**Prevalence of and Factors Associated with Depression, Anxiety, and Stress among Adolescents of Bangladesh during the COVID-19 Pandemic: A Population-Based Study**

**Maruf Haque Khan1, M. Atiqul Haque1 , Mohd. Abdullah Al Mamun2 , Afifa Anjum1, Mohammad Tanvir Islam1 , and Mohammad Robed Amin3**


In Bangladesh, during the COVID-19 pandemic, adolescents were especially in vulnerable conditions both physically and mentally. This study aimed to investigate the prevalence of and associated factors of depression, anxiety, and stress among adolescents in Bangladesh during COVID-19. This cross-sectional study uses a two-stage cluster sampling procedure for collecting the sample. A total of 2,030 adolescents (14- 19 years) were enrolled from both urban and rural areas of eight administrative divisions of Bangladesh. The Depression, Anxiety, and Stress-21 (DASS-21) scale was used to assess depression, anxiety, and stress in adolescents. The outcome variables were depression, anxiety, and stress. Independent variables were age, sex, parental educational qualification, parental occupation, parental marital status, the total number of siblings and family members, residential area, insomnia severity index, food insecurity index, parenting style, screen-based behavior (using the computer, mobile phone, internet, social media), total weekly time spent on the internet, BMI, and BP. Linear regression was done to measure the risk factors. Ethical clearance was taken from the Institutional Review Board of BSMMU (memo no: BSMMU/2021/4408). The adolescent's mean (SD) age was 15.51 (1.32) years. The prevalence of depression, anxiety, and stress among urban and rural adolescents was 18%, 14%, and 16%, respectively. This prevalence is higher than the prevalence found in the National Mental Health Survey in Bangladesh in 2018–2019, and COVID-19 and its associated factors are thought to impact this. Female sex, age, urban residence, food insecurity, and poor parenting were significant risk factors for depression, anxiety, and stress during the COVID-19 pandemic. In addition, inconsistent parenting has been identified as a significant risk factor for depression only. There are some shortfalls in the study. The cross-sectional method of the study failed to identify the causal relationship with the factors related to depression, anxiety, and stress among adolescents. Additionally, collecting data from adolescents always involve recall bias along with misinterpretation of the terminology, which may lead to response bias. During the COVID-19 pandemic in Bangladesh, depression, anxiety, and stress were quite common among adolescents. As a result, quick action is required to prevent the mental health epidemic from spreading.

**anxiety, and stress**

**disorders**

**Figure 2: Characteristics of the study participants**

**Table: Multiple linear regression analysis of factors associated with depression, anxiety, and stress among the participants (n = 2,030)**

*€Depression, R2=.152, F (9, 2020) = 40.079, p < .001; £Anxiety, R2=.117, F (9, 2020) = 29.605, p < .001; ¥Stress, R2=.137,*

*F (9, 2020) = 35.68, p < .001 Abbreviations: B, unstandardized regression coefficient; SE-B, standard error for the unstandardized regression coefficient; CI: Confidence interval*


### Materials and Methods


#### Introduction

COVID-19 pandemic is going to impact various aspects of life including significant mental health challenges among the adolescents. A little research has been reported on the mental health status of Bangladeshi people during the COVID-19 pandemic, where there is a lack of data on adolescents.

#### Aim

This study aimed to investigate the prevalence and associated factors of depression, anxiety and stress among the adolescents of Bangladesh during COVID-19.

*Figure 1: Study places*

#### Conclusion

Given that mental health problems during adolescence increase the risk of adult mental distress, responsible authorities must take immediate action if we are to avert a mental health epidemic in the post- COVID era.

Acknowledgments: This study was funded by the Directorate General of Health Services of the Ministry of Health and Family Welfare, Bangladesh. The funder has no role in design, analysis, and interpretation of the work.

#### Discussion


#### Authors

Maruf Haque Khan1, M. Atiqul Haque1, Mohd. Abdullah Al Mamun2, Afifa Anjum1, Mohammad Tanvir Islam1, and Mohammad Robed Amin3

1 Bangabandhu Sheikh Mujib Medical University, Shahbagh, Bangladesh

2 National Heart Foundation Hospital and Research Institute, Mirpur, Bangladesh

3 Directorate General of Health Services, Mohakhali, Bangladesh
