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The recent COVID-19 pandemic has imposed threats on both physical and mental health since its outbreak. This study aimed to explore the impact of the COVID-19 pandemic on mental health among a representative sample of home-quarantined Bangladeshi adults. A cross-sectional design was used with an online survey completed by a convenience sample recruited via social media. A total of 1,427 respondents were recruited, and their mental health was assessed by the DASS-21 measure. The prevalence of anxiety symptoms and depressive symptoms was 33.7% and 57.9%, respectively, and 59.7% reported mild to extremely severe levels of stress. Perceptions that the pandemic disrupted life events, affected mental health, jobs, the economy and education, predictions of a worsening situation, and uncertainty of the health care system capacities were significantly associated with poor mental health outcomes. Multivariate logistic regressions showed that sociodemographic factors and perceptions of COVID-19 significantly predict mental health outcomes. These findings warrant the consideration of easily accessible lowintensity mental health interventions during and beyond this pandemic.
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Accepted by: International Journal of Environmental Health Research
Link: https://www.tandfonline.com/doi/full/10.1080/09603123.2020.1802409
The impact of the COVID-19 pandemic on the mental health of the adult population in
Bangladesh: A nationwide cross-sectional study
Md. Hasan Al Banna1#, Abu Sayeed2#*, Satyajit Kundu#3, Enryka Christopher4, M. Tasdik Hasan5,
Musammet Rasheda Begum6, Tapos Kormoker7, Shekh Tanjina Islam Dola2, Md. Mehedi Hassan8,
Sukanta Chowdhury9, Md Shafiqul Islam Khan1
1Department of Food Microbiology, Patuakhali Science and Technology University, Patuakhali- 8602,
Bangladesh.
2Department of Post-Harvest Technology and Marketing, Patuakhali Science and Technology University,
Patuakhali- 8602, Bangladesh.
3Department of Biochemistry and Food Analysis, Patuakhali Science and Technology University,
Patuakhali - 8602, Bangladesh.
4Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, United
States.
5Department of Psychological Sciences, University of Liverpool, United Kingdom.
6Department of Agricultural Economics and Social Sciences, Chattogram Veterinary and Animal Sciences
University, Chattogram-4225, Bangladesh.
7Department of Emergency Management, Patuakhali Science and Technology University, Dumki,
Patuakhali-8602, Bangladesh
8Faculty of Nutrition & Food Science, Patuakhali Science and Technology University, Patuakhali- 8602,
Bangladesh.9
9Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,
B), Dhaka 1212, Bangladesh.
#These three authors have equal contribution
*Corresponding author:
Abu Sayeed,
Department of Post-Harvest Technology and Marketing, Patuakhali Science and Technology University,
Patuakhali- 8602, Bangladesh.
Mail address: shuvo.nfs.pstu@gmail.com
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Abstract
The recent COVID-19 pandemic has imposed threats on both physical and mental health since its
outbreak. This study aims to explore the impact of the COVID-19 pandemic on mental health
among a representative sample of home-quarantined Bangladeshi adults. A cross-sectional design
was used with an online survey completed by a convenience sample recruited via social media. A
total of 1,427 respondents were recruited, and their mental health was assessed by the DASS-21
measure. The prevalence of anxiety symptoms and depressive symptoms were 33.7% and 57.9%,
respectively, and 59.7% reported mild to extremely severe levels of stress. Perceptions that the
pandemic disrupted life events, affected mental health, jobs, the economy and education,
predictions of a worsening situation, and uncertainty of the health care system capacities were
significantly associated with poor mental health outcomes. Multivariate logistic regressions
showed that sociodemographic factors and perceptions of COVID-19 significantly predict mental
health outcomes. These findings warrant the consideration of easily accessible low-intensity
mental health interventions during and beyond this pandemic.
Keywords: Home-quarantine, perceptions, DASS-21, mental health, COVID-19, Bangladesh
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Introduction
Former infectious disease outbreaks have significantly affected individuals’ mental health along
with the expected physical health outcomes (Lau et al. 2010). The novel coronavirus disease
(COVID-19) is by far the most concerning outbreak of atypical pneumonia since the far less
detrimental 2003 outbreak of severe acute respiratory syndrome (SARS) (Hawryluck et al. 2004).
The COVID-19 pandemic has been declared an international public health emergency by the
World Health Organization (WHO) (WHO 2020a). As of July 1st 2020, the COVID-19 pandemic
has infected over ten million people across the world, causing more than 5,00,000 deaths (WHO
2020b). Experts are still uncertain of the trajectory of the COVID-19 pandemic, the projected
number of cases and deaths, or to what extent quarantine measures will disrupt daily life (Zandifar
& Badrfam 2020). The unpredictable nature of this situation and uncertainty regarding COVID-
19 can often trigger psychological distress and mental illness, including depression, anxiety, and
traumatic stress (Cheung et al. 2008; Bao et al. 2020; Zandifar & Badrfam 2020). A recent survey
by the Indian Psychiatric Society shows a twenty percent increase in mental illnesses since the
coronavirus outbreak in India (Loiwal 2020).
