European Journal of Cardiovascular Medicine

Mental health disorders constitute a significant proportion of the global disease burden, with an estimated 970 million people worldwide living with a mental disorder [1]. In India, the National Mental Health Survey (2015-2016) reported a lifetime prevalence of mental disorders at 13.7%, with substantial treatment gaps exceeding 80% for most psychiatric conditions [2]. The integration of mental health services within general hospital settings through consultation-liaison psychiatry has emerged as a crucial strategy to address this treatment gap, particularly in resource-constrained environments.

 

Consultation-liaison psychiatry serves as an interface between psychiatry and other medical specialties, facilitating the identification and management of psychiatric morbidity among physically ill patients [3]. Studies have demonstrated that psychiatric comorbidity is present in 20-40% of hospitalized patients, significantly impacting treatment outcomes, length of hospital stay, and healthcare costs [4]. Despite this high prevalence, referral rates to psychiatric services remain disproportionately low, particularly in developing countries where awareness regarding the psychological aspects of physical illness may be limited [5].

 

In rural India, the challenges are particularly pronounced. The shortage of trained mental health professionals, limited psychiatric infrastructure, geographical barriers, and deep-rooted social stigma associated with mental illness contribute to underdiagnosis and delayed treatment [6]. According to recent estimates, India has approximately 0.3 psychiatrists per 100,000 population, with the majority concentrated in urban areas, leaving rural populations severely underserved [7]. General hospital psychiatric units play a pivotal role in bridging this gap by enabling collaborative care models.

 

The pattern of psychiatric referrals in Indian hospitals is influenced by multiple factors, including the awareness of treating physicians regarding psychological components of illness, the perceived severity of symptoms, and the comfort level of both healthcare providers and patients in seeking psychiatric consultation [8]. Previous studies have reported that most referrals originate from medicine departments, with common reasons including deliberate self-harm, substance use disorders, and behavioral disturbances [9]. However, there remains a paucity of data from rural settings, where the epidemiological profile and healthcare-seeking behaviors may differ significantly from urban populations.

 

Recent investigations by Bhardwaj et al. (2024) in North India reported that substance use disorders and mood disorders constituted the majority of psychiatric referrals [10]. Similarly, Pingali et al. (2020) highlighted the predominance of male patients and referrals from medical departments in their tertiary care study [11]. Studies examining rural-urban disparities have documented significant differences in the quality and accessibility of inpatient psychiatric care, emphasizing the need for context-specific research [12].

 

Given the scarcity of literature on consultation-liaison psychiatry in rural Indian settings, this retrospective study was undertaken to assess the sociodemographic and diagnostic profiles, reasons, and referral patterns for psychiatric consultations in a rural tertiary care hospital in Central India. The findings are expected to provide valuable insights into hospital-based mental health service utilization and inform strategies for improving the integration of psychiatric care within general hospital settings.

Study Design and Setting This retrospective observational study was conducted at a rural medical college hospital in Maharashtra, India. The hospital serves as a tertiary care referral center catering to a predominantly rural population from surrounding districts. Study Period and Sample The study reviewed medical records of all inpatients referred to the Department of Psychiatry from various hospital departments between January 1, 2024, and June 30, 2024. The sample size included all eligible referrals during the study period matching the inclusion criteria.As this was a retrospective record based study including all eligible cases, no formal sample size calculation was performed. Inclusion and Exclusion Criteria Inclusion criteria comprised all inpatients who received formal psychiatric consultation during the study period and had complete referral and evaluation documentation. Exclusion criteria included outpatient referrals, incomplete medical records, patients who were discharged before psychiatric evaluation, and referrals where consent for evaluation was refused. Data Collection Data were collected using a semi-structured proforma designed for this study. The proforma captured the following information: (1) Sociodemographic variables including age, gender, marital status, education, occupation, and socioeconomic status (classified using Modified BG Prasad Scale for 2024); (2) Clinical details including past psychiatric history and family history of psychiatric illness; (3) Referral information including referring department, reason for referral, and time of referral; and (4) Diagnostic assessment based on clinical evaluation by consultant psychiatrists. Diagnostic Classification All psychiatric diagnoses were classified according to the International Classification of Diseases, 10th Revision (ICD-10) criteria. The diagnostic categories included: Mental and Behavioral Disorders due to Psychoactive Substance Use (F10-F19), Schizophrenia and related disorders (F20-F29), Mood disorders (F30-F39), Neurotic, stress-related and somatoform disorders (F40-F48), Behavioral syndromes associated with physiological disturbances (F50-F59), Organic mental disorders (F00-F09), and Intentional self-harm cases (X60-X84). Ethical Considerations The study was approved by the Institutional Research and Ethics Committee prior to commencement. Patient confidentiality was maintained throughout the study, and data were anonymized for analysis. Statistical Analysis Data were entered into Microsoft Excel and analyzed using SPSS version 26.0. Descriptive statistics were presented as mean ± standard deviation for continuous variables and frequencies with percentages for categorical variables. Chi-square tests were used to assess associations between categorical variables, and independent t-tests were employed where applicable for comparing continuous variables between groups. A p-value of less than 0.05 was considered statistically significant.