Review of Studies of Mental Health in Bangladesh, with a Focus on Depression

Prevalence of mental disorders in South Asia: A systematic review of reviews

Mental disorders are increasing in South Asia (SA), but their epidemiological burden is under-researched. We carried out a systematic umbrella review to estimate the prevalence of mental disorders and intentional self-harm in the region. Multiple databases were searched and systematic reviews reporting the prevalence of at least one mental disorder from countries in SA were included. Review data were narratively synthesised; primary studies of common mental disorders (CMDs) among adults were identified from a selected subset of reviews and pooled. We included 124 reviews. The majority (n = 65) reported on mood disorders, followed by anxiety disorders (n = 45). High prevalence of mental disorders and intentional self-harm was found in general adult and vulnerable populations. Two reviews met our pre-defined criteria for identifying primary studies of CMDs. Meta-analysis of 25 primary studies showed a pooled prevalence of 16.0% (95% CI = 11.0-22.0%, I 2 = 99.9%) for depression, 12.0% (5.0-21.0%, I 2 = 99.9%) for anxiety, and 14.0% (10.0-19.0, I 2 = 99.9%) for both among the general adult population; pooled estimates varied by country and assessment tool used. Overall, reviews suggest high prevalence for mental disorders in SA, but evidence is limited on conditions other than CMDs.

Food insecurity, depressive symptoms, and the salience of gendered family roles during the COVID-19 pandemic in South Africa

Extensive research has indicated food insecurity to be associated with depressive symptoms, both of which have been indicated to increase globally during the COVID-19 pandemic. Few studies, however, have made use of nationally representative and longitudinal data to investigate this relationship, making causal claims difficult. In South Africa (SA), as with other low- and middle-income contexts, population-based studies have generally focused on mothers during the perinatal period and other vulnerable groups. This study made use of Cross-Lagged Dynamic Panel Models to examine the relationship between household food insecurity and the depressive symptoms of adults across three waves of the National Income Dynamics Survey–Coronavirus Rapid Mobile Survey (NIDS-CRAM) study collected in 2020 and 2021, a dataset nationally representative of all adults in SA in 2017. Stratification of the sample by gender, parenthood and marital statuses allowed for the assessment of gender differences in family roles that might account for differential impacts of food insecurity on mental health outcomes. The findings of this study indicated a significant impact of food insecurity on the depressive symptoms of adults. Controlling for stable trait-like individual differences eliminated much of this relationship, indicating partial or full mediation by unobserved factors. Gender differences in food security's association with depressive symptoms amongst cohabitating parents following the inclusion of individual effects provided support for a gendered role response. These findings provide further evidence of the complex interactions between sex, gender and health.

Depression and generalised anxiety and associated factors among adults in Bhutan: Results of national cross-sectional survey in 2019

The study aimed to evaluate the prevalence and correlates of major depressive disorder (MDD) and generalised anxiety disorder (GAD) in people 15 years in Bhutan in 2019. Cross-sectional data were analyzed from 5575 people (15-69 years) who participated in the 2019 Bhutan STEPS survey. The proportion of mild MDD was 12.3% and moderate to severe MDD 2.0%, and the prevalence of mild GAD was 7.4% and moderate to severe GAD 1.7%. In adjusted ordinal logistic regression analysis, alcohol family problem (Adjusted Odds Ratio-AOR: 2.23, 95% Confidence Interval-CI: 1.35-3.68), suicidal behaviour (AOR: 7.69, 95% CI: 3.69-6.01), passive smoking (AOR: 7.69, 95% CI: 3.69-6.01), heart attack, angina or stroke (AOR: 3.32, 95% CI: 2.13-5.79), and current tobacco use (AOR: 1.74, 95% CI: 1.38-2.19) were positively, and middle-aged (30-44 years) (AOR: 0.77, 95% CI: 0.60-1.00) and male sex (AOR: 0.47, 95% CI: 0.38-0.58) were negatively associated with mild and moderate-severe MDD. Medium wealth status (AOR: 1.82, 95% CI: 1.18, 2.82), alcohol family problem (AOR: 2.36, 95% CI: 1.29-4.31), suicidal behaviour (AOR: 6.11, 95% CI: 2.75-13.59), and heart attack, angina or stroke (AOR: 3.18, 95% CI: 1.61-6.29), were positively, and male sex (AOR: 0.59, 95% CI: 0.44-0.758) was negatively associated with mild and moderate-severe GAD. A low prevalence of mood disorders was found. Factors associated with MDD and/or GAD included sociodemographic factors (female sex, middle wealth status), psychosocial and environmental stressors (alcohol family problem, suicidal behaviour, passive smoking, heart attack, angina or stroke), and health risk behaviour (current tobacco use), which can be targeted in public health interventions.

