Validation of the Bangla version of Beck Depression Inventory-II.

BACKGROUND: Beck Depression Inventory (BDI-II) is a widely used valid instrument to assess the severity of depression in clinical and normal settings. To meet the necessity of a standard scale for measuring depression among above 265 million Bangla speaking population around the world, this scale was translated and validated. METHODS: Two translations of BDI-II into Bangla were prepared, and then, two back translations were done by medical and language experts in parallel. Thereafter, sentence revision followed by pretest on 20 respondents was done to finalize the Bangla version of BDI-II (BDI-II BV). Afterward, a cross-sectional, comparative, and descriptive study was conducted to validate the scale by purposive sampling technique consisting of 111 persons (both clinical and normal) in three tertiary-level hospitals in Bangladesh. Everyone was given to fill up BDI-II BV at first. Then, they were given to fill up BDI-II BV (n = 49), Bangla version of Depression Anxiety Stress Scales 21-item (DASS21-BV, n = 47) and BDI-II (n = 25) 3-7 days later. The diagnosis of depressive disorder was made according to DSM-5. Correlation study and factor analysis were completed. RESULTS: The mean age was 28.83(±8.70) years. The male-female ratio was 1:0.82. Correlation of scores for BDI-II BV with the DASS21-BV depression subscale was .920; BDI-II BV with BDI-II was .985 (Cronbach's α .993; t test not significant) and BDI-II BV applied first and the second time was .960 (Cronbach's α .979; z test not significant). The interitem correlation for all the items was found highly significant (p < .01). Patients having depressive disorder or episodes had significantly higher BDI-II BV scores than normal (M + SD 30.18 + 10.127 than 8.34 + 5.910; p < .001). Partial confirmatory factor analysis demonstrated two-factor loading comprising Cognitive and Somatic-affective symptoms. CONCLUSIONS: Through the translation and validation process, a validated Bangla version of BDI-II was produced to measure depression and its severity among the Bengali population.

Depression, Anxiety, Stress among Postgraduate Medical Residents: A Cross Sectional Observation in Bangladesh.

Objective: Medical training has been reported as being stressful, and postgraduate medical training environment has always been regarded as highly stressful, which may lead to different psychiatric disorders. In this study, it was aimed to determine the extent of depression, anxiety, and stress among the postgraduate medical residents of Bangladesh. Method : This cross sectional study was conducted at the Department of Psychiatry of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Data were collected from 200 residents through face to face interview which was conducted by a psychiatrist using research instruments. Initially, respondents were approached by cluster sampling. Then, they were selected from each cluster using simple random sampling method (lottery method). Sample size was calculated by considering the prevalence of 50%; however, 200 residents were interviewed due to time constraints. The questionnaire consisted of 3 parts: (1) demographic variable, (2) the structured clinical interview for DSM-IV Axis-I disorders, and (3) Bangla Depression Anxiety Stress Scale (DASS-21). Data were analyzed using software Statistical Package for Social Sciences version 16.0. Results: Distribution of depression, anxiety, and stress revealed that 11.5% of the residents had depressive disorders, 11% anxiety disorders, and 10.5% stress disorders. Also, it was found that 14.5% of the respondents were found to have at least one of three disorders. The DASS-21 score revealed that 6% of the residents had severe to extremely severe depression, 3.5% severe to extremely severe anxiety, and 6.5% severe to extremely severe stress disorder. Conclusion: The study revealed that one in every seven residents has been suffering from at least one disorder from depression, anxiety, and stress related disorders. A large-scale multicenter study is recommended to validate the findings of the present study.

Pathways to psychiatric care in Bangladesh.

INTRODUCTION: The pattern of care seeking of psychiatric patients is important for service and policy issues. We conducted a study in 2008 in Bangladesh to find out the referral patterns, delays to reach mental health professional (MHP), diagnoses and treatment received before reaching psychiatric care etc. MATERIALS AND METHODS: We interviewed 50 consecutive new patients at the Psychiatry outpatient department of a tertiary hospital using the translated version of WHO pathway encounter form. RESULTS: 84% of the patients we interviewed consulted other carers before they arrived at a MHP (2.5-3.1 steps were needed to reach MHP) and the range of delay was 8-78 weeks (indirect pathway). 16% of the patients came directly to a MHP with mean delay of 10.5 weeks from onset of mental illness (direct pathway). Among the patients who took the indirect pathway 44% first visited the Individual Private practitioners (PP), 22% first visited native or religious healers (NRH) and 12% rural medical practitioners (RMP). Patients reaching NRH or RMP made the least delay (2-2.5 weeks) and the shortest pathway to MHP (4.5-7 weeks). Most delay occurred from PP to MHP/General Hospital (22-31 weeks). About a third of patients were informed of diagnosis with poor concordance with the diagnosis made by MHP. 70 and 40% of patients with mental illness who attended General Hospital and PP were referred to MHP, respectively. CONCLUSION: In the study we found four major pathways to mental health care in Bangladesh. They are direct pathway and referrals from PP, general hospitals and NRH. PP did not play a pivotal role in reaching MHP. Family members had a significant role on the decision to seek help from health service.