The COVID-19 situation in Bangladesh is worsening day by day. The Government of Bangladesh
closed all educational institutions and both public and private offices on March 16th 2020 in an
effort to contain the outbreak. Public gatherings were also banned (WHO 2020c), and travel from
countries with high transmission risk, such as China, Iran, and Italy, was suspended (Anadolu
2020). Despite these efforts, COVID-19 has reached all 64 administrative districts in Bangladesh
by July 1st 2020, causing over 145,000 cases and 1,874 deaths thus far (IEDCR 2020). High
population density, poor personal hygiene practices, and poor economic conditions make the
majority of the Bangladeshi population particularly vulnerable to this virus. Fear of becoming sick,
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the isolation of lockdown, the financial necessity to work, and the inability to avoid venturing out
in public for essential items such as food may increase psychiatric problems within the general
population. Recent publications suggest mental health during the COVID-19 pandemic is
associated with gender, socioeconomic status, occupation, having COVID-19-like symptoms,
perceptions of COVID-19 impacts, interpersonal conflicts, social media use, and social support
(Mowbray 2020; Wang et al. 2020a). Older adults and individuals with low incomes are at
increased risk for poor mental health (Holmes et al. 2020).
There is no information yet on mental health associations with or during this COVID-19 pandemic
in the general population of Bangladesh. Exploratory studies of mental health conditions and
associated factors during this time is essential to mitigate future negative mental health outcomes.
We hypothesize that the prevalence of mental health distress is high among Bangladeshi residents
during this pandemic. This study estimates the prevalence of and identifies the risk factors for
depressive and anxiety symptoms during the COVID-19 pandemic among the adult population in
Bangladesh. Symptoms of psychological stress are also explored in a similar manner.
Methods
Setting and participants
A prospective cross-sectional web-based survey was conducted to assess the psychological
response of the general population from April 29th to May 7th 2020, about one month after the start
of lockdown measures enacted by the government. As a community-based national sampling
survey during this time was not feasible, data was collected online. The authors distributed the
survey link in all divisions of Bangladesh via social media using snowball sampling. Considering
the limited number of studies on the topic, a 50% response rate, 5% significance level, and 2.5%
margin of error was used to calculate the needed sample size of 1,315 to achieve 80% power. Data
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was ultimately collected from 1,427 participants. All were included in analyses to obtain more
precise results. Eligibility criteria included the ability to read Bangla and residence in Bangladesh
for the duration of the government mandated lockdown. Participants were predominantly (99.1%)
18 years of age and older, although age was not an exclusion criterion. Each division constituted
10.5-16% of the entire sample, except for the Sylhet division (6.3%), which was lower.
Procedures
An anonymous online questionnaire was developed using WHO materials on COVID-19
pandemic-related mental health to gather data from respondents (WHO 2020d). The research team
collaborated on reviewing the literature provided in the WHO materials, decided on the framework
of the questionnaire, and drafted individual questions through an iterative process of discussion
and editing. The initial survey was written in English and then translated into Bangla by a
researcher fluent in both languages. The survey was piloted with a small online user group to test
its clarity. The survey included a short overview of the study context, purpose, procedures,
confidentiality agreement, and informed consent. Clicking on the survey link directed the
participants first to the study overview and informed consent. Demographic information was
required in order to begin the survey, after which a series of survey questions appeared.
Survey contents
The survey consisted of 37-close ended queries, which took about 7-8 minutes in total to complete.
The survey was split into three sections: participant characteristics (10 items), perceptions
regarding COVID-19 (6 items), and mental health (21 items). Sociodemographic data were
collected on age, gender, educational status, occupation, location of residence, marital status,
monthly income, religion, family size, number of children, and elderly persons residing in the
household. Demographic questions were simple and straightforward with options to choose for
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answers, such as “Does someone over the age of 50 currently reside in your household?” with
answer options “yes” and “no”.
The second section included questions on the pandemic’s disruption to daily life, the level of
negative impacts the current lockdown is having on mental health, the perceived capacity of health
care facilities, beliefs on the trajectory of the outbreak, job, income, and educational impacts, and
the level of perceived impact the pandemic has on the mental health of those with chronic physical
health conditions (such as distress stemming from limited access to medications, getting to
hospitals for treatment, availability of doctors, etc.). An example of a question from this second
section is, Do you think COVID-19 will have a negative impact on the mental health of those
with existing health conditions?” with answer options of “yes,” “no,” and “somewhat”.