Mental Health in Hospitalised COVID 19 Patients in Quarantine During Second Wave in a South Indian Private Teaching Hospital

BACKGROUND

Covid 19 lockdown measures were taken all of a sudden during the devastating second wave in India, when there was a considerable loss and suffering in the country. The coronavirus disease 2019 (COVID 19) pandemic has led to unprecedented hazards to mental well-being globally.

PURPOSE

To assess the prevalence and evaluate risk factors of depression, insomnia or sleep disturbances and suicidal ideation among covid 19 positive patients admitted in covid wards with mild-to-moderate disease.

MATERIALS AND METHODS

A total of 635 hospitalised patients who were covid-19 positive were requested to fill an online quality of life pre-validated questionnaire comprising of 4 sections - the sociodemographic information section, health care assessment related to depression symptoms, insomnia assessment and assessment of suicidal ideation. The survey comprised of pre-validated questions on sociodemographics, knowledge of covid 19, fear of covid 19, insomnia, feeling of sadness, depression, feeling of rejection and suicidal ideation among the covid 19 positive inpatients in quarantine due to mild or moderate covid 19 disease.

RESULTS

The prevalence of depression and insomnia or sleep disturbances after being diagnosed as covid 19 positive and hospitalized was nearly 40% and 28.8%, respectively, among the inpatients. Depression was significantly observed in female group (p < 0.001), unmarried or separated individuals (p < 0.001), housewives (p < 0.001) and patients with comorbidities (p < 0.001). Insomnia was more likely to be present in elderly covid positive patients (p < 0.001) and separated or divorced group of participants (p < 0.001). The prevalence of suicidal ideation was 5% of the total covid 19 positive patients participated in this study, and it was significantly observed among separated or divorced patients, cancer patients, patients from suburban residence and among graduates (p < 0.001).

CONCLUSION

Covid 19 is associated with major psychological impact among the patients suffering from thus warrants counselling.

Psychological Consequence of the Corona Virus Disease Pandemic in Kinshasa, Democratic Republic of the Congo. A Population-Based Cross-Sectional Survey

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic is impacting the mental health of the population, but data on its impact in developing countries are lacking. The purpose of this study is to assess the psychological aspects of the COVID-19 pandemic in the population of Kinshasa.

METHODS

This cross-sectional and analytical study included 456 randomly selected respondents in the Ngafani district of the municipality of Selembao during the period from August 1 to October 30, 2020. Socio-demographic data, and data concerning COVID-19 and its impact on mental health, were studied. Anxiety and depression were studied using the Hospital Anxiety and Depression Scale (HADS).

RESULTS

The two genders were represented in equal proportions; the patients had a mean age of 40.4±17.2 years with a high frequency of patients aged over 50 years. All had agreed to observe social distancing, but only 36.8% had accepted isolation. Using the HADS, 47.4% had a doubtful anxiety state and 23.7% had a definite anxiety state; 36.8% had a doubtful depressive state and 25% had a definite depressive state. Old age (≥50 years), female gender, lack of occupation, and isolation were independent determinants associated with anxiety and depression.

