Depression, anxiety and stress among people infected with COVID-19 in Dhaka and Chittagong cities

Background: Covid-19 is an acute respiratory infectious disease caused by novel coronavirus 2019. Many individuals have suffered or are experiencing psychological symptoms due to feelings of isolation, insecurity and instability triggered by Covid-19. This study aimed to explore the perceived psychological distress and associated factors among people infected with Covid-19 in Dhaka and Chittagong cities. Methods: Using the face-to-face interview method, a survey was conducted from 23 April to 22 May 2021 on a questionnaire on depression, anxiety and stress scale (DASS-21), socio-demographic, economic and health factors. Among those who had ever been infected with Covid-19, a total of 2092 respondents (1180 from Dhaka and 912 from Chittagong) were randomly selected and interviewed. chi(2) test for independence of attributes was employed to observe the association of various socioeconomic, cultural, demographic and health factors with psychological distress. Moreover, multinomial logistic regression analysis was performed to explore the factors that contributed to psychological distress. Results: Among participants from Dhaka, of three mental health conditions, the prevalence was higher for anxiety (80.0%), followed by stress (64.2%) and depression (59.8%), respectively. Anxiety was also more prevalent (57.3) among respondents in Chittagong, followed by depression (47.7%) and stress (39.5%). As the coexistence of symptoms, 52.8% of respondents in Dhaka, 34.4% in Chittagong experienced depression, anxiety and stress simultaneously. Moreover, in both Dhaka and Chittagong, all three psychological symptoms were strongly correlated in pairs. Multivariate analysis revealed that the most consistent factors associated with mild to moderate (MM), and severe to extremely severe (SES) depression were respondents from Chittagong who were illiterate or primary educated (OR = 0.166, CI: 0.076-0.364 for MM and OR = 0.041, CI: 0.013-0.131 for SES), male (OR = 0.999, CI: 0.666-1.496 for MM and OR = 0.395, CI: 0.249-0.625 for SES), single (OR = 0.393, CI: 0.157-0.982 for MM and OR = 0.121, CI: 0.049-0.303 for SES) and married (OR = 0.403, CI: 0.177-0.916 for MM and OR = 0.075, CI: 0.033-0.167 for SES), had a family of size & LE; 4 (OR = 0.253, CI: 0.140-0.458 for MM and OR = 0.114, CI: 0.059-0.218 for SES) and a family of size 5-6 (OR = 0.151, CI: 0.084-0.272), and no family members at risk being infected with Covid-19 (OR = 0.699, CI: 0.487-1.002 for MM and OR = 0.332, CI: 0.199-0.522 for SES). The analysis yielded similar findings for the other two mental health subscales, such as anxiety and stress. For respondents in Dhaka, the effect of factors other than sex on psychological distress was the opposite in Chittagong. Overall, psychological distress during the outbreak was greater among respondents in Dhaka than in Chittagong if respondents were not classified based on various characteristics. Conclusion: This study showed that in both Dhaka and Chittagong, a substantially large portion of Covid-19-infected respondents experienced all three psychological distress (e.g., depression, anxiety and stress). Regardless of the dissimilarity between the results in Dhaka and Chittagong, better mental health support was needed for women in both cities.