Prevalence of depressive and anxiety symptoms and their sociodemographic correlates among adult clinical population in Pakistan

Abstract

Background Depression and anxiety contribute substantially to the mental health burden in low- and middle-income countries, yet clinic-based evidence from Pakistan remains limited. This study examined the distribution of depressive and anxiety symptom severity and their sociodemographic correlates in outpatient mental health clinics in Pakistan. Methods This cross-sectional study included 267 participants recruited through consecutive sampling from four urban outpatient mental health clinics in Pakistan. Depression and anxiety were assessed using Hamilton Depression Rating Scale-17 and Generalized Anxiety Disorder Scale-7, respectively. Symptom severity was categorized as low, moderate, and high based on cut-offs (HDRS-17: 0–13, 14–26, ≥27; GAD-7: 0–9, 10–14, ≥15). Sociodemographic correlates included gender, age, marital status, educational attainment, employment status, and socioeconomic status. Multinomial logistic regression was used to estimate adjusted associations. Results Moderate-to-high symptom severity was common for both depression and anxiety. For depression, 64.8% of participants had high depressive symptom severity and 22.3% had moderate symptom severity. For anxiety, 32.6% had high anxiety symptom severity and 30.3% had moderate symptom severity. In adjusted analyses, unemployment was significantly associated with higher depression severity (OR=2.55, 95% CI: 1.23–5.29). Low socioeconomic status was associated with moderate anxiety severity (OR=6.08, 95% CI: 1.97–8.75), while middle socioeconomic status was associated with higher anxiety severity (OR=6.11, 95% CI: 2.79–13.23). Gender, age, marital status, and education showed no consistent adjusted associations. Conclusion This study extends clinic-based mental health evidence from Pakistan by showing that depressive and anxiety symptom severity is strongly patterned by socioeconomic disadvantage. The findings shift attention from individual symptom burden alone to the broader social conditions shaping clinical mental health presentations.