A validated Bangla version of the Depression, Anxiety, and Stress Scale (DASS-21) was used to
measure the mental health of participants (Le et al. 2019; Alim et al. 2014). The DASS-21 contains
three self-report scales with a total of 21-items designed to assess the negative domains of
depressive symptoms, anxiety symptoms, and stress levels (Lovibond & Lovibond 1995). Likert
scale scores range from 0 (item does not apply at all) to 3 (item applies strongly) for occurrences
over the last week. The DASS has proven to be reliable and relevant for assessing mental health
in the Bangladeshi population (Alim et al. 2015; Sadiq et al. 2019). The DASS-21 has been used
for assessing the psychological impacts of COVID-19 in several studies, and thus was deemed
most appropriate for use in the current study (Kazmi et al. 2020; Wang et al. 2020a; Wang et al.
2020b). The Cronbach’s alpha coefficient of the DASS-21 was 0.92, indicating acceptable internal
consistency (Taber 2018). Prior to this, the DASS was also used in SARS research (McAlonan et
al. 2007).
Statistical analysis
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Descriptive statistics were conducted for all covariates and survey responses. Chi-square tests
assessed the associations of sociodemographic variables and perceptions of COVID-19 with stress
level, anxiety symptom, and depressive symptom scores. Multivariate logistic regression models
were applied to determine possible associations between independent variables and mental health
outcomes. The final model was selected using a backward selection procedure and lower Akaike
information criteria (AIC) value. Coefficients were found significant by Wald tests. The lack of fit
of the model was checked by the Hosmer-Lemeshow test. The results are described using odds
ratio (OR) and 95% confidence interval (CI). SAS version 9.3 was used for all analyses, with a 5%
level of significance for a two-tailed test.
Results
A total of 1,427 participants completed the online survey. The mean age of respondents was 25.75
years (SD: 6.75). The majority were male (71.5%), 24-39 years old (48.6%), unmarried (66.9%),
and Muslim (75.4%). Many participants (59%) completed an undergraduate education, 43.7%
were students, and 42.2% were employed. Almost half (47.3%) of respondents’ monthly income
was between 21000 and 40000 BD TK ($250-470 USD) and over half (55.9 %) lived in rural areas.
About half (51.9%) of respondents lived in families with less than four members. The majority
(73.7%) did not have children younger than five in their family, but 76.4% of respondents had at
least one elderly family member (>50 years old; Table 1).
Among the participants, 59.7% suffered from stress symptoms, however, mild (28.0%) and
moderate (22.0%) symptoms were more common. One third (33.7%) of participants reported
symptoms of anxiety; among them, 11.6% had moderate anxiety symptoms, and 11.6% had
extreme anxiety symptoms. More than half (57.9%) of the respondents experienced depressive
symptoms, including mild (14.5%), moderate (21.2%), and severe (13.2%) levels. [Figure 1]
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The prevalence of mental health symptoms differed among subgroups (Table 1). Higher levels of
stress were significantly associated with females (70.9%), monthly income >40,000 BDT (63.8%),
and unemployment (71.9 %). The prevalence of anxiety symptoms was significantly higher among
females (45.6%), those ≥40 years of age (44.0%), those with low education (secondary; 87.5%),
and housewives (68.2%). Higher rates of depressive symptoms were associated with females
(64.3%), ≤23 years of age (62.8%), and the unemployed (77%). Marital status and occupation were
also significantly associated with depressive symptoms, anxiety symptoms, and stress levels.
Stress levels were found to be further associated with education and monthly income. Anxiety
symptoms were further associated with location of residence and living with an elderly family
member. Depressive symptoms were also associated with having an elderly family member in the
household. [Table 1]
Many respondents (47.7 %) reported that their daily lives were significantly disrupted due to the
COVID-19 pandemic and ensuing quarantine measures. Over one third (35.5%) thought this
pandemic had a medium effect on mental health. Over half (59.8%) believed that COVID-19
disrupted the health care system. A majority (81%) said “the worst is yet to come” when asked to
speculate on the trajectory of the COVID-19 outbreak in Bangladesh. A majority (77.2%) also
believed that the pandemic would negatively impact their job, income, or education. Over half
(55%) agreed that the pandemic would especially jeopardise the mental health of those with
existing physical health conditions. Negative perceptions regarding the COVID-19 pandemic were
significantly associated with worse mental health scores. [Table 2]
Multivariate logistic regression models between demographic characteristics and mental health
outcomes fulfilled the goodness of fit criteria. A Hosmer and Lemeshow test statistic of stress
levels (2: 15.51, p-value: 0.06), anxiety symptoms (2: 12.94, p: 0.11) and depressive symptoms
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(2: 5.60, p: 0.69) indicated that the model fit well. Males (vs. female; OR=0.41; CI=0.31-0.54;
p<0.0001), those with higher secondary and undergraduate education (vs. graduate, 0.58, 0.36-
0.94, p<0.009; 0.67, 0.48-0.93, p<0.020), and those with a family income of 20000 BDTK (vs.
> 40000 BDTK, 0.60; 0.43-0.85; p<0.001) had a lower risk of experiencing high stress levels.
Unemployed respondents had a greater risk of experiencing high stress levels (3.20; 1.97-5.18; p<
0.0001) than employed respondents.
