Depressive Symptoms Among Adolescents in Bangladesh

International Journal of Mental Health and Addiction https://doi.org/10.1007/s11469-022-00860-8 ORIGINAL ARTICLE Depressive Symptoms Among Adolescents in Bangladesh Israt Irean Ria1 · Raaj Kishore Biswas2 Sadia Tahsin5 · Asraful Alam3 · Pradipto Vaskar Rakshit4 · Accepted: 17 June 2022 © The Author(s) 2022 Abstract Adolescent mental well-being hardly took precedence in Bangladesh, which is reflected in both policies and literature. This study assessed the common symptoms of depression among school-going adolescents (aged 10–19 years) in Bangladesh. Primary data were collected during October–November 2019 from 289 participants in four schools using a questionnaire based on the WHO global school-based student health survey and WHO stepwise approach to NCD (Tools version 9.5). Sadness (45.3%) and aggression (40.5%) were the most common depressive symptoms found in the study, followed by confusion (27.7%), worthlessness (21.8%), fatigue (21.5%), and insomnia (18.0%). The sex of the student, grade of study, and duration of daily sleep showed differential associations with these symptoms. These findings indicate a crucial stage of adolescence, where the different societal pressures often ignored by primary carers, could have detrimental effect on children. There is an urgent need to address the growing adolescent mental health issue in Bangladesh and a need for health system to recognize its precedence. Keywords Screen time · Depression · Children · Insomnia · Fatigue · Aggression · Bangladesh Mental health is the new challenge in public health. While it is slowly getting recognized as public health issue worldwide, in low- and middle-income countries (LMICs) like Bangladesh, the issue is still being less prioritized. Bangladesh has only passed a new Mental Health Act in 2018 with a number of loopholes (Ahn & Jun, 2007; Anjum et al., 2019). The World Health Organization Mental Health Action Plan (2013–2030) sets a global objective for mental health promotion and prevention. One of the targets of Sustainable Development Goals (SDGs) is to “reduce one third of premature mortality from non-communicable diseases through prevention and treatment, and to promote mental health and well-being” (SDG 3.4) (Bennett et al., 2018). However, the World Health Organization (WHO) only focused on suicide mortality rates in adults and has largely ignored the severity of mental distress in adolescents. Almost 264 million people suffer from depression worldwide (James et al., 2018). Depression-related mortality rate is quite high as suicide is the second leading cause * Raaj Kishore Biswas Extended author information available on the last page of the article 13 Vol.:(0123456789) International Journal of Mental Health and Addiction of death for 15–29 years old (World Health Organization, 2012). The scenario is not different in Bangladesh, with 16.05% of the adult population in the country suffering from mental disorders. A recent systematic review found a large variation in the prevalence of mental disorders and reported a variation from 6.5 to 31.0% among adults and 13.4 to 22.9% among children (Hossain et al., 2014). These numbers necessitate an assessment of the mental health conditions for children and adolescents in Bangladesh. Traditionally, mental health rarely takes precedence over infectious and communicable diseases in Bangladesh. However, despite severe resource constraints, there has been a gradual improvement in the public health sector of Bangladesh, and hence, the need to focus on chronic conditions such as mental health conditions of children and adolescents has become urgent (Chowdhury et al., 2013). Although neuropsychiatric disorders contribute to 11.2% of the total disease burden in Bangladesh, only 0.44% of the USD 2.3 billion national health budget was allocated for mental health in 2010 (Hasan & Thornicroft, 2018; Nuri et al., 2018). Few studies surveyed various aspects of mental disorders among adolescents in Bangladesh. For example, World Health Organization found that 5% of adolescents aged between 13 and 17 years had suicidal ideation and anxiety, and 25% were bullied by other students at school (WHO, 2017). Similar estimates were observed by Begum et al. (2017) who found that unmarried females living without parents had higher suicide ideation. Survey-based studies mostly assessed eating disorders (Pengpid et al., 2015), depressive symptoms and help-seeking behavior (Nasreen et al., 2016), obsessive–compulsive disorders (Chowdhury et al., 2016), and intimate partner violence (Biswas et al., 2017; Rahman et al., 2014). Despite these studies in recent times, there is a lack of assessment on the other aspects of mental health such as worthlessness, confusion, aggression, insomnia, sadness or hopelessness, and tiredness or fatigue, all of which are considered to be symptoms of depression (Taheri et al., 2019). A focus on these depressive symptoms is particularly important in Bangladesh due to the typical ignorance of parents or primary caregivers while nursing the depressive symptoms of school-going children or adolescents (Selim, 2010). Research on how these depressive symptoms manifest in this vulnerable age group can help future research to develop targeted intervention strategies, specific to the low-income and highly conservative settings like Bangladesh. Furthermore, literature gap exists regarding the association of lifestyle factors with depression in Bangladesh. While health outcomes such as obesity were found to be associated with electronic screen time (Khan & Burton, 2016), its association with depressive symptoms remains unexplored. Similarly, sleep patterns and physical activity have been shown to be important risk factors for mental health (Askeland et al., 2020; Bailey et al., 2018), which has not yet been adequately studied in the context of Bangladesh. Therefore, the paucity of studies in this area indicates research gap that our study has aimed to resolve through the application of a global school-based student health survey. The primary objective of this study is to identify the most prevalent symptoms of depression among school-going adolescents (aged 10–19 years) in urban and rural areas of Bangladesh. The secondary objective is to assess the sociodemographic and lifestyle factors associated with depressive symptoms of secondary school students. These would allow the detection of the vulnerable cohort of children in Bangladesh who are more likely to be depressed and require attention. 13 International Journal of Mental Health and Addiction Theoretical Framework Several theories relate to adolescent mental health and its risk factors, including the socialecological theory, social cognitive theory, social stress model, recovery theory, and the developmental intergroup theory (Heary et al., 2017; Kelly & Coughlan, 2019; van Praag et al., 2009; Yen et al., 2009). These theories explain how the individual traits, relation with parents and pe (...truncated)