Stakeholder perspectives of mental healthcare services in Bangladesh, its challenges and opportunities: a qualitative study.

This study explores Bangladesh's mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it's mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.

Assessment of the feasibility of a community-based mental health training programme for persons with disabilities by non-specialists from different stakeholders' perspectives in Bangladesh.

INTRODUCTION: Bangladesh is a developing country where 11% of the population has at least one disability, but no community-level mental health service is available. There is limited evidence of the burden of mental health issues and health-seeking behaviour among this population. This study assessed the feasibility of a training intervention for persons with disabilities, where peer support providers provided community-based disability-inclusive mental health services. METHODS: Four stakeholder groups participated in this qualitative study: peer responders (trained persons with disabilities), trainers, representatives of organisations of persons with disabilities and disability-specific organisations, and officials of international and national non-governmental organisations. Two types of qualitative interviews were used to collect data, and thematic analysis techniques were utilised. RESULT: Stakeholders perceived the peer responder training programme as acceptable for persons with disabilities to develop themselves as peer support providers, with potential benefits including increased mental health literacy, ensuring accessible mental health services, and improving the well-being of persons with disabilities. Potential challenges included receiving training and delivering services. Increased training duration, more fieldwork, supervision opportunities, and refresher training were recommended to mitigate training challenges. Financial support and formal community recognition were deemed necessary for training delivery. CONCLUSION: The peer responder training programme was feasible to ensure accessible mental health services for persons with disabilities, build a workforce to screen for mental health conditions, and provide appropriate referrals. A multi-sectoral collaboration of government and non-governmental institutions is recommended to policy advocates to expand the peer responder training programme in the mainstream mental healthcare system.

Depressive symptoms and anxiety among women with a history of abortion living in urban slums of Bangladesh.

BACKGROUND: Globally, major emphasis has been placed on understanding the physiological consequences of losing a pregnancy. However, its mental health impact on socially disadvantaged women remains unexplored. To further inform the field the present study investigated the prevalence and factors associated with the development of depressive symptoms and anxiety among women with a history of spontaneous abortion living in the urban slums of Dhaka, Bangladesh. METHODS: Information was obtained from 240 women who experienced a spontaneous abortion from July 2020 to December 2021. It was obtained through the urban health and demographic surveillance system (UHDSS) survey. Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were used to measure mental health symptoms. Bivariate and multivariate linear regression analyses were performed to assess the associated factors with the mental health outcomes. RESULTS: Of the 240 women, majority (77.50%) of the women experienced mild to severe depressive symptoms and more than half (58.75%) of the respondants experienced mild to severe anxiety, within one and half years of experiencing spontaneous abortion. A higher level of education and being employed were protective factors for anxiety and depressive symptoms, respectively. However, women with higher sexual and reproductive health rights (SRHR) knowledge had significantly increased anxiety and depressive symptoms. In contrast, receiving post-abortion care (PAC) was associated with decreased anxiety and depressive symptoms. CONCLUSION: The findings indicate that ensuring access to affordable PAC services and integrating mental health services into the standard PAC service package is crucial. This study also emphasizes the importance of providing education for women living in urban slums and encouraging them to participate in economic activities.

Prevalence of insomnia among the post-menopausal women who suffered from COVID-19 in Bangladesh: A nationwide cross-sectional study.

Objectives: The impact of the pandemic on sleeping problems in all age groups has been widely reported, but insomnia in post-menopausal women has been understudied worldwide. The study sought to determine the prevalence and associated factors for insomnia in post-menopausal women who were infected with COVID-19 in Bangladesh. Material and methods: A cross-sectional telephonic survey was conducted from August to December 2021 among post-menopausal women with a history of COVID-19 infection in Bangladesh. Data on socio-demographic factors, lifestyle and behavioral factors, COVID-19-associated factors, and self-reported pre-existing co-morbidities were collected. A validated scale Insomnia Severity Index (ISI) was applied to assess the level of insomnia . Bivariate and multiple linear regression analyses were performed to assess the associated factors with insomnia. Results: Of the total 900 participants, the prevalence of insomnia was reported at 70%, with 33.67% moderately severe, 25.11% subthreshold, and 11.22% severe insomnia. Participants with increased ISI scores were significantly more likely to be retired, had 2-4 children, felt disturbed by COVID-19 related news, hospitalized for COVID-19 management, receieved the first dose of vaccine, and experienced post COVID-19 symptoms such as fatigue, lack of concentration, and memory loss. On the other hand, living in a nuclear family and taking care of COVID-19-infected family members were significantly negatively associated with insomnia. Conclusions: Our findings indicate the need to safeguard the well-being considerations of post-menopausal women through a well-designed comprehensive social safety net program for the present pandemic and similar crises in the future.