Respondents that were aged 24 to 39 years (vs. 40, 0.65; 0.42-.83; p<.0001), males (vs. female,
0.37; 0.27-0.51; p<0001), students (vs. employed, 0.77; 0.45-0.94; p<.0001), had a family income
of 20000 BDTK (vs. > 40000 BDTK, 0.67; 0.45-0.90; p=0.021), and lived in a rural residence
(vs. urban, 0.45; 0.34-0.59; p<.0001) had lower risks of experiencing anxiety symptoms.
Conversely, respondents that were aged 23 years (vs. 40 years, 1.56; 1.86-2.85; p=0.005), had
either secondary or undergraduate education (vs. employed, 12.87, 3.89-42.54, p<.0001; 1.12,
1.04-1.68, p=0.0003), owned a business or were unemployed (vs. employed, 4.55, 2.76-7.52,
p<.0001; 4.28, 2.47-7.40, p<.0001), and had four or less members in their household (vs. > 4,
1.40; 1.07-1.84; p=0.016) had a higher risk of experiencing anxiety symptoms.
Respondents that were male (vs. female, 0.56; 0.43-0.74; p<.0001) or had no elderly members
within their household (vs. yes, 0.73; 0.55-0.97; p=0.029) had a lower risk of experiencing
depressive symptoms. Those with secondary education (vs graduate, 2.30; 1.94-5.64; p=0.04) had
a higher risk of experiencing depressive symptoms. [Table 3].
Multivariate logistic regression models on perceptions regarding COVID-19 and mental health
outcomes were modelled without questions 2 and 6 when analysing stress levels and anxiety
symptoms and without questions 2 and 3 when analysing depressive symptoms (Table 4). The
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logistic regression models of stress levels (2: 11.98, p: 0.10), anxiety symptoms (2: 1.74; p: 0.11)
and depressive symptoms (2: 15.49, p: 0.07) fit the data. Several unadjusted logistic regression
models showed significance. Participants who believed that the healthcare system would be
overrun (OR=2.64; CI=2.0-3.48; p<0.001), or who were unsure about the fate of the healthcare
system (2.82; 1.97-4.03; p<0.001), had higher odds of experiencing high stress levels than those
that believed the healthcare system would withstand the pandemic. Respondents who fully agreed
that the COVID-19 pandemic would have a negative impact on education and the economy (1.57;
1.15-2.14; p=0.002), or said it would have a “somewhat” negative impact (1.71; 1.03-2.85;
p=0.004), had higher odds of experiencing high levels of stress than participants who did not
believe the pandemic would have any negative impact.
Respondents who believed that the worst of the crisis has not yet passed (1.95; 1.07-3.56; p<0.001)
had higher odds of experiencing anxiety symptoms than those who did not consider the COVID-
19 pandemic as a major problem for Bangladesh. Those who agreed that the COVID-19 pandemic
would negatively impact the economy and education had higher odds of experiencing depressive
symptoms (1.42; 1.11-2.21; p=0.001) than respondents who denied negative impacts. Respondents
who agreed that COVID-19 would be detrimental to the mental health of those with chronic
physical health conditions had higher odds (1.10; 1.21-1.54; p<.0001) of depressive symptoms
than those who believed COVID-19 would only have a “somewhat” negative impact. [Table 4]
Discussion
This study investigated the mental health of the general adult population in Bangladesh during the
COVID-19 pandemic. This study provides the first nationwide data on stress levels, anxiety
symptoms, and depressive symptoms in Bangladeshi residents during the COVID-19 pandemic.
Our findings indicate that COVID-19 pandemic was associated with increased mental health
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issues, and these results were similar with previous outbreaks of Severe Acute Respiratory
Syndrome ( SARS) and Middle East Respiratory Syndrome (MERS) (Lau et al. 2010; Jeong et al.
2016). Nearly 60% of the respondents suffered from high levels of stress, which is close to the
figure (64.3%) reported in India (Kazmi et al. 2020). However, this estimate is much higher than
the 32.1% reported in China (Wang et al. 2020b) and the 16.8% reported in the UK (Shevlin et al.
2020). Findings indicate that 26% of respondents reported moderate to severe anxiety symptoms,
which is similar to a study done in China (28.8%) during the COVID-19 pandemic (Wang et al.
2020a). The prevalence estimate of depressive symptoms ranging from mild to extremely severe
was 57.9% in the current study. Previous studies have reported prevalence rates of depressive
symptoms among the general population at 16.5% in China (Wang et al. 2020a; Wang et al. 2020b)
and 11.4% in Japan (Ueda et al. 2020). These discrepancies may be attributable to developed
socioeconomic and healthcare systems. Pre-COVID-19 era prevalence rates of mental disorders
varied from 6.5% to 31.0% among adults in Bangladesh, starkly in contrast to the higher numbers
reported in the current study (Ahmed et al. 2014).
