Conducting a cross-sectional study examining prevalence of mental health issues in conflict-affected adults attending primary care in Northern Sri Lanka: Challenges and lessons-learned

The country of Sri Lanka underwent a Civil War from 1983-2009 which resulted in approximately half a million people displaced from their homes. The Northern Province of the country was particularly affected by the conflict. Research suggests that the experience of living in a conflict setting can affect people’s mental health resulting in depression, anxiety and post-traumatic stress disorder, among other issues. Treatment of these mental health disorders is then made more difficult in low-resource settings where there is a lack of specialised care available, such as psychiatrists and psychologists. Before this study, the prevalence of mental health disorders in post-conflict Northern Province was unknown and therefore it was unclear how many people required help. As the Northern Province has a strong primary care system, we decided to explore if people went to their GP to seek help for mental health disorders. To accomplish this, we decided to use a cross-sectional survey to take a snapshot of how many people attended primary care facilities with potential mental health disorders. We included both males and females over the age of 18 who were displaced during the conflict. We found high rates of anxiety, depression, post-traumatic stress disorder, somatoform symptoms, and psychosis with hypomania among our participants. These results indicate that there are many people attending primary care facilities who require treatment. Our findings are being used to train GPs in the region to identify and manage mental health disorders to ensure people who need help are able to access it.