Prevalence of depression, anxiety and associated factors among school going adolescents in Bangladesh: Findings from a cross-sectional study

PLOS ONE RESEARCH ARTICLE Prevalence of depression, anxiety and associated factors among school going adolescents in Bangladesh: Findings from a cross-sectional study Md. Saiful Islam ID1,2*, Md. Estiar Rahman1, Mst. Sabrina Moonajilin1, Jim van Os3,4 1 Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh, 2 Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, Bangladesh, 3 Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands, 4 Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 * , Abstract Background OPEN ACCESS Citation: Islam M.S, Rahman M.E, Moonajilin M.S, van Os J (2021) Prevalence of depression, anxiety and associated factors among school going adolescents in Bangladesh: Findings from a crosssectional study. PLoS ONE 16(4): e0247898. https://doi.org/10.1371/journal.pone.0247898 Editor: Markos Tesfaye, St. Paul’s Hospital Millenium Medical College, ETHIOPIA Received: April 20, 2020 Accepted: February 10, 2021 Published: April 1, 2021 Copyright: © 2021 Islam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Common mental disorders in early life represent a major concern as they become more complex and intense with transition into adolescence. Despite global recognition of the significance of adolescent mental health, it remains a neglected area in research and health policy in Bangladesh. This study aimed to investigate the prevalence and factors associated with depression and anxiety among school going adolescents in Bangladesh. Methods A cross-sectional survey was conducted among 563 students aged 13–18 years at selected schools (secondary and higher secondary) in Dhaka City. After providing written informed consent, participants completed a survey examining socio-demographic variables, along with the PHQ-9 and GAD-7 scales. Logistic regression was used to examine associations between variables under examination. Results The prevalence rates of moderate to severe levels of depression and anxiety were 26.5% and 18.1%, respectively. Based on multivariable analyses, unsatisfactory sleep (AOR = 3.17; 95% CI = 1.81–5.53, p < .001), cigarette smoking (AOR = 2.00; 95% CI = 1.01–3.97, p = .048), and anxiety (AOR = 10.47; 95% CI = 6.11–17.95, p < .001) were associated with depression. Anxiety was associated with being 15–16 years (AOR = 2.66; 95% CI = 1.18– 6.00, p = .018), not having good perceived relationships with friends (AOR = 2.10; 95% CI = 1.24–3.56, p = .006) and depression (AOR = 10.22; 95% CI = 6.01–17.38, p < .001). PLOS ONE | https://doi.org/10.1371/journal.pone.0247898 April 1, 2021 1 / 13 PLOS ONE Depression, anxiety and associated factors among adolescents in Bangladesh Conclusions Depression and anxiety were prevalent among school going adolescents in Bangladesh. The findings suggest epidemiological data can direct policy-level decisions regarding evaluation, prevention, and intervention of mental health conditions among school going adolescents in Bangladesh. Introduction Adolescence (aged 10–19 years) can be characterized as a transitional period from childhood to adulthood. Various physical, emotional and social changes, including exposure to poverty, abuse or violence, can predispose adolescents vulnerable to mental health disorders [1]. Mental health disorders in children and adolescents have become a significant public health and mental health services concern worldwide [2]. An estimate of the World Health Organization (WHO) reported that mental disorders account for 16% of the global burden of disease and injury in people aged 10–19 years [1]. Depression and anxiety are the most common mental disorders (CMDs) among children and adolescents [3]. CMDs of adolescents have become a neglected public health problem in Bangladesh. According to WHO estimation, adolescents comprise 10.2% of the total population of Bangladesh (16.4 million; 8.4 million boys and 8.0 million girls), and suffer from suicidal behavior (i.e., suicidal ideation, suicidal ideation with a plan, attempted suicide), anxiety, loneliness, lack of close friends and substance use (i.e., tobacco, cigarette, alcohol, marijuana, multiple substances, etc.) [4]. The prevalence of mental disorders is rising among adolescents worldwide. A systematic review and meta-analysis demonstrated that the worldwide pooled prevalence of mental disorders was 13.4% in children and adolescents [5]. There have been various studies that have investigated depression and anxiety among adolescent populations in the Asian region. For example, reported prevalence rates for adolescent depression are 25.8% in India [6], 17.2% in Pakistan [3], 26.2% in Malaysia [7], 36% in Sri Lanka [8], and 52.6% in Iran [9]. Prevalence rates for adolescent anxiety are 21.4% in Pakistan [3], 28% in Sri Lanka [8], and 16.3% in Jordan [2]. These studies have opined several contributing factors to mental disorders, including social-demographic and lifestyle factors. These include sex, age, lower economic status, academic grade, father’s education, mother’s education, living with the family, alcohol intake, and satisfaction with sleep [2, 3, 7, 8]. Despite the aforementioned studies on depression and anxiety among students, there is a knowledge gap regarding depression and anxiety among adolescents in Bangladesh. A systematic review on the mental health situation of Bangladesh concluded that the overall prevalence of mental health problems ranged from 6.5–31% among adults and from 13.4–22.9% among children [10]. Although a previous study of Bangladeshi adolescents reported that the prevalence of adolescent depression was 36.6% [11], there is no study in Bangladesh that studied associated factors of anxiety and depression. Similarly, although many studies outside Bangladesh have focused on anxiety and depression, separate investigation in Bangladesh is still required, given strong cultural and sociodemographic differences between countries on the one hand and evidence of similarly strong contextual effects on common mental disorder on the other. In other words, developing public health approaches towards a mental disorder phenotype requires local inventory of prevalence as resulting from a unique mix of contextual PLOS ONE | https://doi.org/10.1371/journal.pone.0247898 April 1, 2021 2 / 13 PLOS ONE (...truncated)