandemic.

Official journal of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.Interested in submitting to this journal? We recommend that you review the About the Journal page for the journal's section policies, as well as the Author Guidelines. Authors need to register with the journal prior to submitting or, if already registered, can simply log in and begin the five-step process.

Introduction Substance abuse and dependence are common among prison populations. However, there is few data regarding this problem in Sri Lankan. Objective: To determine the prevalence of substance use disorders among inmates in a Sri Lankan prison Method: A semi- structured interviewer administered questionnaire and ICD 10 clinical diagnostic criteria were applied to 410 randomly selected male and female prisoners in minimum/medium security settings in the largest prison in Sri Lanka. Results: 75.6% (95% CI 71.2 – 79.5) of prisoners had lifetime substance use disorder while 24.4% (95% CI 20.2– 28.6) met criteria for current substance use disorder. 56.8% and 67 % of participants met criteria for lifetime alcohol and tobacco use disorders, respectively, while and 42 %and 25.6% had lifetime cannabis and opioid dependence, respectively. Factors significantly associated with lifetime substance use disorder were male gender, residence in an urban area, younger age and being unemployed or having only temporary employment. 23% of participants who met criteria for dependence were intravenous substance users. Conclusions: Services should be improved in the prison health system to minimize harm from substance use disorders.

INTRODUCTION:Post-stroke depression (PSD) is known to be associated with poor functional outcome and high mortality. There is limited data on the prevalence and associated factors of depression in the acute phase after stroke.OBJECTIVES:To determine the prevalence of PSD in the acute phase and its correlates among patients with stroke in a tertiary care hospital in Sri Lanka.METHOD:A cross sectional descriptive study was conducted among patients with stroke admitted to the stroke unit of a tertiary care hospital in Sri Lanka over a 3-year period. Demographic and clinical information was obtained using an interviewer administered questionnaire. Depression was diagnosed using the ICD-10 criteria. Group comparisons were performed using Pearson's Chi-square test and Mann-Whitney U test Multiple logistic regression was used to identify factors associated with PSD.RESULTS:Of 374 patients, 106 patients experienced moderate to severe PSD, with a prevalence of 28.3 % (95 % CI: 23.8 %-32.9 %). Of them, 54.7 % were females, 49 % were above the age of 60 years, and 79.9 % had ischemic strokes. Female gender (OR-2.77, 95 % CI: 1.46-5.07, P = 0.002), a longer duration of hypertension (OR-1.31, 95 % CI: 1.01-1.721, P = 0.004), strokes involving the temporal lobe (OR-7.25, 95 % CI: 2.81-20.25, P < 0.001) and post-stroke functional disability (OR- O.98, 95 % CI:0.97-0.99, P = 0.001) were associated with PSD on multivariate analysis.CONCLUSION:More than one fourth of the patients suffered from PSD in the acute phase of stroke. Female gender, longer history of hypertension, physical dependence and temporal lobe strokes were predictive of PSD.

Sri Lanka boasts of making significant strides in the indicators of maternal healthcare during the past few decades. However, these indicators mostly look only at the physical well-being of women. Lack of awareness regarding maternal mental health problems among grass-root level healthcare workers, poor integration of services, and the culture and stigma regarding perinatal mental disorders are barriers to improving services in maternal mental healthcare in Sri Lanka.

Ceylon Medical Journal (CMJ) is a peer-reviewed, open access journal published quarterly by the Sri Lanka Medical Association in the last week of March, June, September and December each year. The mission of the CMJ is to promote the science and art of medicine and betterment of public health. The Journal publishes original papers and commentaries which have relevance to medicine and allied sciences. The CMJ is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.

Neurological manifestations are reported only occasionally in patients with thalassaemia and are given much less prominence than the complications related to anaemia and iron overload. White matter changes (WMCs) on magnetic resonance imaging (MRI) in patients with thalassaemia were first reported two decades ago but the significance of these lesions remains unclear. We studied the neurological and cognitive manifestations in 82 older patients with thalssaemia [25 Thalassaemia major (TM), 24 thalassaemia intermedia (TI) and 33 haemaglobin E β thalassaemia (EBT)] and 80 controls, and found that headaches were more common in thalassaemia patients (50/82, 61%) than in controls (18/80, 22·5%: P < 0·001). WMCs on MRI were found in 20/82 (24·3%) patients and 2/29 (6·9%) controls had (P = 0·078). WMC were more common among those with headaches (17/50: 34%) than in those without headache (3/32; 9·3%) (P = 0·023). WMCs were not associated with reduction of cognition. Nevertheless, cognition was lower in the TI and EBT groups compared with those with TM (P = 0·002). The association of headache with WMC in thalassaemia has not been reported before and warrants further study.

Samele et al [1][1] have highlighted the implications of patient choice in psychiatry and some of its main challenges. The importance of a patient-oriented approach in psychiatry has even been emphasised in the World Health Report.[2][2] Patients seem to want more say in their treatment decisions,