Higher levels of stress, anxiety symptoms, and depressive symptoms were observed in females,
which is consistent with most previous findings (Limcaoco et al. 2020; Mazza et al. 2020; Wang
et al. 2020a), as well as extensive previous epidemiological research placing women at a higher
risk for experiencing anxiety symptoms (Wang et al. 2020b). However, Shevlin and Kazmi
reported the opposite relationship between stress and gender (Kazmi et al. 2020; Shevlin et al.
2020), while Zhang and Ma observed no relationship between stress and gender (Zhang & Ma
2020). Directives of lockdown may increase domestic violence against women, with social
services focused on mitigating risks limited in their capacity to conduct much-needed outreach
during quarantine.
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Surprisingly, respondents with a graduate level of education experienced high levels of stress more
so than those with undergraduate or higher secondary educations, which reflects some earlier
research (Othman 2020). Other studies have found no significant differences in the mental health
of participants with different educational backgrounds (Jung & Jun 2020; Zhang & Ma 2020). It
is possible that those with graduate degrees have more access to information regarding COVID-
19 and are therefore more aware of the dire situation, which contributes to higher levels of stress
compared to those with less education. Concurrently, those with the lowest level of education have
the highest rates of increased stress, anxiety symptoms, and depression symptoms during the
pandemic, which is similar to results from a study in China (Wang et al. 2020a). In order to support
those with limited education during the pandemic, local agencies should provide information in
easily understood diagrammatic or audio formats. Students reported lower anxiety symptoms
(27%) than other occupational groups, and this prevalence estimate is lower than that of Chinese
students (37.4 %) (Zhou et al. 2020).
Another surprising finding is that high-income respondents experienced high levels of stress at
higher rates than low-income respondents. More thorough research and qualitative studies will
need to be conducted in order to understand the mechanisms behind this finding. Unsurprisingly,
unemployed respondents experienced high levels of stress at higher rates than employed
respondents. This finding is different from another study, which found no differences between
employment status and stress rates (Kazmi et al. 2020). Unemployed respondents in the current
study experienced high levels of stress at even greater rates than healthcare workers. Unemployed
individuals face challenges to earning incomes needed to survive during lockdown, likely
increasing stress. All public offices in Bangladesh continue to pay workers in order to limit
financial stress. The rate of anxiety symptoms among health professionals was 27.7%, which is
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similar to a study on health workers in China (Lu et al. 2020). Following the outbreak of COVID-
19, studies indicated that hospital staff, particularly doctors and nurses, who had engaged in SARS
care more than a decade ago were at high risk of psychological disorders (Verma et al. 2004).
Close interactions with COVID-19 patients and lack of protective equipment contribute to
experiencing symptoms of anxiety.
Those in the older age group (40 years and older) reported a high rate of anxiety symptoms. This
finding may be attributed to anxieties regarding the higher COVID-19 death rate among older
individuals (Mahase 2020). Youth (23 years and younger) had a high prevalence of depressive
symptoms. Individuals with elderly family members also had a high rate of depressive symptoms.
The higher mortality rate for the elderly may also contribute to depressive symptoms, as
individuals become aware of the health risks faced by their loved ones. The rate of anxiety
symptoms among widows is higher than that of married or single individuals. However, older age
typically acts as a confounder for this finding (Mahase 2020; Wang et al. 2020b).
Respondents who agreed that COVID-19 has disrupted life events and feared that “the worst is yet
to come” were 47% and 81% respectively, which is similar to American findings (KFF 2020). Of
the study sample, 77% believe the pandemic may affect their education, job, or income; this rate
was 56% among Americans (KFF 2020). Almost half of respondents believed that COVID-19
would especially be detrimental to the mental health of those with physical health conditions,
which is more than the rate among Americans (KFF 2020). Participants who believed that the
healthcare system would be disrupted, as well as those who were unsure about the fate of the
healthcare system, experienced high stress levels at greater rates than those who were confident in
the country’s healthcare system. Recent research has suggested that 86.1% of the population
believe Bangladesh does not have the economic or structural capacity to properly address COVID-
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19, reflecting public perceptions of the rudimentary healthcare systems of Bangladesh (Islam &
Siddika 2020).
This study is the first on mental health impacts of the COVID-19 pandemic in a Bangladesh
context. Results establish a baseline of the mental health in Bangladesh during the beginning of
the pandemic for other studies to expand on. Respondents from all divisions of Bangladesh were
included in this study, which formed a large population-based sample. Piloting of the surveys
ensured its suitability for collecting information in the study context and setting. This study
identifies groups that may be particularly vulnerable to the deterioration of mental health during
the COVID-19 pandemic in Bangladesh, such as those with chronic physical health conditions.
These findings warrant consideration of easily accessible low-intensity mental health interventions
during and beyond this pandemic that can be targeted for vulnerable subgroups.
