Psychological distress and Quality of Life in Rural Bangladesh

The current project was a PhD project. Dr Nazim Uddin completed his PhD on this investigation.

Introduction: A significant proportion of the global burden of disease has been attributed to mental and behavioural disorders.  People with mental disorders (MD) have lower levels of health-related quality of life than those without MD. There is a lack of evidence of literacy, the prevalence and risk factors of common mental disorders , or any validated instruments to measure psychological distress or to evaluate the quality of life in rural areas of Bangladesh. 

Aims of the study were to (1) Report the awareness, knowledge, attitudes and practice (KAP) of MD, (2) Estimate the prevalence of and risk factors for  psychological distress, (3) Measuring association of psychological distress and other socio demographic factors with quality of life, (4) Test the feasibility to use of Kessler-10 and WHOQOL-BREFE questionnaires in rural Babgladesh for measuring psychological distress and quality of life.

Methods and Analysis: A sample of 1500 adults aged 18-59 years and 1200 older adults aged 60 to 90 years will be interviewed from a multi-stage cluster random sample. Each participant will go through a face-to-face interviewto assess their  awareness and KAP of MD.Information about the participant’s demographic and socio-economic status will also be collected along with psychological distress (K10) and quality of life (WHOQOL-BREF) questionnaire. Internal consistency, validity, reliability, and item discrimination of K10 and WHOQOL-BREF instruments will be determined by using Rasch analysis., and regression techniques. 

Strengths and Limitations of this Study

• This study was conducted using a large and representative sample from a typical rural district Narail to report the awareness, knowledge, attitudes and practice about mental health disorders.  
• The study estimated the prevalence of the factors associated with psychological distress to conduct appropriate intervention programs.
• The study applied a sophisticated Rasch analysis technique to validate the psychometric properties of the WHOQOL-BREF and Kessler 10 items (K10) questionnaire for their use in Bangladesh.  These validated tools can be used to measure psychological distress and quality life in the rural areas of Bangladesh, and in clinical setting.

SUMMARY FINDINGS

1. Of 2526 participants 52.5% had psychological distress, including 20.8% moderate and 9.0% severe.  
2. Compared to married, psychological distress among widowed older adults was almost five times higher
3. Psychological distress among very poor or wealthy was higher in middle class people
4. People living in pourashava (semi-urban areas) had higher rate of psychological distress compared to people living in typical rural unions.
5. Awareness of mental health problems, such as depression (8.5%), anxiety (6.2%), psychosis (3.5%), and bipolar disorder (3.3%), was found to be very low.
6. Insted of Kesseler-10 items, a revised seven-item scale has shown adequate for masuring psychological distress
7. Instead of WHO Quality of life questionnaire with 26 items, 18 items are adequate without losing any information.
8. 27.1% people were current smoker and 23.5% consumed bittle leaf. 
9. People with psychological distress smoked more, or smoker were more psychologically distressed.
10. Females living alone had pooer quality of life, males whose sources of income from relatives had below average quality of life,
11. Females engaged in income generation activities had better QoL

PEER-REVIEWED PUBLICATIONS:

1. Islam, FMA. Gender difference in domain-specific quality of life measured by modified WHOQoL-BREF questionnaire and their associated factors among older adults in a rural district in Bangladesh. PLOS One 2025. doi: 10.1371/journal.pone.0317113.
2. Uddin N. Islam FMA. 2020.Psychometric evaluation of the modified 19-item Bengali version of WHOQOL scale using Rasch analysis: a cross-sectional study of a rural district in Bangladesh. 2020. BMC Psychology, Vol 8, No.1. Article # 44.
3. Uddin N. Islam FMA. 2020. Psychometric evaluation of the modified Kessler seven-item version (K7) for measuring psychological distress using Rasch analysis: a cross-sectional study in a rural district of Bangladesh. BMJ Open, Vol 10, No.2. e034523.
4.  Islam, FMA. Psychological distress and its association with socio-demographic factors in a rural district in Bangladesh: A cross- sectional study. PLOS One. 2019. 10.1371/journal.pone.0212765.
5. Islam FMA and Walton A. Tobacco smoking and use of smokeless tobacco and their association with psychological distress and other factors in a rural district in Bangladesh: A cross-sectional study.Journal of Environmental Public Health. 2019. https://doi.org/10.1155/2019/1424592.  
6. Uddin N.Bhar S. Islam FMA. 2019. Awareness, knowledge, attitudes and practice regarding mental health disorders in the general population in a rural district in Bangladesh. BMC Health Service Research 13 August 2019. https://doi.org/10.1186/s12913-019-4385-6.
7. Uddin N. Islam FMA. Psychometric evaluation of an interview-administered version of the WHOQOL-BREF questionnaire for use in a cross-sectional study of a rural district in Bangladesh: an application of Rasch analysis. BMC Health Service Research. 2019. 19(1). https://doi.org/10.1186/s12913-019-4026-0
8. Uddin N. Islam FMA and Mahmud AA. Psychometric evaluation of an interview-administered version of the Kessler 10-item questionnaire (K10) for measuring psychological distress in rural Bangladesh. BMJ Open. 2018. http://hdl.handle.net/1959.3/444034.
9. Uddin N., Bhar S. Mahmud AA, Islam FMA. 2017. Psychological distress and quality of life in a rural district in Bangladesh: Methodology of the study. BMJ Open. 2017 Sep 1;7(9):e016745. doi: 10.1136/bmjopen-2017-016745.