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Research Article | DOI: https://doi.org/10.31579/2768-0487/142
1Assistant Medical Coordinator, Medecins Sans Frontieres- Bangladesh Mission.
2Bachelor of Public Health student, German University Bangladesh.
3Graduate Student, University of Missouri, United States of America.
4Bachelor of Arts Student, City University, New York.
*Corresponding Author: Atiya Sharmeen, 1Assistant Medical Coordinator, Medecins Sans Frontieres- Bangladesh Mission.
Citation: Atiya Sharmeen, Khondoker M. Hossen, Fahim Ahmed, Jabin Tasnim, (2024), Variation of Mental Health Status Among Socio-Economic Groups, Journal of Clinical and Laboratory Research. 7(6); DOI:10.31579/2768-0487/142
Copyright: © 2024, Atiya Sharmeen. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 20 June 2024 | Accepted: 28 June 2024 | Published: 05 July 2024
Keywords: mental health; socio-economic class; vulnerability
There is a persistent lack in detecting the vulnerability and care for mental health disorders among the populations of low-and-middle-income countries like Bangladesh. Socio-economic factors have been the key determinant for this negligence. Also, a suitable screening tool is essential to assess the disorders to ultimately plan for a mental health action. In this study, we aimed to assess the mental health disorders in various socio-economic groups using modified Self Reporting Questionnaire 20 (SRQ-20) as a potential questionnaire-based screening-tool. A total of 576 participants having various socio-economic backgrounds were screened to assess the vulnerability and detect the mental health disorders through the questionnaire-based survey. It was a prospective community-based data collection. Middle-income group had significant-level of vulnerability to develop mental health disorders. In a similar way, highest number of somatic and cognitive disorders and anxiety and depression were detected among the same income group. Treatment seeking behavior for mental health disorder was high among middle and richest group. The symptoms of mental health disorders were more in middle income comparing with richest household except headache, thinking ability and lost interest. Cognitive disorder was same in middle & richer household. Lower income group has low prevalence. Taken together, modified SRQ-20 could be an effective survey tool to detect vulnerability to develop mental health disorders. However, a large group study including confirmatory psychiatric assessment by physician would be essential to further validate the result of the study.
Mental health is a pillar of health, nobody can avoid it and it has vital connection to physical health and World Health Organization (WHO), rightly states that mental health is a state of wellbeing in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. It is obvious assumption that mental health status definitely varies according to socioeconomic parameters but need to be specifically studied considering local context. Our day to day observation we usually find that most of the cases regarding mental health issues, problems are masked and hindering due to socio-cultural taboos. Presumptive identification can be useful tool to filtering those issues in a systemic manner. The main contributor to the mental ill-health burden is depression, which along with anxiety and somatic complaints affects one in three people within their lifetime.1 Mental health disorder is one of the most neglected disease categories that have contributed to 13% of global morbidities, when present as a comorbidity with other chronic diseases, it can reduce the life expectancy by 20 years.2 In Bangladesh to some extent; the situation is alarming. All of the community studies identified a very high prevalence of mental health disorders. Self-Reporting Questionnaire 20 (SRQ-20) is a screening tool, which is a valid tool for screening of mental health disorder according to WHO.3 With the help of this screening tool, early detection of mental health disorder can be done at community level. In 2006 Bangladesh mental health policy, strategy and plan was approved. The policy addressed the prevention & surveillance of non- communicable disease & community-based activity in mental health.3 This screening tool can be adapted in the surveillance system of mental health.3 With this screening tool we can compare the prevalence of mental health disorder between the lower and middle socio-economic group of Dhaka city.4
It was a prospective study and carried out by obtaining data from the household by using the SRQ-20. The sociodemographic data and other relevant variables of the participant were collected from household. From each household one trained research assistant collected the data from the participants. The questionnaires were translated in Bengali. The questions of SRQ-20 were explained to the participants by the field research assistant. Yes, answer to more than 7 questions is considered as vulnerability to develop mental disorders. Most of the similar study in our country, the data was captured in hospital setup or in private chamber. There is no comparison study by using the similar variables in household level. From May 2018 to December 2018 data were collected from different locations of Dhaka city. Data were entered by data entry operator, were analyzed by using statistical package for Social Science (SPSS) Version -20.
| Characteristics | Categories | n (%)/mean ± SD | 95% CI |
| Age (years) | Mean | 36.60 ± 14.85 | (35.39, 37.79) |
| Sex | Female | 310 (54) | (49.8-57.6) |
| Male | 266 (46) | (42.4-50.2) | |
| Type of the family | Nuclear | 372 (65) | (60.6-68.4) |
| Extended | 204 (35) | (31.6-39.4) | |
| Marital status | Single | 52 (9) | (6.8-11.1) |
| Married | 493 (86) | (83.0-88.4) | |
| Separated | 17 (3) | (1.6-4.3) | |
| Divorced | 1 (0.1) | (0.0-0.5) | |
| Widow/ widower | 13 (2) | (1.2-3.5) | |
| Level of education | No education | 134 (23) | (19.6-26.6) |
| Primary | 66 (11) | (8.9-14.2) | |
| Secondary | 122 (21) | (18.1-24.8) | |
| Higher Secondary | 210 (36) | (32.5-40.5) | |
| Graduation | 34 (6) | (4.0-8.0) | |
| Post-graduation | 10 (2) | (0.7-3.0) | |
| Occupation | Unemployed | 37 (6) | (4.5-8.5) |
| Day-laborer | 76 (13) | (10.4-16.0) | |
| Garment worker | 46 (8) | (5.9-10.2) | |
| Government job | 6 (1) | (0.3-1.9) | |
| Private job | 43 (7) | (5.4-9.9) | |
| Housewife | 153 (27) | (23.1-30.2) | |
| Part-time job | 16 (3) | (1.6-4.2) | |
| Other job | 199 (35) | (30.6-38.4) | |
| Monthly Income | Low-income (≤10) | 37 (6) | 4.5-8.3 |
| Middle-income(10-30) | 300 (52) | 48.1-56.1 | |
| Richest house hold (>30) | 239 (42) | 37.7-45.5 |
The socio-demographic characteristics of the participants (n=576) are shown in (Table 1).