However, this study was not free from limitations, including the snowballing of sample
recruitment, which may suggest sampling bias by unintentionally excluding those who do not have
access to internet. This recruitment strategy may also have contributed to the skewed demographic
distribution of gender and occupation, with the current sample comprised of larger proportions of
males and students while data from females and older adults is scarce. While this sampling bias
limits the generalizability of findings, these demographics are likely to not have access to the
survey or internet due to socioeconomic factors or gender- and age-based discrimination.
Extensive research has shown these subpopulations to be even more vulnerable to mental health
consequences, leading to the conclusion that the results of this study underestimate the true
negative impact of the COVID-19 pandemic on mental health in the population. Limited research
on this novel topic hinders the robustness of any one study’s conclusions, especially given that
there have not been any studies on the mental health impact of COVID-19 within the Bangladesh
15
context. The self-reported survey mode may also introduce response bias, as results likely differ
from clinical diagnoses. Additionally, several confounding factors, such as Ramadan of Muslims
(fasting months), domestic violence, and exposure to online media were not included in the survey.
Conclusion
This study observed a high prevalence of mental health symptoms in the general population of
Bangladesh during the latest COVID-19 pandemic. The prevalence of mental health conditions in
the adult population was lower (6.5% -31.0%) in pre-COVID-19 Bangladesh, which suggests that
the pandemic may be responsible for increases in impaired mental health. Our findings indicates
that this pandemic may strongly impact mental health outcomes such as anxiety symptoms,
depressive symptoms, and acute or long-term post-traumatic stress disorders. Similar to other
studies, socio-demographic factors and perceptions on COVID-19 were found to be associated
with mental health symptoms.
Ethical approval
The research protocol was reviewed and approved by the Research Ethical Committee (REC) of
the Department of Food Microbiology, Patuakhali Science and Technology University,
Bangladesh (Approval no: FMB:22/04/2020:02). This study complied with the most recent
revision of the Helsinki Declaration and followed the Checklist for Reporting Results of Internet
E-Surveys (CHERRIES) guidelines.
Disclosure statement
The authors declare that there are no conflicts of interest.
Informed consent
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All procedures followed were in accordance with the ethical standards of the responsible
committee on human experimentation (institutional and national) and with the Helsinki
Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for
being included in the study.
Acknowledgement
Authors like to thank the participants.
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21
Table 1: Prevalence of stress, anxiety and depressive symptoms across sociodemographic variables
(n=1427)
Parameters
Category
% in the
sample
% Stress
(>10)
% Anxiety
(>6)
All
59.7
33.7
Age (years)
23
38.1
61.3
36.3***
24-39
48.6
58.2
28.9
40
13.4
60.7
44.0
Gender
Male
71.5
55.2***
29.0***
Female
28.5
70.9
45.6
Marital status
Married
32.2
58.5*
42.0***
Unmarried
66.9
59.8
29.1
Widow
0.8
100
83.3
Education level
Secondary
2.2
81.3***
87.5***
Higher secondary
10.4
51.0
43.0
Undergraduate
59.0
57.5
30.2
Graduate
28.3
65.8
33.4
Occupation
Student
43.7
58.2**
26.9***
Health profession
7.1
63.4
27.7
Employed-not health
25.4
56.4
28.2
Business
9.7
58.7
55.8
Unemployed
9.7
71.9
48.9
Housewife
3.1
72.7
68.2
Others
1.3
42.1
42.1
Family monthly
income
20000 BDT
25.2
53.2**
29.5
21000-40000 BDT
47.3
60.5
33.9
>40000 BDT
31.2
63.8
36.9
Residence
Rural
55.9
58.8
26.6***
Urban
44.1
60.8
42.7
Religion
Muslim
75.4
58.9
33.9
Hindu
23.2
62.8
32.6
Others
1.40
50.0
40.0
Family size
≤ 4
51.9
58.4
35.4
> 4
48.1
61.1
31.9
Child <5 years
in family
Yes
26.3
57.3
33.1
No
73.7
60.6
33.9
Elderly >50
years in family
Yes
76.4
60.9
31.7**
No
23.6
55.8
40.1
*Significant at P <0.05; **Significant at P <0.01; ***Significant at P <0.001
Others included Buddhists, Christians etc. Others included Farmers, Fisherman etc.
22
Table 2: Prevalence of stress, anxiety and depressive symptoms based on perceptions of COVID-19
Perceptions
Response
% in the
sample
% Stress
(>10)
% Anxiety
(>6)
% Depression
(>9)