Mental healthcare-seeking behavior of women in Bangladesh: content analysis of a social media platform.

BACKGROUND: Mental health remains a highly stigmatized area of healthcare, and people often conceal their concerns rather than seek assistance or treatment. The Women Support Initiative Forum (WSIF) is a social media platform established in 2018 to provide expert and peer-led psychosocial support services to women of all ages in Bangladesh. The anonymous nature of the forum means that mental health concerns can be aired without fear of identification. METHOD: A content analysis was conducted on the anonymous posts retrieved from the WSIF platform between 8th March 2020 and 7th July 2022. Around 1457 posts were initially selected for analysis which was reduced to 1006 after removing duplicates and non-relevant posts, such as queries about the addresses of the doctors and other non-mental health-related issues. A thematic analysis of the data was conducted using an inductive approach. RESULT: The 1006 posts generated four themes and nine sub-themes. All the women mentioned mental health symptoms (n = 1006; 100%). Most also mentioned reasons for seeking mental healthcare (n = 818; 81.31%), healthcare-seeking behavior (n = 667; 66.30%), and barriers to seeking mental healthcare (n = 552; 54.87%). The majority of women described symptoms of stress, depression, and anxiety-like symptoms, which were aggregated under common mental health conditions. Mental health symptoms were ascribed to various external influences, including marital relationship, intrafamilial abuse, and insecurities related to the COVID-19 pandemic. A large proportion of posts were related to women seeking information about mental healthcare services and service providers (psychologists or psychiatrists). The analysis found that most women did not obtain mental healthcare services despite their externalized mental health symptoms. The posts identified clear barriers to women accessing mental health services, including low mental health literacy, the stigma associated with mental healthcare-seeking behavior, and the poor availability of mental health care services. CONCLUSION: The study revealed that raising mass awareness and designing culturally acceptable evidence-based interventions with multisectoral collaborations are crucial to ensuring better mental healthcare coverage for women in Bangladesh.

Exploring the potential of delivering mental health care services using digital technologies in Bangladesh: A qualitative analysis.

Background: Bangladesh is a lower-middle-income country affected by a severe lack of mental health service availability due to a scarcity of mental health experts, limited mental health literacy, and community stigma. In other low and middle-income countries, the online provision of mental health care services has addressed issues affecting service availability, accessibility, mass awareness of services, and stigma. Objective: The current study sought to understand stakeholders' perceptions of the potential of digital media-based mental health care delivery in strengthening Bangladesh's mental health system. Method: Online in-depth interviews were conducted with seven psychiatrists and eleven people with lived experiences of mental health issues. In addition, two online focus groups were conducted with ten psychologists and nine mental health entrepreneurs. A thematic analysis of the audio transcriptions was used to identify themes. Result: Stakeholders perceived that the benefits of digital media-based mental health services included the potential of increasing the awareness, availability, and accessibility of mental health services. Participants recommended: the rehabilitation of existing pathways; the use of social media to raise awareness; and the implementation of strategies that integrate different digital-based services to strengthen the mental health system and foster positive mental health-seeking behaviors. Conclusion: Growing mental health awareness, combined with the appropriate use of digital media as a platform for distributing information and offering mental services, can help to promote mental health care. To strengthen mental health services in Bangladesh, tailored services, increased network coverage, and training are required on digital mental health.

Prevalence of Overweight and Obesity in People With Severe Mental Illness: Systematic Review and Meta-Analysis.

