Rizwanul Karim

Background: Academic stress is a widespread challenge in medical education, with psychological, behavioral, and contextual factors contributing to it. This study estimated the prevalence of academic stress among Bangladeshi medical students and identified key psychosocial and behavioral predictors to guide targeted interventions. Methods: A multicenter cross-sectional study (October–December 2022) used a stratified random sample of 1,072 undergraduate students from eight public medical colleges representing all administrative divisions of Bangladesh. Validated instruments measured academic stress (Academic Stress Scale, ASS-40), depressive symptoms (PHQ-9), anxiety (GAD-7), insomnia (ISI), internet addiction (IAT), self-esteem (RSES), and coping styles (SCSI). Analyses included descriptive statistics, chi-square and Mann–Whitney U tests, multivariable logistic regression to identify independent predictors, and structural equation modeling (SEM) and network analysis to explore direct and indirect pathways. Result: Academic stress was reported by 47.5% of participants. In adjusted logistic regression models, moderate anxiety was associated with increased odds of academic stress (AOR = 3.95; 95% CI 1.98–7.90), and severe depression showed a markedly elevated association (AOR = 21.54; 95% CI 7.21–64.38). Behavioral factors were also influential: moderate-to-severe problematic internet use was strongly associated with academic stress (AOR = 17.78; 95% CI 9.66–32.72). Additional independent predictors included advanced academic year, higher monthly expenditure, and urban residence. Active problem-focused coping conferred modest protection against academic stress (AOR = 0.89; 95% CI 0.83–0.95). Structural equation modeling supported a model in which psychological distress exerted both direct effects on academic stress and indirect effects mediated by sleep disturbance and internet addiction, while network analysis identified depressive symptoms, insomnia, and internet addiction as central nodes within the stress network. Conclusions: Nearly half of the sampled medical students experienced significant perceived academic stress. Interventions that integrate mental health services, sleep-hygiene promotion, responsible digital-use policies, and training in adaptive, problem-focused coping are recommended.

Background: Mental health service utilisation (MHSU) in Bangladesh remains limited due to cultural, social and structural barriers, including stigma, reliance on traditional healing practices, concerns about medication and restricted access to care. This study aimed to develop and validate a culturally appropriate tool to assess barriers to MHSU and to examine sociodemographic, clinical and psychosocial factors associated with these barriers. Methods: Data were drawn from the National Mental Health Survey of Bangladesh (August 2019–May 2020), a multicentre, community-based study using stratified cluster random sampling across 496 primary sampling units (PSUs). A total of 7238 adults were included. Exploratory and confirmatory factor analyses were conducted to validate the Barriers to Mental Health Service Utilization Scale (BMHSUS). Binary logistic regression identified predictors of perceived barriers. Results: Confirmatory factor analysis validated a four-factor, eight-item BMHSUS with strong psychometric properties. Overall, nearly three-quarters of participants reported at least one barrier to mental health service utilisation, with social concerns (47%) and perceived stigma (39%) emerging as the most prevalent obstacles. Females had significantly lower odds of reporting barriers than males (adjusted OR (AOR)=0.49; 95% CI 0.38 to 0.61), and urban residents were less likely than rural residents to report barriers (AOR=0.84; 95% CI 0.75 to 0.94). Individuals with depressive (AOR=1.48; 95% CI 1.15 to 1.90) and anxiety disorders (AOR=1.75; 95% CI 1.28 to 2.39) were more likely to experience barriers. Higher stigma-related scores for relationship disruption, anxiety and hygiene concerns were associated with increased barriers, whereas favourable beliefs about treatability and recovery reduced the odds (AOR=0.89; 95% CI 0.88 to 0.90). Conclusions: The BMHSUS is a reliable and culturally valid tool for assessing barriers to MHSU in Bangladesh. Addressing stigma, geographic inequities and disorder-specific vulnerabilities is essential to improving access to mental health services and informing evidence-based policy and intervention strategies.

