Prevalence and Associated Factors of Depression, Anxiety, and Stress Among Patients with Chronic Illnesses in Sri Lanka: A Study at Teaching Hospital Kalutara

Abstract

Chronic Non-communicable Diseases (NCDs) have been a significant public health problem in Sri Lanka, accounting for approximately 83% of all deaths nationally. Although the physical burden of conditions such as diabetes mellitus, hypertension, ischemic heart disease, and chronic respiratory diseases is well established, their psychological consequences remain insufficiently explored in routine clinical care. This cross-sectional study included 365 adult patients attending the medical clinic at Teaching Hospital Kalutara. The study aimed to assess the prevalence of depression, anxiety, and stress symptoms, and to identify associated sociodemographic, clinical, and psychosocial factors. Depression, anxiety, and stress were estimated using the Depression Anxiety Stress Scales-21, and a questionnaire was designed specifically to collect data on associated factors. The prevalence of anxiety, depression, and stress was 43.0%, 27.4%, and 9.3%, respectively. Age was significantly associated with all three domains (p<0.05), with younger participants exhibiting higher levels of severe depression. Gender was significantly associated with anxiety and stress (p<0.05), with males reporting higher mean scores. Lower educational attainment, unemployment, and low income were significantly associated with increased depression and anxiety (p<0.05). Clinical factors, including type of chronic illness and increased healthcare utilization, were also significantly associated with higher psychological distress (p<0.01). Economic strain and lack of social support were also significantly associated with the levels of depression, anxiety, and stress (p<0.05). The findings indicate the importance of integrating routine psychological screening and psychosocial support into chronic disease management programs in Sri Lanka.