Introduction

Growing interest in the gut-brain axis in the context of mental health contrasts with the implementation of microbiota-targeted interventions in routine psychiatric practice. This study assessed psychiatrists’ knowledge, attitudes, and clinical practice regarding gut microbiota, probiotics, prebiotics, and postbiotics, with particular emphasis on the gap between declared knowledge and clinical implementation.

Material and methods

A cross-sectional survey was conducted among 62 psychiatrists and/or physicians undergoing specialist training in psychiatry. The original questionnaire was organized into 19 variables covering respondent characteristics, sources of information, conceptual knowledge, beliefs, prescribing practice, barriers, and personal experience. Data were analyzed descriptively and using ordinal logistic regression, logistic regression for the knowledge-attitude-practice gap variable, and Spearman’s rank correlation.

Results

Most respondents agreed that modulation of the microbiota may be relevant to mental functioning (79.0%). However, 64.5% reported rarely recommending probiotics, prebiotics, or postbiotics, and 14.5% never recommended them. The knowledge-attitude-practice gap was present in 23 of 60 respondents with complete data (38.3%). Among respondents with higher declared knowledge and positive beliefs, 65.7% still reported low practical implementation. Longer professional experience was associated with more frequent recommendations (OR = 1.62, 95% CI: 1.11-2.40), whereas working in a day ward was associated with less frequent recommendations (OR ~0.25, 95% CI: 0.07-0.92).

Conclusions

The findings indicate an implementation gap: positive beliefs and declared conceptual knowledge did not automatically translate into clinical practice. The main barriers appear to be lack of clear clinical guidelines, difficulties in selecting appropriate products, and organizational constraints.