CONCLUSION

The frequency of anxiety and depression during the COVID-19 pandemic was high. Older age, female gender, lack of a profession, and isolation were associated with anxiety and depression.

The COVID-19 pandemic and serious psychological consequences in Bangladesh: A population-based nationwide study

BACKGROUND

As with other countries worldwide, lockdown measures during the COVID-19 outbreak in Bangladesh were sudden and unexpected, and have the capacity to elicit serious psychological consequences. The present study examined the psychological consequences of COVID-19 in Bangladesh during the lockdown period.

METHODS

A nationwide online cross-sectional survey study recruited 10,067 individuals covering all 64 districts in Bangladesh via social media (April 1-10, 2020). The survey comprised questions concerning socio-demographics, knowledge of COVID-19, behavior towards COVID-19, fear of COVID-19, insomnia, depression, and suicidal ideation. Logistic regression and structural equation modeling (SEM) analyses were performed to identify the risk factors depression and suicidal ideation. Geographical information system (GIS)-based spatial analysis was used to identify district-wise susceptibility to depression and suicidal ideation.

FINDINGS

The prevalence rate of depression and suicidal ideation related to COVID-19 was 33% and 5%%. Common risk factors for suicidal ideation and depression included being young, being female, being a cigarette smoker, having comorbid diseases, having high scores on the Fear COVID-19 Scale, and having insomnia symptoms. GIS-based maps detected high depression and suicidal ideation in the capital of Bangladesh and the districts near the capital as well as coastal areas where COVID-19 prevalence was high, as compared with districts with no reported cases.

LIMITATIONS

Self-reported scales and cross-sectional design of the study.

CONCLUSION

COVID-19 is associated with major psychological impact across Bangladesh, underlining the need of strategically located psychological support measures and improved access to mental health services, especially among women and younger people.

Suicidal Behavior and Flood Effects in Bangladesh: A Two-Site Interview Study

Background

Bangladeshi flood survivors are reported with such higher mental disorders that are not ever observed in any other cohorts. Although there are a few studies that assessed mental disorders, suicide or suicidal behaviors are not investigated yet. Hence, the present study for the first time investigated suicidal behaviors and its relationship with socio-demographics, flood effects and psychopathology.

Methods

A cross-sectional interview study was carried out between November and December 2019, after 4/5 months of the flood occurrence. Two completely affected villages from two districts residing in two parts of the country were randomly selected (whereas Manikganj district was less affected by the recent flood compared to Kurigram), and a total of 348 flood survivors were interviewed (45.53 ± 14.85 years). Questions related to basic socio-demographics, flood effects, psychological impacts, and suicidal behaviors were asked in the interviews.

Results

In the total sample, 57.5% of flood survivors reported having suicidal ideation, whereas 5.7% and 2.0% madea suicide plan and suicide attempt, respectively. Within two study sites, participants belonging to Kurigram reported significantly higher suicidal ideation compared to Manikganj (84.8% vs 33.2%, χ² = 94.475, p<0.001). Belonging to a lower-class family, having less education, and less earning members in the family, being affected severely by the flood, suffering from depression, anxiety, and PTSD, and experiencing financial threat, and economic hardship were suicidal behavior risk factors in the total sample.

Conclusion

Considering the present findings (ie, suicidality commensurately increases with flood effects), a multi-sectoral policy and its effective implementation should be adopted for alleviating the flood-related psychological burdens.