1
A lot
47.7
65.0***
39.3***
64.0***
Medium
27.5
52.4
28.0
53.2
Some
19.8
59.4
24.0
51.9
Not at all
5.0
50.7
50.7
49.3
2
A lot
28.0
68.0***
50.5***
67.0***
Medium
35.5
66.9
35.9
64.1
Some
28.9
47.3
17.7
44.9
Not at all
7.6
42.6
22.2
44.4
3
I think so
59.8
65.2***
32.7*
60.9***
I don’t think so
23.3
40.5
30.6
47.7
Don’t know
16.8
66.7
41.7
61.3
4
The worst is behind us
5.6
70.0
62.5***
68.8
The worst is yet to come
81.0
59.0
29.8
56.9
Covid-19 is/will not be a major
problem for Bangladesh
3.8
61.1
25.9
51.9
Don’t know
9.6
59.1
52.6
62.0
5
Yes
77.2
62.1***
33.1***
61.6***
No
15.3
47.2
27.5
41.7
Somewhat
7.5
60.7
52.3
52.3
6
Yes
55.0
64.7***
37.1**
63.2***
No
10.7
42.5
26.1
37.3
Somewhat
34.3
57.1
30.7
55.8
*Significant at P <0.05; **Significant at P <0.01; ***Significant at P <0.001
1. How much has your life been disrupted by the COVID-19 pandemic?
2. How much has the COVID-19 pandemic negatively affected your mental health?
3. Do you think the country’s healthcare system will be overrun and people will not be able to get medical care?
4. Which of the following do you suspect about the trajectory of COVID-19 in Bangladesh?
5. Do you think COVID-19 will have a negative impact on your job/income/education?
6. Do you think COVID-19 will have a negative impact on the mental health of those with existing health
conditions?
23
Table 3: Effects of sociodemographic variables on mental health (n=1427)
Variables
Stress
Anxiety
Depression
OR (95% CI)
OR (95% CI)
OR (95% CI)
Age group (ref.: 40 years )
23
-
1.56 (1.86-2.85)*
-
24 to 39
-
0.65 (0.42-0.83)***
-
Gender (ref.: female)
Male
0.41 (0.31-0.54)***
0.37 (0.27-0.51)***
0.56 (0.43-0.74)***
Marital status (ref.: married)
Unmarried
-
0.60 (0.39-0.93)*
Widowed
-
2.47 (0.38-15.94)
-
Education (ref.: graduate)
Secondary
2.20 (0.79-6.14)
12.87 (3.89-42.54)***
2.30 (1.94-5.64)*
Higher secondary
0.58 (0.36-0.94)*
1.50 (0.87-2.59)
0.95 (0.61-1.50)
undergraduate
0.67 (0.48-0.93)*
1.12 (1.04-1.68)***
0.91 (0.67-1.25)
Occupation (ref.: employed)
Student
1.47 (0.19-2.10)
0.77 (0.45-0.94)***
-
Health professional
1.82 (0.28-3.07)
1.02 (0.53-1.95)
-
Business
1.59 (0.98-2.57)
4.55 (2.76-7.52)***
-
Unemployed
3.2 (1.97-5.18)***
4.28 (2.47-7.40)***
-
Housewife
1.144 (0.51-2.58)
1.28 (0.56-2.91)
-
Others
0.844 (0.30-2.34)
1.58 (0.54-4.65)
-
Family income (ref.: >4000 BDT)
20000
0.60 (0.43-0.85)**
0.67 (0.45-0.90)*
-
21000-40000
0.93 (0.70-1.24)
1.01 (0.75-1.37)
-
Residence (ref.: urban)
Rural
-
0.45 (0.34-0.59)***
-
Religion (ref.: Muslim)
Hindu
-
-
0.85 (0.65-1.12)
Others
-
-
4.11 (1.33-12.67)*
Family size (ref.: > 4)
4
-
1.40 (1.07-1.84)*
-
Elderly > 50 in family (ref.: yes)
No
-
-
0.73 (0.55-0.97)*
*Significant at P <0.05; ** Significant at P <0.01; *** Significant at P <0.001
Others included Buddhists, Christians etc. Others included Farmers, Fisherman etc.
24
Table 4: Effects of COVID-19 perceptions on mental health (stress, anxiety and behavior)
Perceptions
Stress
Anxiety
Depression
OR (95% CI)
OR (95% CI)
OR (95% CI)
Perception 1a (ref.: not at all)
A lot
1.59 (0.93-2.71)
0.88 (0.51-1.51)
1.63 (0.96-2.78)
Medium
1.10 (0.64-1.90)
0.55 (0.31-0.96)
1.14 (0.66-1.97)
Some
1.43 (0.81-2.50)
0.44 (0.25-0.79)
1.01 (0.57-1.77)
Perception 3b (ref.: I don’t think so)
I think so
2.64 (2.0-3.48)***
0.82 (0.59-1.14)
-
Don’t know
2.82 (1.97-4.03)**
0.77 (0.53-1.11)
-
Perception 4c (ref.: COVID-19 is/will not be a major problem for Bangladesh)
The worst is behind us
1.25 (0.58-2.72)
1.95 (1.07-3.56)***
0.91 (0.48-1.73)
The worst is yet to come
0.68 (0.37-1.25)
0.50 (0.33-0.76)
0.49 (0.32-1.76)
Don’t know
0.75 (0.37-1.51)
0.33 (0.16-0.69)
0.47 (0.23-1.93)
Perception 5d (ref.: no)
Yes
1.57 (1.15-2.14)**
0.60 (0.39-0.93)
1.42 (1.11-2.21)**
Somewhat
1.71 (1.03-2.85)**
0.41 (0.24-0.69)
0.74 (0.45-1.22)
Perception 6e (ref.: somewhat)
Yes
-
-
1.10 (1.21-1.54)***
No
-
-
0.29 (0.44-0.66)***
*Significant at P <0.05; **Significant at P <0.01; ***Significant at P <0.001
a How much has your life been disrupted by the COVID-19 pandemic?