Mean age for the participants was 36.6 years where 54% were female and 65% of the participants lived in a nuclear family. Almost 86% of them were married, 36% of them were house-wives and 35% were involved in other occupations. Majority (52%) of the participants were from middle-income category and 42% were from richest household. According to the modified SRQ-20, each of participants were assessed for mental health through the predefined 24-questions.
| Questions asked | Low-income n (%) | Middle income n (%) | Richest household n (%) | Total |
| Do you often have headaches? | 15 (7) | 119 (56) | 78 (37) | 212 |
| Do you have uncomfortable feelings in your stomach? | 10 (8) | 72 (59) | 40 (33) | 122 |
| Is your digestion poor? | 7 (7) | 57 (58) | 35 (35) | 99 |
| Is your appetite poor? | 13 (8) | 88 (58) | 52 (34) | 153 |
| Are you easily tired? | 18 (9) | 124 (59) | 69 (33) | 211 |
| Do you feel tired all the time? | 8 (11) | 41 (54) | 27 (36) | 76 |
| Do you sleep badly? | 11 (7) | 79 (53) | 58 (39) | 148 |
| Do your hands shake? | 12 (11) | 67 (59) | 35 (31) | 114 |
| Are you easily frightened? | 7 (10) | 44 (61) | 21 (29) | 72 |
| Do you find it difficult to make decisions? | 6 (10) | 31 (52) | 23 (38) | 60 |
| Is your daily work suffering? | - | 17 (61) | 11 (39) | 28 |
| Do you have trouble thinking clearly? | 1 (4) | 8 (32) | 16 (64) | 25 |
| Do you find it difficult to enjoy your daily activities? | 2 (7) | 17 (63) | 8 (30) | 27 |
| Do you cry more than usual? | 11 (13) | 42 (49) | 33 (38) | 86 |
| Do you feel unhappy? | 8 (13) | 37 (62) | 15 (25) | 60 |
| Do you feel nervous, tense or worried? | 7 (11) | 37 (56) | 22 (33) | 66 |
| Do you feel that you are a worthless person? | 7 (13) | 32 (60) | 14 (26) | 53 |
| Are you unable to play a useful part in life? | 3 (14) | 13 (59) | 6 (27) | 22 |
| Has the thought of ending your life been in your mind? | 2 (11) | 11 (61) | 5 (28) | 18 |
| Have you lost interest in things? | - | 7 (44) | 9 (56) | 16 |
| Do you feel that somebody has been trying to harm you in some way? | 4 (11) | 21 (58) | 11 (31) | 36 |
| Are you a much more important person that most people think? | 3 (8) | 19 (47) | 18 (45) | 40 |
| Have you noticed any interference or anything else unusual with your thinking? | 2 (12) | 8 (50) | 6 (38) | 16 |
| Do you ever hear voices without knowing where they come from out which other people cannot hear? | 1 (7) | 10 (72) | 3 (21) | 14 |
Answers received from the participants were noted and counted accordingly (Table 2).
Vulnerability for developing mental health disorders were highest among middle-income people (n=47 and 13). Richest households showed vulnerability and prevalence of mental health disorders next to middle-income (n= 20 and 11). Low-income group showed the vulnerability and prevalence at lowest (n=9 and 2). Pearson’s Chi-square test showed significant association between vulnerability and economic groups while richest households and middle-income groups were considered.
Mental disorder as a disorder that has increased by 41% worldwide between 1990 to 2010.3 The percentage of old age people is increasing. With the increase of aging population depression, anxiety, mental & neurological disorder has increased. An article on Lancet Psychiatry says that, the number of mental health disorder among old age have been notreportedcorrectly.5 There is no documentation of suicidal cases in manycountries.6 The modified version of SRQ-20 was used to screen the vulnerability of developing mental health disorder. Both the vulnerability of mental health disorders was highest among middle-income people 47 (8%) and prevalence of mental health disorders is 3 %. Richest household have prevalence of mental health disorder 4% and Prevalence 2 % among the whole population.7 In Some Studies shows that Four out of every ten people suffering from mental disorders such as schizophrenia, depression, intellectual disability, alcohol use disorders, epilepsy, and those committing suicide are living in low-and middle-income countries.8 The burden of mental health disorder of low and middle- income countries is higher than developed country. Among the cause of the disease burden, mental health disorder ranks four out of ten. Still, it remains less important in the agenda of policy planning in middle- and lower-income country. There is immediate need to address the social stigma regarding illness associated with mental health. The mental healthcare needs to be available and accessible to every one of the communities.9 Bangladesh also does not have appropriate human resources to give the mental health services. Dhaka based National Institute of Mental Health has given significant effort on mental health. The health care system also has to address the disease burden regarding mental health. WHO has defined mental health as a state of wellbeing on which people can realize their potentials, can cope up with the stress of life. In this way, they can contribute to the community.10 The limitation in this study was that we could not reach all economic groups of Dhaka city. We have searched for but could not obtain similar data in ultra-poor group. As the perception about mental health is very limited in this group. They do not notify the symptoms of the disease.
The findings of this study can be utilized to establish the modified SRQ 20 as a screening tool for early detection of mental health disorders. These cases can be identified and treated earlier. This tool can be used as a preventive measure and basic screening tool at community level. This can be used in college& university level for early detection of suicide and prevention of suicide.
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