Risk factors for suicide in Bangladesh: case-control psychological autopsy study.

BACKGROUND: Suicide is an important, understudied public health problem in Bangladesh, where risk factors for suicide have not been investigated by case-control psychological autopsy study. AIMS: To identify the major risk factors for suicide in Dhaka, Bangladesh. METHODS: We designed a matched case-control psychological autopsy study. We conducted a semi-structured interview with the next-of-kin of 100 individuals who died by suicide and 100 living controls, matched for age, gender and area of residence. The study was conducted from July 2019 to July 2020. RESULTS: The odds ratios for the risk factors were 15.33 (95% CI, 4.76-49.30) for the presence of a psychiatric disorder, 17.75 (95% CI, 6.48-48.59) for life events, 65.28 (95% CI, 0.75-5644.48) for previous attempts and 12 (95% CI, 1.56-92.29) for sexual abuse. CONCLUSIONS: The presence of a psychiatric disorder, immediate life events, previous suicidal attempts and sexual abuse were found as significant risk factors for suicide in Dhaka, Bangladesh.

The prevalence of psychiatric disorders among 3-4 year olds in an urban sample in Bangladesh.

Preschool period is the most important stage of life when major development occurs that lays the foundation of later life. Nearly similar ranges of psychiatric disorders start during preschool age and they continue to childhood and adolescence. Early intervention can reduce risks of adverse psychosocial outcome and longitudinal continuity of disorders. Detailed assessment of psychiatric disorders among this population is increasingly of high importance. Present study was aimed to determine the prevalence of psychiatric disorders among 3-4 year olds and to find out possible baseline correlates. This was a quantitative, cross-sectional and descriptive study carried out from March to May 2018 in 160 random urban community samples of Dhaka city. Of these, 86 were boys and 74 were girls. Household Questionnaire and validated parent version of Bangla Strengths and Difficulties Questionnaire (SDQ) for screening psychopathology had been applied to the consented parents or caregivers of the respondents. Mean age of the subjects was 3.63 ± 0.49 years. Overall, predictive prevalence of psychiatric disorder was 11.9 %. Among them, 4.4 % was emotional disorder, 5.6 % was conduct disorder and 1.9 % was hyperactivity. Prevalence of predictive psychiatric disorders was roughly similar in 3 and 4 years age. Girls had an excess of emotional disorder and boys had more behavioral disorder. Comorbidity was found at a higher rate with significant overlapping among the broad types of psychiatric disorders. This study supports the other findings of psychiatric disorders among the preschool children that would ultimately help in applying suitable screening procedures and subsequent management of psychiatric conditions.

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.

Clinical Profile and Comorbidity of Obsessive-Compulsive Disorder among Children and Adolescents: A Cross-Sectional Observation in Bangladesh.

Obsessive compulsive disorder (OCD) is a common disorder characterised by persistent and unwanted intrusive thoughts, images, and urges and repetitive behaviours or mental acts and can cause pervasive impairments. In Bangladesh, the prevalence of OCD among children is 2% which is higher than in previous reporting. This study was aimed at looking into the type, frequency, and severity of symptoms of OCD and comorbidity among children and adolescents. A consecutive 60 OCD cases from a child mental health service with age range of 5-18 years were recruited and divided into below and above 12 years of age group. The assessment was carried out using standardized Bangla version of Development and Wellbeing Assessment and Children's Yale-Brown Obsessive Compulsive Scale was administered. Of the obsession, contamination was the highest followed by doubt, and of the compulsion, washing/cleaning was the highest followed by checking, repeating, and ordering rituals. More than half of the subjects had severe OCD and comorbidity was present in 58% subjects. Specific phobia, social phobia, major depressive disorder, and tic disorder were more prevalent. These symptoms and comorbidity profile can serve the baseline data for a country like Bangladesh and further large scale study would better generalize the study results.

Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence.