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Prevalence of mental disorders in South Asia: An umbrella review of systematic reviews and meta-analyses

Mental disorders are highly prevalent in eight South Asian countries, yet there is a gap of a synthesized overview of the prevalence of mental disorders in this region. This umbrella review aims to summarize the prevalence of mental disorders from systematic reviews and meta-analyses of South Asian studies. A systematic search of 11 major databases and additional sources was conducted until December 11, 2019. Articles were included if they were systematic reviews or meta-analyses, reported the prevalence of mental disorders, and reported primary studies conducted in South Asian countries only. Among 2591 citations, a total of 23 reviews met all the criteria of this umbrella review. The synthesized findings from those reviews suggest high prevalence rates for mental disorders, including depressive disorders, anxiety disorders, mood disorders, suicidal behavior and self-harm, schizophrenia, substance use disorders, neurodevelopmental disorders, dementia, and other mental health problems. Also, findings suggest a high burden of maternal depression, psychiatric comorbidities in chronic physical illnesses, and various mental disorders among children, elderly adults, refugees, and other vulnerable populations. Most studies were from India whereas evidence from Afghanistan, Bhutan, and Maldives was limited. The findings of this review are constrained with heterogeneity in prevalence estimations, methodologies, sampling issues, and limitations in the existing literature, which should be addressed in future research. The evidence synthesized in this review provides national and regional overview of the prevalence of mental disorders, which may inform better policymaking and practice advancing mental health in South Asia.

Associations of intimate partner violence with screening for mental health disorders among women in urban Bangladesh

OBJECTIVES

We examined the association between intimate partner violence (IPV) and screening for depression in Bangladesh, a country with high prevalence of IPV and lack of data, awareness and provider infrastructure for mental illness.

METHODS

We used data from a representative sample of 11,202 women from the 2006 Bangladesh Urban Health Survey. Elements of social learning theory were used to examine the association. Additionally, we examined the interaction effect of experiencing IPV and justification of IPV on screening for mental health disorders.

RESULTS

Results indicate that women who experienced IPV were significantly more likely to be screened for mental health disorders (AOR = 2.09; 95% CI = 1.86-2.34). However, the direction of this association is reversed for women who justify various forms of IPV to varying degrees.

CONCLUSIONS

These findings reflect the importance of how women's perception of violence may influence their mental health. Our results indicate a counter-intuitive association, given that we found that women's justification of IPV is adaptive for them in terms of preventing symptoms of mental health problems and have potential to inform future public health policy and research.

Experiencing Lifetime Domestic Violence: Associations with Mental Health and Stress among Pregnant Women in Rural Bangladesh: The MINIMat Randomized Trial

Background

Experience of domestic violence has negative mental health consequences for women. The association of cumulative and specific forms of domestic violence, particularly emotional violence and controlling behavior, with common mental disorders and stress has rarely been studied in pregnant women. The aim of this study is to evaluate associations of specific and multiple forms of lifetime domestic violence and controlling behavior with distress and cortisol level during pregnancy in rural Bangladeshi women.

Methods and findings

In this observational sub-study of larger MINIMat trial, 3504 pregnant women were interviewed using a shortened Conflict Tactic Scale about their lifetime experience of domestic violence including physical, sexual, emotional domestic violence and controlling behavior. Women’s levels of emotional distress were assessed using the self-reported questionnaire (SRQ-20) developed by WHO, and levels of morning salivary cortisol were measured in a subsample (n = 1300) of women during week 28–32 of pregnancy. Regression analyses were used to estimate the associations of lifetime physical, sexual, emotional domestic violence and controlling behavior with levels of distress and cortisol during pregnancy. The prevalence of lifetime domestic violence was 57% and emotional distress was 35% in these pregnant women. All forms of domestic violence were associated with higher levels of emotional distress. Women who experienced either emotional violence or controlling behavior had the highest levels of emotional distress. There was a dose-response relationship between cumulative number of the different forms of domestic violence and women’s levels of emotional distress. There was no association between women’s experience of domestic violence and level of morning salivary cortisol.

Conclusion

Including emotional violence and controlling behavior as major types of violence in future research and health interventions is warranted. Furthermore, the extent of the negative impacts of domestic violence on pregnant women, multiple forms of violence and their cumulative effects need to be investigated.