b Do you think the country’s healthcare system will be overrun and people will not be able to get medical care?
c Which of the following do you suspect about the trajectory of COVID-19 in Bangladesh?
d Do you think COVID-19 will have a negative impact on your job/income/education?
e Do you think COVID-19 will have a negative impact on the mental health of those with existing health
conditions?
25
Figure 1: The rate of different severities of stress, anxiety and depression of the participants
(n=1427)
40%
28%
22%
9%
1%
66%
8% 12%
6% 8%
42%
15%
21%
9%
13%
0
100
200
300
400
500
600
700
800
900
1000
Normal Mild Moderate Severe Extremely severe
Stress Anxiety Depression
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Our study aimed to investigate the immediate impact of the COVID-19 pandemic on mental health and quality of life among local Chinese residents aged ≥18 years in Liaoning Province, mainland China. An online survey was distributed through a social media platform between January and February 2020. Participants completed a modified validated questionnaire that assessed the Impact of Event Scale (IES), indicators of negative mental health impacts, social and family support, and mental health-related lifestyle changes. A total of 263 participants (106 males and 157 females) completed the study. The mean age of the participants was 37.7 ± 14.0 years, and 74.9% had a high level of education. The mean IES score in the participants was 13.6 ± 7.7, reflecting a mild stressful impact. Only 7.6% of participants had an IES score ≥26. The majority of participants (53.3%) did not feel helpless due to the pandemic. On the other hand, 52.1% of participants felt horrified and apprehensive due to the pandemic. Additionally, the majority of participants (57.8–77.9%) received increased support from friends and family members, increased shared feeling and caring with family members and others. In conclusion, the COVID-19 pandemic was associated with mild stressful impact in our sample, even though the COVID-19 pandemic is still ongoing. These findings would need to be verified in larger population studies.
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The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.
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In addition to being a public physical health emergency, Coronavirus disease 2019 (COVID-19) affected global mental health, as evidenced by panic-buying worldwide as cases soared. Little is known about changes in levels of psychological impact, stress, anxiety and depression during this pandemic. This longitudinal study surveyed the general population twice - during the initial outbreak, and the epidemic's peak four weeks later, surveying demographics, symptoms, knowledge, concerns, and precautionary measures against COVID-19. There were 1738 respondents from 190 Chinese cities (1210 first-survey respondents, 861 second-survey respondents; 333 respondents participated in both). Psychological impact and mental health status were assessed by the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale (DASS-21), respectively. IES-R measures PTSD symptoms in survivorship after an event. DASS -21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. This study found that there was a statistically significant longitudinal reduction in mean IES-R scores (from 32.98 to 30.76, p<0.01) after 4 weeks. Nevertheless, the mean IES-R score of the first- and second-survey respondents were above the cut-off scores (>24) for PTSD symptoms, suggesting that the reduction in scores was not clinically significant. During the initial evaluation, moderate-to-severe stress, anxiety and depression were noted in 8.1%, 28.8% and 16.5%, respectively and there were no significant longitudinal changes in stress, anxiety and depression levels (p>0.05). Protective factors included high level of confidence in doctors, perceived survival likelihood and low risk of contracting COVID-19, satisfaction with health information, personal precautionary measures. As countries around the world brace for an escalation in cases, Governments should focus on effective methods of disseminating unbiased COVID-19 knowledge, teaching correct containment methods, ensuring availability of essential services/commodities, and providing sufficient financial support.
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The pandemic of 2019 coronavirus disease (COVID-19) has burdened an unprecedented psychological stress on people around the world, especially the medical workforce. The study focuses on assess the psychological status of them. The authors conducted a single-center, cross-sectional survey via online questionnaires. Occurrence of fear, anxiety and depression were measured by the numeric rating scale (NRS) on fear, Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD), respectively. A total of 2299 eligible participants were enrolled from the authors’ institution, including 2042 medical staff and 257 administrative staff. The severity of fear, anxiety and depression were significantly different between two groups. Furthermore, as compared to the non-clinical staff, front line medical staff with close contact with infected patients, including working in the departments of respiratory, emergency, infectious disease, and ICU, showed higher scores on fear scale, HAMA and HAMD, and they were 1.4 times more likely to feel fear, twice more likely to suffer anxiety and depression. The medical staff especially working in above-mentioned departments made them more susceptible to psychological disorders. Effective strategies toward to improving the mental health should be provided to these individuals.