Mental health, quality of life, and nutritional status of adolescents in Dhaka, Bangladesh: Comparison between an urban slum and a non-slum area

doi:10.1016/j.socscimed.2006.04.013

Social Science & Medicine

Volume 63, Issue 6, September 2006, Pages 1477-1488

https://doi.org/10.1016/j.socscimed.2006.04.013 Get rights and content

Abstract

This study aims to clarify the quality of life (QOL), mental health, and nutritional status of adolescents in Dhaka city, Bangladesh by comparing non-slum areas and slums, and to find the factors associated with their mental health problems. A sample of 187 boys and 137 girls from non-slum areas, and 157 boys and 121 girls from slums, between 11–18 years old were interviewed with a questionnaire consisting of a Bangla translation of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF), Self Reporting Questionnaire (SRQ), Youth Self-Report (YSR) and other questions. The height and weight of the respondents were measured. All significant differences in demographic characteristics, anthropometric measures, and WHOQOL-BREF were found to reflect worse conditions in slum than in non-slum areas. Contrarily, all differences in SRQ and YSR were worse in non-slum areas for both genders, except that the “conduct problems” score for YSR was worse for slum boys. Mental states were mainly associated with school enrolment and working status. Worse physical environment and QOL were found in slums, along with gender and area specific mental health difficulties. The results suggest gender specific needs and a requirement for area sensitive countermeasures.

Introduction

According to the World Health Organization (WHO), about 450 million of the world's population suffer from mental or neurological disorders or from psychosocial problems; while one in every four persons is affected by a mental disorder at some stage in their life (WHO, 2001a). In particular, major depression, with a life time prevalence of 10–25% for females and 5–12% for males (American Psychiatric Association, 2000), is ranked fourth in terms of the global burden of disease, and is projected to be the second cause of the global disease burden within 20 years (WHO, 2001a). However, mental health issues tend to be overtaken by other health problems, especially in developing countries.

Particularly, such situations in the ever increasing slum areas is a global concern with rapid urbanization taking place in developing countries, where slum inhabitants today are estimated to constitute 60% of the inhabitants in big cities (Hussain, Ali, & Kvale, 1999). Urbanization has been shown to be associated with higher incidents of injuries from traffic accidents (United Nations Environment Programme, & WHO, 1994), respiratory illness (Lovik, Dybing & Smith, 1996; SIDRIA, 1997), cancer (Schouten, Meijer, Huveneers, & Kiemeney, 1996), cardiovascular diseases and hypertension (Barnett, Strogatz, Armstrong, & Wing, 1996; Kaufman, Owoaje, James, Rotimi, & Cooper, 1996; Mufundu, Sigola, Chifamba, & Vengesa, 1994), deterioration in infant and child mortality (Backmann, London, & Barron, 1996; Kuate Defo, 1996; Sastry, 1997), and mental health problems (Cheng, 1989; Gillis, Welman Kock, & Joyi, 1991; Mueller, 1981; Rahim & Cederblad, 1986; Shepherd, 1984; Sijuwade, 1995; Varma et al., 1997). As for children's and adolescents’ mental health, Takano, Nakamura, and Watanabe (1996) indicated that in young people urbanization increased risks such as drug, alcohol, tobacco, and risky sexual behaviours, and that these behaviours were linked to the rise of psychological problems. Also, Harpham (1994) pointed out that urbanization initiated rapid social changes, disintegration, dissolution of social relations, and decreased social control, and that these factors contributed to mental diseases particularly in young people. However, research regarding the mental health status of slum-living adolescents is lacking.