Aims: 1) To determine the pooled prevalence of overweight and obesity in people with severe mental illness (SMI), overall and by type of SMI, geographical region, and year of data collection; and 2) to assess the likelihood of overweight and obesity, in people with SMI compared with the general population. Methods: PubMed, Medline, EMBASE, and PsycINFO databases were searched to identify observational studies assessing the prevalence of obesity in adults with SMI. Screening, data extraction and risk of bias assessments were performed independently by two co-authors. Random effect estimates for the pooled prevalence of overweight and obesity and the pooled odds of obesity in people with SMI compared with the general population were calculated. Subgroup analyses were conducted for types of SMI, setting, antipsychotic medication, region of the world, country income classification, date of data collection and sex. We assessed publication bias and performed a series of sensitivity analyses, excluding studies with high risk of bias, with low sample size and those not reporting obesity according to WHO classification. Result: 120 studies from 43 countries were included, the majority were from high income countries. The pooled prevalence of obesity in people with SMI was 25.9% (95% C.I. = 23.3-29.1) and the combined pooled prevalence of overweight and obesity was 60.1% (95% C.I. = 55.8-63.1). Sub-Saharan Africa (13.0%, 95%C.I. = 6.7-25.1) and South Asia (17.7%, 95%C.I. = 10.5-28.5) had the lowest prevalence of obesity whilst North Africa and the Middle East (35.8%, 95%C.I. = 23.8-44.8) reported the highest prevalence. People with SMI were 3.04 more likely (95% C.I. = 2.42-3.82) to have obesity than the general population, but there was no difference in the prevalence of overweight. Women with schizophrenia were 1.44 (95% C.I. = 1.25-1.67) times more likely than men with schizophrenia to live with obesity; however, no gender differences were found among those with bipolar disorder. Conclusion: People with SMI have a markedly high prevalence and higher odds of obesity than the general population. This may contribute to the very high prevalence of physical health conditions and mortality in this group. People with SMI around the world would likely benefit from interventions to reduce and prevent obesity.

Workplace Violence Against Doctors in Bangladesh: A Content Analysis.

Workplace violence in healthcare settings is a common global problem, including in Bangladesh. Despite the known presence of workplace violence in healthcare environments of developing countries, there is limited understanding of factors that lead to hospital violence in Bangladesh. This study aims to explore factors that influence incidents of violence against healthcare professionals in Bangladesh, as reported by doctors via social media forum. Content analysis was conducted on 157 reported incidents documented on "Platform," the online social media most used by medical students and doctors in Bangladesh. Posts by doctors detailing experiences of physical or verbal violence at their workplace between July 2012 and December 2017 were included in this study. The majority of reported incidents were reported by male doctors (86%) and from government hospitals (63.7%). Findings showed that primary healthcare centers experienced more violence than secondary and tertiary facilities. This may largely be due to insufficient human and other resources in primary care settings to meet patient demand and expectations. Most of the events happened at night (61%), and as a result, entry-level doctors such as emergency duty doctors and intern doctors were commonly affected. Six themes were identified as vital factors in workplace violence against doctors: patients' perspectives, delayed treatment, power practice, death declarations, extreme violence, and care-seeking behaviors. Most incidents fell under the categories of delayed treatment and power practice at 26.8 and 26.1%, respectively. This study identified possible factors for reported violence in hospital settings. To address and reduce these incidents, hospital administrators should be aware of risk factors for violent behavior and design appropriate measures to prevent workplace violence. Further qualitative and quantitative research is needed to appropriately address the consequences of violence on healthcare workers and implement measures to mitigate these events.

Health-Related Quality of Life among Rural-Urban Migrants Living in Dhaka Slums: A Cross-Sectional Survey in Bangladesh.

BACKGROUND: The study aimed to assess the health-related quality of life (HRQoL) and its associated factors among urban slum dwellers who migrated from different rural parts of Bangladesh. METHODS: The present study analyzed data from a Migration and Mobility Determinants on Health survey and was conducted in 2017 among 935 migrant slum dwellers of Dhaka city (North & South) and Gazipur City Corporations, as a part of the icddr,b's Urban Health and Demographic Surveillance System (UHDSS). The face-to-face interviews were conducted with the adult population by using a semi-structured questionnaire that included variables related to socio-demographics, migration, occupation, and HRQoL (SF-12). Bivariate and multiple linear regression analyses were performed to determine the factors associated with HRQoL. RESULTS: The mean (±SD) scores of physical component summary (PCS), and mental component summary (MCS) were 57.40 ± 22.73 and 60.77 ± 22.51, respectively. As per multiple regression analysis, lower PCS scores were associated with having older age, being female, and not having any job. Mean MCS scores were significantly lower among participants who reported having older age, not having any job, not working/ less working hours (≤8 h/day), as well as increased work-related stress in the current urban slum. CONCLUSIONS: The findings suggest that available urban social protection programs should include a comprehensive social safety net for the improvement of the slum infrastructure as well as proper health care and risk mitigation plans at workplaces.