Objectives: Depression is highly prevalent among medical students, especially in resource-constrained settings like Bangladesh, where academic stress serves as a prominent contributing factor. This study aims to explore the predictors of depression among medical students, with a specific focus on academic stress and coping mechanisms, while also evaluating the influence of behavioral and sociodemographic factors on depression in Bangladeshi medical students. Methods: This cross-sectional study, conducted from October to December 2022, involved 1,072 undergraduate medical students from six public medical colleges in Bangladesh, selected through simple random sampling. Depression was measured using the PHQ-9, while academic stress, anxiety, insomnia, self-esteem, coping strategies, and internet addiction were assessed using the ASS-40, GAD-7, ISI, RSES, SCSI, and IAT, respectively. Data were analyzed by SPSS and Jamovi software employing chi-square tests, Mann–Whitney U tests, and binary logistic regression. The predicted probabilities were presented as beta coefficients, including crude and adjusted odds ratios (AOR), 95 % confidence intervals, and p-values. Results: Over half of the participants experienced moderate to severe depression. Key predictors of depression included academic stress, coping strategies, and various sociodemographic and behavioral factors. Inadequate study facilities (OR: 1.32, 95 % CI: 1.21–1.44) and feelings of personal inadequacy (OR: 1.33, 95 % CI: 1.23–1.43) significantly increased the likelihood of depression. Among coping strategies, passive problem-focused coping was associated with higher odds of depression (OR: 1.17, 95 % CI: 1.08–1.26), whereas passive emotion-focused coping slightly reduced the risk (OR: 0.91, 95 % CI: 0.85–0.98). Active emotional coping had a marginal effect (OR: 1.07, 95 % CI: 1.00–1.15). Sociodemographic factors also played a significant role. Females were less likely to experience depression than males (OR: 0.35, 95 % CI: 0.19–0.68), and urban residents had lower odds than rural counterparts (OR: 0.40, 95 % CI: 0.19–0.86). Higher paternal education was protective (OR: 0.09, 95 % CI: 0.04–0.21), while maternal education beyond the secondary level was linked to increased risk (OR: 4.07, 95 % CI: 1.61–10.33). Among behavioral factors, insomnia significantly increased the odds of depression (OR: 1.38, 95 % CI: 1.29–1.48), while moderate internet use showed a protective effect compared to no use (OR: 0.26, 95 % CI: 0.13–0.52). Anxiety emerged as a strong predictor (OR: 1.78, 95 % CI: 1.61–1.97). Economically, having a personal income reduced the risk of depression by 49 % (OR: 0.51, 95 % CI: 0.27–0.96). Conclusions: Depression among medical students is significantly associated with academic stress, ineffective coping strategies, insomnia, and anxiety, which may further intensify among high-risk groups such as males, rural residents, and those facing financial challenges. Effective interventions should focus on reducing stress, developing adaptive coping skills, ensuring equitable access to academic resources, and enhancing mental health screening and support services.

Background: Patient satisfaction is critical for healthcare utilization in resource-constrained settings like Bangladesh, yet evidence on outpatient satisfaction determinants remains limited. This study assessed perceived service quality and identified predictors of satisfaction in a public medical college hospital. Methods: A cross-sectional study (March–May 2025) recruited 1,089 adult outpatients via systematic random sampling. Data were collected using validated Bengali instruments measuring perceived quality (24 items) and satisfaction (14 items). Binary logistic regression was used to identify significant predictors (p < 0.05). The model was validated using the area under the curve (AUC), pseudo-R², and classification accuracy. Results were reported as odds ratios with 95% confidence intervals. Data entry, editing, and analysis were performed using SPSS and Jamovi software. Results: Participants (mean age 34±15.64 years; 51.5% male; 63.0% rural) reported positive physician interactions (e.g., 56.7% felt respected). Critical deficiencies included poor toilet cleanliness (75.5%), inadequate drinking water (67.6%), and medication shortages (30.6%). Female patients reported insufficient consultation time (17.5%). Regression analysis (AUC=0.92) revealed higher satisfaction among males (AOR=1.79, 95% CI: 1.02–3.16), suburban residents (vs. rural; AOR=2.01, 1.06–3.81), businesspersons (vs. students; AOR=2.89, 1.19–7.04), and those with prior positive experiences (AOR=1.50, 1.42–1.58). Upper-middle-class patients had lower satisfaction (AOR=0.40, 0.20–0.79). Positive perceptions of management and administration independently increased satisfaction (AOR=1.14 for both). Conclusion: Patient satisfaction in a Bangladeshi public hospital outpatient department is influenced by multifaceted determinants: demographics, service experiences, and perceived quality. Key predictors of higher satisfaction included male gender, suburban residence, business occupation, positive prior experiences, and perceived administrative quality. Conversely, upper-middle-class status and female gender predicted lower satisfaction, indicating equity concerns. These findings necessitate urgent, targeted improvements in non-clinical areas (administration, resource logistics, facility environment) and gender-sensitive, equity-focused interventions to enhance satisfaction, trust, and service utilization.

Background Areca nut, the main component of betel quid (BQ) and the fourth most-used psychoactive substance worldwide, is consumed by over 600 million people, primarily in South Asia, and is a recognized carcinogen linked to serious health risks, especially oral conditions such as precancerous lesions and oral cancer. This study aimed to assess the dependency among BQ users and identify the key sociodemographic and behavioral predictors that significantly influence this dependency. Method This cross-sectional study was carried out between January and June 2023 on a randomly selected sample of 400 individuals from Bhaluka Upazila in the Mymensingh district of Bangladesh. A structured questionnaire collected data on sociodemographics, BQ consumption, chewing motivations, quitting intentions, and dependency levels. Data analysis was conducted using SPSS and Jamovi, employing confirmatory factor analysis, structural equation modeling, and binary logistic regression. Results The study used a seven-item, three-factor adapted Betel Quid Dependency Scale with good reliability (Cronbach’s α = 0.83). The study revealed that approximately half of the participants (48.5%) were BQ-dependent, with a higher prevalence observed among females. Key predictors of dependence included education levels, expenditures on BQ, tobacco with BQ, and unsuccessful attempts to quit. Among BQ-tobacco users, more than half of the females primarily consumed smokeless tobacco, and the rate of failed quit attempts among females was more than twice that of males. The reasons for chewing BQ were found to predict dependency, while the intention to quit BQ had an opposing effect. Conclusion The study validated a shortened version of the Betel Quid Dependence Scale and identified key sociodemographic and behavioral determinants of dependence, including education level, intention to quit, previous quit attempts, and expenditure on betel quid. It recommends implementing health education campaigns, providing behavioral support, strengthening anti-tobacco policies, and designing targeted interventions for high-risk populations to reduce BQ dependency.

