Research Article: Psychological distress and its association with socio-demographic factors in a rural district in Bangladesh: A cross-sectional study

Date Published: March 13, 2019

Publisher: Public Library of Science

Author(s): Fakir M. Amirul Islam, Stefano Federici.


Psychological distress including depression and anxiety are among the most serious causes of morbidity and mortality in Bangladesh. There has been no study in the rural area to report the prevalence of and risk factors for psychological distress. The aim of this study was to estimate the prevalence of and risk factors for psychological distress in a rural district in Bangladesh.

A total of 2425 adults (1249 women) aged 18–90 years were selected from the Narail upazilla using multi-level cluster random sampling for a cross-sectional study. Psychological distress was assessed using the Kessler 10 items questionnaire. Participants’ socio-demographic status, life style factors and health conditions were also collected. Odds ratios and 95% confidence intervals for binary outcomes and mean changes for continuous outcomes of psychological distress score were computed. Logistic regression and generalized linear model techniques were used for analytical purpose.

The overall prevalence of psychological distress was 52.5%. This proportion included 22.7% people rated as having mild psychological distress, 20.8% moderate and 9.0% severe. The prevalence of moderate (24.7% vs. 17.5%, p<0.001) and severe (16.2% vs. 2.5%, p<0.001) psychological distress was significantly higher in older adults of age 60–90 years than that in younger adults of age 18–59 years. The prevalence of severe psychological distress was higher in females than males and the difference increased with age (vs. (females vs males: 1.9% vs. 1.1% at age of <30 years, 12.2% vs. 10.1% at age between 60–69 years, and 45.5% vs. 25.4% at age of 80 years or older). After multivariate adjustment, compared to degree or equivalent level of education, no education (odds ratio (OR), 1.71, 95% confidence interval (CI), 1.03–2.82) was associated with higher prevalence of any psychological distress in the total sample. Compared to married, psychological distress among widowed older adults was almost five times higher prevalence (OR, 4.89, 95% CI, 2.51–9.55). Socio-economic status showed a U-shaped relationship with the prevalence of psychological distress; being very poor or wealthy was associated with higher prevalence of psychological distress compared to those of moderate socio-economic status. People living in pourashava (semi-urban areas) reported significantly higher prevalence of psychological distress compared to people living in typical rural unions. In this rural Bangladeshi community, the prevalence of psychological distress was high, especially among older women. Factors including lower level of education, inability to work, and living in semi-urban areas were associated with higher prevalence of psychological distress. Public health programmes should target people in high risk groups to reduce their psychological distress in Bangladesh.

Partial Text

Psychological distress is common across the world [1, 2]. There are currently over 542 million people living with depression or anxiety symptoms, which represents an increase of more than 18% from 2005 to 2015 [3–5]. It is projected that one in four individuals globally will be affected by depressive symptoms at some point in their lifetime [6, 7]. If this depression is present with chronic diseases as co-morbid conditions, it can reduce life expectancy by approximately 20 years [8]. Psychological distress is the presence of a number of depressive symptoms including lack of enthusiasm, feeling hopeless about the future, and anxiety symptoms [9].

Of 2425 participants, 51.5% were female (52.8% in adults and 50% in older adults). In comparison of socio-demographic factors between adults and older adults, 13.4% vs. 43.6% had no schooling, 9% vs. 30% had house duties, 16% vs. 7.9% were labourers, 91% vs. 68% were married, 3% vs. 32% were widowed, 26% vs. 28.6% were tobacco smokers and 11.0% vs. 37.9% consumed smokeless tobacco (SLT), respectively (Table 1).

Our study reported the prevalence of psychological distress, its severity and its associations with socio-demographic, lifestyle and medical conditions in a typical rural district in Bangladesh. Using the internationally validated K10 psychological distress measuring tool[27], we report that overall 52.5% of adults had any psychological distress—44% in people who were younger than 60 years of age and 62% in people who were older or equal to 60 years of age. Severe psychological distress was nine times more likely in older adults compared to younger adults. The study adds further evidence of high prevalence of psychological distress to a literature that was lacking current data for more than a decade.

The prevalence of psychological distress in a rural area in Bangladesh was considerably high. Generally, the prevalence of mild psychological distress was similar in males and females but the prevalence of moderate and severe psychological distress in females showed a sharp increase after the age of 60 years. The risk factors associated with psychological distress in this sample included older age, low SES, being widowed, being unable to work and having a medical condition. The study suggests that hypertension, diabetes and other chronic diseases are closely linked and suggest a need for management through a common strategy.