In Bangladesh, there has been no official data on mental health. As to mental health research in Bangladesh, Islam, Ali, Ferroni, Underwood and Alam (2003) conducted a community survey in urban middle-class adult population in Dhaka, and presented prevalence of psychiatric disorders as 28%. A study of a married rural population utilizing MOS-Short Form 36 (SF-36) by Ahmed, Rana, Chowdhury and Bhuiya (2002) showed consistent negative self-evaluation of mental health status, and its deterioration with the advancement of age. Khan (2002) indicated suicides in the countries of the Indian subcontinent including Bangladesh had differences from those in Western countries, showing higher organophosphate insecticides use, a higher ratio of married women, fewer elder subjects, and more problems in interpersonal relationship and life events as causative factors. As to children, Rabbani and Hossain (1999), using teachers’ reports, showed that 13.4% of urban primary school children in Dhaka had emotional, conduct or undifferentiated disorders. As to adolescents, though the reliability and validity of the Strengths and Difficulties Questionnaire (SDQ) has been assessed utilizing adolescent subjects (Goodman, Renfrew, & Mullick, 2000; Mullick & Goodman, 2001), the mental health status of such subjects remains unclear. To add to the prevailing poverty and severe health status; 33% of the total population of approximately 129 million is malnourished and the infant mortality rate in 2000 was 54 in 1000 births (United Nations Development Programme, 2002; World Bank & Bangladesh Centre for Advanced Studies, 1998), the urban growth rate in Bangladesh is projected to be 5.4% in the period 1999–2010 (Bangladesh Bureau of Statistics, 2002), and Bangladeshi urban population in 2020 is estimated to be nearly half the national total; and that of its capital Dhaka will be doubled by 2010 (WHO, 1997). A good percentage of this population increase will reside in slums due to lack of job opportunities, income and housing. Thus the mental health status of children and adolescents in urban slum population in Bangladesh needs to be evaluated.

Therefore, this study aimed at (A) clarifying the QOL, general mental health, behavioural, emotional and social problems and nutritional status of adolescents in Dhaka city, Bangladesh in comparisons between non-slum area adolescents and slum area adolescents using internationally comparable scales; and (B) finding factors (age, sex, nutritional status, educational status, job status, and family income) associated with mental health problems.

Section snippets

General population subjects

This study was conducted in Dhaka, the capital of Bangladesh. To obtain a representative cross sample of Dhaka city, six wards were randomly selected, with one non-slum area and one slum area being selected from each ward as study sites. A UN expert group established an operational definition of slums as being an area that to various extents combines the following characteristics: inadequate access to safe water; inadequate access to sanitation and other infrastructure; poor structural quality

Demographic characteristics

Demographic data are shown in Table 1. Since there was a significant age difference between the Non-Slum and Slum groups for both genders $(p < 0.01)$ ; parametric analyses between the groups were performed using age as the covariate. Almost all of the respondents in this research were Muslim and of Bangla ethnicity. Slum adolescents had significantly lower school enrolment, literacy, family income and higher employment rates than non-slum area adolescents $(p < 0.01)$ . There was no significant

Discussion

The present study investigated Bangladeshi urban adolescents’ QOL and mental health status utilizing internationally recognized scales. At the same time, this study showed differences in living status, QOL, mental health and nutritional status between adolescents in urban slums and those living in non-slum areas.

Slum adolescents had lower school enrolment rates, lower literacy rates, lower family incomes, lighter weights, lower BMI (in females only a tendency was observed), and higher rates of

Acknowledgements

The authors would like to express their gratitude to National Institute of Mental Health, Bangladesh, and to the interviewers Abu Ala Mahmudul Hasan, Anjuman Tahmina Ferdous, Imran Al Amin, Jasmin Khan, Khadiza Begum, Md. Saiful Islam, Shormin Sultana, Zahangir Alam, and Md. Iqbal Hossain for their enormous contribution, and without whom the data collection would have been impossible. This study was supported by Mitsubishi Foundation grants for social welfare activities.

