'He was a brilliant student but became mad like his grandfather': an exploratory investigation on the social perception and stigma against individuals living with mental health problems in Bangladesh.

BACKGROUND: Worldwide, mental health issues constitute a substantial threat to people's social, economic, and mental well-being and contribute significantly to many fatalities each year. In Bangladesh, people with mental health issues typically delay contacting health professionals because they prefer traditional or religious healers. Moreover, the situation is exacerbated by a lack of awareness, social stigma, and negative perception of sufferers of mental health issues on the part of families and the community. Therefore, this paper investigates the social perception and stigmatization of individuals living with mental health problems and their caregivers in Khulna, Bangladesh. METHODS: Data were collected from university students with concurring mental health issues as well as their closest caregivers, who had in-depth knowledge of the problem and a willingness to take care of the individuals with mental health issues. Following the criteria for data collection, eight individuals living with mental health problems and five caregivers were purposively selected for this research. A semi-structured in-depth interview guide was used for the confidential data collection process, which took place in November and December 2021, and each interview lasted 40-50 min on average. RESULTS: This study used thematic analysis to present the results; the findings showed that: individuals afflicted with mental health problems sought both medical and spiritual support to recover. Those with mental health issues who received positive family support recovered relatively faster than those who did not. However, negative social perception and stigmatization were the key impediments for individuals suffering from mental health problems and their families, as they found it difficult to discuss their issues with relatives and communities when attempting to access support or seek remedies. Moreover, the commonality of social stigmas, such as labeling mental health problems as equal to 'madness,' hindered disclosure to family members, peers, and the community. CONCLUSION AND RECOMMENDATIONS: In Bangladesh, the majority of individuals living with mental health problems are stigmatized and do not receive emotional support. Hence, we suggest nationwide community-based awareness-building programs to promote more positive perceptions of the fight against mental health disorders. Furthermore, counseling and awareness-building programs for effective discouragement of non-scientific remedies such as spiritual healing, as well as diagnosis and medication at the primary stage of sickness, are recommended for early detection and better medical assistance.

A qualitative investigation of stressful life events and mental health disorders: The views of patients and caregivers in Bangladesh.

BACKGROUND: Mounting mental health disorders among students has become a significant challenge in producing quality graduates with bright minds. Therefore, it is crucial to investigate the underlying causes of students' mental health-related problems and their experiences while living with mental health disorders. This study investigates the causes and exposures of mental health problems among university students in Bangladesh. For this purpose, a qualitative method was used, and an unstructured in-depth interview schedule was used to collect data from students and caregivers. The students were selected from Khulna University, and data were collected in two consecutive months, i.e., November and December 2021. Using a convenient sampling technique, eight (8) students with mental health issues and five (5) caregivers were interviewed to obtain the necessary data. RESULTS: The findings showed that the intertwined social circumstances led to mental health problems among university students. The students experienced deep depression following a breakup of their romantic affairs/relationships. The prolonged isolation or social distancing due to the government-imposed strict lockdown during the COVID-19 also produced frustration regarding the possible loss of both academic and professional careers. Furthermore, the growing academic pressure in a form of an unfamiliar approach to teaching and learning-online education-also compelled students to complain about depression and suicidal tendencies as parts of their experiences. CONCLUSIONS: This study recommends that the government and policymakers prioritize mental health issues in educational institutions, and they should enforce specific strategies, such as introducing age-specific mental health services and student counseling at educational institutions to reduce growing mental health issues. Furthermore, a positive approach from the family and community is also required to battle against mental health disorders. Besides, nationally representative empirical research is recommended to comprehend the growing mental health issues among students in the 21st century to figure out solutions for the present and the future.

Disability, physical activity, and health-related quality of life in Australian adults: An investigation using 19 waves of a longitudinal cohort.