PURPOSE: To examine whether the widely used Strengths and Difficulties Questionnaire (SDQ) can validly be used to compare the prevalence of child mental health problems cross nationally. METHODS: We used data on 29,225 5- to 16-year olds in eight population-based studies from seven countries: Bangladesh, Brazil, Britain, India, Norway, Russia and Yemen. Parents completed the SDQ in all eight studies, teachers in seven studies and youth in five studies. We used these SDQ data to calculate three different sorts of "caseness indicators" based on (1) SDQ symptoms, (2) SDQ symptoms plus impact and (3) an overall respondent judgement of 'definite' or 'severe' difficulties. Respondents also completed structured diagnostic interviews including extensive open-ended questions (the Development and Well-Being Assessment, DAWBA). Diagnostic ratings were all carried out or supervised by the DAWBA's creator, working in conjunction with experienced local professionals. RESULTS: As judged by the DAWBA, the prevalence of any mental disorder ranged from 2.2% in India to 17.1% in Russia. The nine SDQ caseness indicators (three indicators times three informants) explained 8-56% of the cross-national variation in disorder prevalence. This was insufficient to make meaningful prevalence estimates since populations with a similar measured prevalence of disorder on the DAWBA showed large variations across the various SDQ caseness indicators. CONCLUSIONS: The relationship between SDQ caseness indicators and disorder rates varies substantially between populations: cross-national differences in SDQ indicators do not necessarily reflect comparable differences in disorder rates. More generally, considerable caution is required when interpreting cross-cultural comparisons of mental health, particularly when these rely on brief questionnaires.

Teaching and training in psychiatry and the need for a new generation of psychiatrists in Bangladesh: role of the Royal College of Psychiatrists.

Bangladesh is a small, populous South Asian nation with poor literacy, limited resources and a lack of basic healthcare. Caring for people with psychiatric disorders in such a setting is challenging. The prevalence of psychiatric disorder in Bangladesh is similar to that in other countries, yet there is a severe shortage of well trained psychiatrists and a lack of even basic mental health services. To generate large numbers of well trained psychiatrists, Bangladesh must expand its high-quality psychiatric training and education at both the postgraduate and the undergraduate levels. To achieve these ambitious goals, Bangladesh needs help and assistance from regional and international institutions. The Royal College of Psychiatrists can play a role of critical psychiatric public health importance by helping Bangladesh locally train a new generation of psychiatrists who will care for the vast number of those with ailments of mind and soul.

Psychiatric morbidity, stressors, impact, and burden in juvenile idiopathic arthritis.

Juvenile idiopathic arthritis (JIA) is a chronic painful disorder conceivably with adverse psychological sequelae that might influence the outcome of the disease and its treatment. This study was designed to detect the presence of psychiatric disorders and associated abnormal psychosocial situations among children and adolescents with JIA and to evaluate their impact on and burden for their caregivers. Forty subjects with JIA suffering for at least one year were included in the study. Forty age- and sex-matched healthy subjects were included as controls. Clinical psychiatric assessment was carried out blindly, and psychiatric disorders and stressors on abnormal psychosocial situation were assigned on the basis of ICD-10 clinical diagnoses of multiaxial classification of child and adolescent psychiatric disorders. Chronicity, distress, social impairment, and burden for others were rated with the impact supplement of the strengths and difficulties questionnaire (SDQ). Of the 40 cases of JIA, 24 were boys and 16 were girls aged 10-18 years, with a mean age of 13.25 years. The frequency of psychiatric disorders was 35% in the JIA and 12.5% in the control group (p<0.001). The long duration of illness was associated with a higher proportion of cases with psychiatric disorders. In the JIA group, the diagnoses in decreasing order were depressive disorder (15%), somatoform disorder (12.5%), adjustment disorder (5%), and mixed anxiety and depressive disorder (2.5%). Significantly higher stressors, perceived difficulties, distress, social impairment, and burden for caregivers were reported in the JIA group with psychiatric morbidity. The presence of psychiatric disorders was associated with substantial impairment of learning, peer relationship, and leisure activities. Early psychiatric intervention might increase the likelihood of satisfactory outcome of treatment in JIA.