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Following ethics clearance from the ethics committees of the University of Alberta and University of Ghana, a cross-sectional survey was carried out in the Summer of 2018 with a snowballed sample of older adults residing in the Nima slum (n = 302) and the Adabraka-Asylum Down non-slum neighbourhood (n = 301). The sample size was computed using Dhand and Khatkar's (2014) statistical tool, the pooled mean difference and standard deviation of a similar study (Izutsu et al., 2006), and an alpha level of 0.01. The sample size computation yielded 255 respondents for each neighbourhood, which we deemed as: (1) having a 90% statistical power for detecting statistically significant differences in mean QoL scores between the two independent samples, if any existed; and (2) being adequate for statistically adjusting for the confounding influence of covariates in multivariable regression analyses.
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To assess the mental health risk associated with exposure to violence among Bangladeshi youth.
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Independent of age, sex, and food security, exposure to violence is significantly associated with mental illness symptomology. These relationships are not the same between adolescent boys and girls, or between depressive and anxiety symptoms. We explain the differences using Susan Rosenfield’s concept of gender differences in externalization and internalization of problems. Implications are discussed.
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Aunque se espera que el comportamiento de viajeros afecte su salud personal, pocas investigaciones han estudiado el efecto de estos comportamientos sobre la salud mental. En este estudio examinamos asociaciones entre patrones de viaje y salud mental en individuos de 11 ciudades de América Latina.
Utilizamos una encuesta del Banco de Desarrollo de América Latina (CAF) del 2016, para medir la presencia de síntomas depresivos con la escala de tamizaje de depresión del Center for Epidemiologic Studies (CESD-10). Usamos modelos de multinivel no-lineales para estimar asociaciones entre patrones de viaje y riesgo de depresión, ajustando por factores socio-demográficos individuales y características del vecindario de residencia.
Encontramos que en promedio, cada 10 minutos adicionales de tiempo de viaje están asociados con un aumento de 0.5% (p = 0.011) en la probabilidad de presentar síntomas depresivos de acuerdo con la prueba de tamizaje. Al descomponer el tiempo de viaje en tiempo de demora por congestión y tiempo de viaje sin congestión, encontramos que el tiempo de demora por congestión está asociado con síntomas depresivos, más no el tiempo sin congestión. Específicamente, cada 10 minutos adicionales de tiempo de demora están asociados con 0.8% (p = 0.037) mayor probabilidad de presentar síntomas depresivos. Cuando comparamos los resultados por medio de transporte utilizado, encontramos que usuarios del sistema de transporte público formal (p.ej. metro o buses rápidos) tienen una probabilidad 4.8% (p = 0.040) menor de presentar estos síntomas depresivos con relación a conductores de vehículos privados. Además, no tener paradas de transporte público (formal o informal) a diez minutos o menos a pie del lugar de residencia está asociado con una probabilidad más alta de presentar síntomas depresivos.
Esta es evidencia preliminar que muestra que la utilización de transporte masivo, mejor acceso a éste, y menor congestión están asociados a mejor salud mental de los residentes de la ciudad.
Padrões de deslocamento influenciam a saúde pessoal do indivíduo, porém, poucos estudos examinaram suas associações com a saúde mental. Este estudo examina associações entre padrões de deslocamento e saúde mental usando dados de inquéritos realizados em 11 cidades da América Latina.
Utilizando uma pesquisa realizada pelo Banco de Desenvolvimento da América Latina em 2016, medimos a presença de sintomas depressivos usando a escala de triagem do Centro de Estudos Epidemiológicos de Depressão (CESD-10), com 10 itens. Utilizamos modelos multiníveis não lineares para estimar a magnitude das associações entre os padrões de deslocamento e o risco de depressão, ajustando para características sociodemográficas e de vizinhança.
Verificou-se que, em média, cada 10 minutos a mais no tempo de deslocamento está associado a 0,5% (p = 0,011) maior probabilidade de rastreamento positivo para depressão. Além disso, ao decompor o tempo de deslocamento entre tempo de fluxo livre e tempo de atraso, descobrimos que o atraso e não o tempo de fluxo livre estava associado à depressão. Especificamente, cada 10 minutos adicionais de atraso no trânsito está associada a 0,8% (p = 0,037) maior probabilidade de rastreamento positivo para depressão. Ao examinar as diferenças por modo de viagem, descobrimos que os usuários de transporte público (por exemplo, metrô ou Transporte Rápido por Ônibus-BRT) têm 4,8% (p = 0,040) menos probabilidade de serem testados positivamente para depressão do que os motoristas. Além disso, não haver paradas de transporte público em um raio de caminhada de 10 minutos a partir do local de moradia também é associado com maior probabilidade de rastreio positivo para depressão.
Nossos resultados fornecem evidências preliminares de que um melhor acesso a sistemas de transporte público e menos congestionamento podem ser fatores associados a uma melhor saúde mental entre os residentes de áreas urbanas.
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These are also a mobile population, subject to evictions and threats from gangs and overlords.25,26 The difference in the two types of living is bound to make differences in the quality of personal relationships, including marital relationships, as urban life is more likely to be stressful, economically unstable, and socially isolating.27 This makes it important to assess whether men married to microfinance participants in urban areas report different levels of IPV justification and perpetration, compared to men married to microfinance participants in rural areas.17,28
The present study adds to extant literature on the association between microfinance participation and intimate partner violence (IPV) by assessing a national sample of men married to microfinance participants. The key objective was to assess whether there was a positive association between wives' microfinance participation and men's perpetration and justification of IPV in urban areas of Bangladesh.
This study is based on a population-based secondary data analysis.
In this cross-sectional study, data from a national sample of men from the 2007 Bangladesh Demographic and Health Survey were analysed using logistic regression analyses. IPV perpetration was measured using a modified Conflict Tactics Scale and justification of IPV was measured based on ‘justification of wife beating’ statements with which men agreed or disagreed.
Men married to microfinance participants were not significantly different from men married to non-participants of microfinance in terms of IPV perpetration in both urban and rural areas. However, the interaction effect of wives' microfinance participation and urban living on men's justification of IPV revealed a significant and positive beta coefficient. Specifically, wives' participation in microfinance was positively associated with men's justification of IPV in urban areas (β = 0.51, P < 0.05).
Microfinance organizations in urban areas should bundle microfinancial services with IPV screening and intervention geared toward men and women.