BACKGROUND: Any form of long-term physical or mental impairment might negatively influence health-related quality of life (HRQoL). HRQoL, as an independent concept, covers a wide range of characteristics that includes physical, mental, social, and spiritual functions. People with disabilities are continuously exposed to multiple barriers that deteriorate their HRQoL. It also creates impairment in performing physical activities. However, experts opine regular physical exercise as an intervention to help disabled people. This research aims to investigate the association between disability and physical activity with HRQoL among the adult population in Australia. DESIGN: A retrospective cohort study. METHODS: This study utilized the most recent 19 waves of data (2002-2020) from the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. Component summary scores such as physical component summary (PCS) and mental component summary (MCS), and SF-6D utility scores were utilized to measure HRQoL. Random-effects GLS regression technique was fitted to estimate the association between disability and physical activity with HRQoL, after adjusting for a range of socio-demographic and health-related characteristics. RESULTS: Disability was negatively associated with the PCS (-5.95), MCS (-2.70) and SF-6D (-0.060) compared with non-disabled counterparts. However, respondents engaged in the recommended level of physical activity had substantial gain in PCS (b = 0.96), MCS (1.57), and SF-6D (0.021) scores. Besides, the results showed that performing the recommended level of physical activity in the presence of disability has lessen the negative effect of disability/ positive moderating effect of physical activity on PCS, MCS, and SF-6D scores by 1.84 points, 0.82 points, and 0.013 percentage points, respectively. CONCLUSION: This study found an inverse association between disability and HRQoL among Australian adults. However, physical activity was associated with improved HRQoL. Therefore, public health interventions, such as the orientation of physical activities, have a higher potential to dwindle the burden regarding HRQoL.

Obesity and the risk of developing chronic diseases in middle-aged and older adults: Findings from an Australian longitudinal population survey, 2009-2017.

BACKGROUND: Overweight and obesity impose a significant health burden in Australia, predominantly the middle-aged and older adults. Studies of the association between obesity and chronic diseases are primarily based on cross-sectional data, which is insufficient to deduce a temporal relationship. Using nationally representative panel data, this study aims to investigate whether obesity is a significant risk factor for type 2 diabetes, heart diseases, asthma, arthritis, and depression in Australian middle-aged and older adults. METHODS: Longitudinal data comprising three waves (waves 9, 13 and 17) of the Household, Income and Labour Dynamics in Australia (HILDA) survey were used in this study. This study fitted longitudinal random-effect logistic regression models to estimate the between-person differences in the association between obesity and chronic diseases. RESULTS: The findings indicated that obesity was associated with a higher prevalence of chronic diseases among Australian middle-aged and older adults. Obese adults (Body Mass Index [BMI] ≥ 30) were at 12.76, 2.05, 1.97, 2.25, and 1.96, times of higher risks of having type 2 diabetes (OR: 12.76, CI 95%: 8.88-18.36), heart disease (OR: 2.05, CI 95%: 1.54-2.74), asthma (OR: 1.97, CI 95%: 1.49-2.62), arthritis (OR: 2.25, 95% CI: 1.90-2.68) and depression (OR: 1.96, CI 95%: 1.56-2.48), respectively, compared with healthy weight counterparts. However, the study did not find any evidence of a statistically significant association between obesity and cancer. Besides, gender stratified regression results showed that obesity is associated with a higher likelihood of asthma (OR: 2.64, 95% CI: 1.84-3.80) among female adults, but not in the case of male adults. CONCLUSION: Excessive weight is strongly associated with a higher incidence of chronic disease in Australian middle-aged and older adults. This finding has clear public health implications. Health promotion programs and strategies would be helpful to meet the challenge of excessive weight gain and thus contribute to the prevention of chronic diseases.

Estimating Catastrophic Costs due to Pulmonary Tuberculosis in Bangladesh.

To eliminate TB from the country by the year 2030, the Bangladesh National Tuberculosis (TB) Program is providing free treatment to the TB patients since 1993. However, the patients are still to make Out-of-their Pocket (OOP) payment, particularly before their enrollment Directly Observed Treatment Short-course (DOTS). This places a significant economic burden on poor-households. We, therefore, aimed to estimate the Catastrophic Health Expenditure (CHE) due to TB as well as understand associated difficulties faced by the families when a productive family member age (15-55) suffers from TB. The majority of the OOP expenditures occur before enrolling in. We conducted a cross-sectional study using multistage sampling in the areas of Bangladesh where Building Resources Across Communities (BRAC) provided TB treatment during June 2016. In total, 900 new TB patients, aged 15-55 years, were randomly selected from a list collected from BRAC program. CHE was defined as the OOP payments that exceeded 10% of total consumption expenditure of the family and 40% of total non-food expenditure/capacity-to-pay. Regular and Bayesian simulation techniques with 10,000 replications of re-sampling with replacement were used to examine robustness of the study findings. We also used linear regression and logit model to identify the drivers of OOP payments and CHE, respectively. The average total cost-of-illness per patient was 124 US$, of which 68% was indirect cost. The average CHE was 4.3% of the total consumption and 3.1% of non-food expenditure among the surveyed households. The poorest quintile of the households experienced higher CHE than their richest counterpart, 5% vs. 1%. Multiple regression model showed that the risk of CHE increased among male patients with smear-negative TB and delayed enrolling in the DOTS. Findings suggested that specific groups are more vulnerable to CHE who needs to be brought under innovative safety-net schemes.