Prevalence of PTSD Symptoms among Flood Affected Survivors: Access to Mental Health Services as Determinant

Abstract

Background: Flooding is one of the most common and devastating climate-related disasters in Pakistan, often resulting in negative psychological sequelae. One of the most prominent sequelae is post-traumatic stress disorder (PTSD), yet there is limited evidence documenting its prevalence after the floods of 2025, and especially in relation to access to mental health services.

Method: A cross-sectional survey was conducted with 200 adult flood survivors (100 from Punjab, 100 from Khyber Pakhtunkhwa KPK). Participants completed the PTSD Checklist for DSM-5 (PCL-5), with a cut-off score of ≥33 indicating probable PTSD. Access to mental health services was explored among four domains: availability, accessibility, affordability, and acceptability. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression.

Results: The proportion of participants with probable PTSD symptoms was 38.0% (n=76/200), higher in KPK (42.0%) than Punjab (34.0%), but not statistically significant (χ² = 1.52, p = .217). Displaced participants were significantly more likely to screen positive for PTSD symptoms than non-displaced (45.7% compared to 20.0%; χ² = 12.41, p < .001). In logistic regression models, being displaced was a strong predictor of PTSD (AOR = 2.10, 95% CI [1.18–3.74], p = .012). Limited availability of services (AOR = 1.89, 95% CI [1.05–3.41], p = .032), poor accessibility (AOR = 2.24, 95% CI [1.22–4.10], p = .009), and high stigma (poor acceptability) (AOR = 2.42, 95% CI [1.32–4.45], p = .004) were each associated with PTSD symptoms. There were higher odds of males and province, but the findings were not statistically significant, while affordability was approaching significance (AOR = 1.71, 95% CI [0.96–3.05], p = .067).

Conclusion: Among survivors of the Pakistan floods in 2025, PTSD symptoms were highly prevalent, with particularly strong associations with displacement and limited access to mental health services.