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Mental health, quality of life, and nutritional status of adolescents in Dhaka, Bangladesh: Comparison between an urban slum and a non-slum area

Abstract

Introduction

Section snippets

General population subjects

Demographic characteristics

Discussion

Acknowledgements

Social Science and Medicine

General Hospital Psychiatry

Toxicology Letters

Public Health

Social Science and Medicine

Social Science and Medicine

Manual for the ASEBA school-age forms & profiles

Measuring perceived health outcomes in non-Western culture: does SF-36 have a place?

Journal of Health, Population & Nutrition

Diagnostic and statistical manual of mental disorders fourth edition text revision

Developing an interactive STD-prevention program for youth: Lessons from a north Indian slum

Studies in Family Planning

Infant mortality rate inequalities in the Western Cape province of South Africa

International Journal of Epidemiology

2000 Statistical yearbook of Bangladesh

Urbanization and coronary heart disease mortality among African Americans in the US south

Journal of Epidemiology and Community Health

Psychotic disorders in the adult population of an urban slum

Indian Journal of Public Health

Urbanization and minor psychiatric morbidity

Social Psychiatry & Psychiatric Epidemiology

Urbanisation and adolescent risk behavior

South African Medical Journal

Psychological distress and depression in urbanizing elderly black persons

South African Medical Journal

Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka

European Child & Adolescent Psychiatry

Determinants of mortality among children in the urban slums of Dhaka city, Bangladesh

Tropical Medicine and International Health

Reliability and validity of the youth self-report, Bangladesh version

International Journal of Methods in Psychiatric Research

Validity and reliability of the Bangla version of WHOQOL-BREF on an adolescent population in Bangladesh

Quality of Life Research

Determinants of hypertension in West Africa: contribution of anthropometric and dietary factors to urban-rural and socioeconomic gradients

American Journal of Epidemiology

Suicide on the Indian subcontinent

Journal of Crisis Intervention & Suicide