The present study was undertaken to identify the major nutrient content in processed foods commonly consumed in Bangladesh, their label conformity healthiness, and percent daily nutrient contribution. Twenty‐four nationally representative composite samples were analyzed using AOAC and other standard methods. Results were compared with label information using a restrictive approach and EU tolerance guidelines. The healthiness of the products was evaluated in terms of the Health Star Rating (HSR) scheme and the UK traffic light labeling system. Among the analyzed samples, fried pulse, chanachur, lozenge, and fried peas had the highest amount of protein, fat, carbohydrates, and dietary fiber, respectively. Biscuits and milk chocolate had high levels of trans fatty acids (TFA) and saturated fatty acids (SFA). It was observed that around half of the products lacked information about saturated fatty acid (46%), followed by total dietary fiber and trans‐fat (38% each). Other information was missing in one‐fifth of the products, namely protein (17%), total fat (17%), available carbohydrate (17%), energy (17%), sugar (21%), and salt (21%). Label compliance analysis according to the restrictive approach revealed that none of the products accurately reported the salt, sugar, saturated fat, and trans fat content on the label. According to the EU tolerance guideline, approximately half of the products had protein (58%), fat (54%), and carbohydrate (42%) levels that fell within the EU tolerance limit. However, only around one‐third of the samples had sugar (21%), salt (38%), and saturated fat (33%) levels that met the EU tolerance limit. In terms of healthiness analysis, according to the HSR, the range of stars was between 0.5 and 2.5 of the foods where fried peas got the highest rating (2.5 stars), while in terms of the UK traffic light system, none of the samples got all green signals. The lozenge got green lights for fat, SFA, and salt contents. It was also found that consumption of 100 g of fried peas or pulse would exceed the acceptable daily limit of salt, sugar, and SFA compared to the daily maximum allowable intake for the 2000 kcal diet recommended by the WHO. However, according to the serving size, biscuits were major contributors of TFA, sugar, and SFA, whereas fried pulse was a key contributor of sodium/salt. Proper regulatory actions should be introduced to promote healthy processed foods with user‐friendly front‐of‐the‐pack labeling and monitor their quality to prevent non‐communicable diseases (NCDs).

There is mounting evidence that Facebook Addiction is associated with poor mental health, physical symptoms, social dysfunction, and despair among the adolescent and youth population. The current study set out to identify the prevalence of Facebook Addiction among Bangladeshi medical students as well as its influencing factors. This cross-sectional survey was conducted on 720 randomly selected medical students from eight public medical colleges from January to June 2022. Data were obtained using a semi- structured, self-reported questionnaire and analyzed using the SPSS v.23 programs. The Bergen Facebook Addiction Scale BFAS was used to assess Facebook Addiction, while the Generalized Anxiety Disorder GAD-7, Patient Health Questionnaire PHQ-9, Perceived Stress Scale PSS10, Chen Internet Addiction Scale CIAS, and Pittsburg Sleep Quality Index PSQI was used to assess anxiety, depression, perceived stress, internet addiction, and sleep quality. Binary logistic regression was used to evaluate the influence of several demographic, psychological, and behavioral characteristics on the likelihood of respondents being addicted to Facebook. Facebook Addiction was observed in 29.4% of medical students. According to data, 63.7% of medical students reported mild to severe anxiety, 29.3% moderate to severe depression, and 84.9% moderate to high perceived stress. Lack of personal income [OR with (95% CI), 1.82 (1.13, 2.96)], poor academic performance [2.46 (1.45, 4.15)], moderate anxiety [2.45 (1.22, 4.92)], moderate perceived stress [5.87 (1.92, 17.95)], and moderately severe depression [2.62 (.97, 7.08)] were all found to play a significant role in the development of Facebook Addiction. However, living with parents [OR with (95% CI), .37 (.14, .95)] and positive family relationships [.40 (.18, .87)] reduces the likelihood of becoming addicted to Facebook. An integrated participative Behavioral and psychological intervention should be devised to reduce the risks of Facebook addiction in medical students while also improving their mental health-related quality of life.

Background: During the COVID-19 pandemic the health care workers (HCWs) encountered one of the heaviest blows by saving lives while endangering their own. This study was carried out to investigate risk exposures, risk perceptions, challenges, and coping strategies, leading to anxiety and depression, among HCWs in Bangladesh. Methods: This hospital-based cross-sectional survey was conducted from February to July 2021 among 1,112 frontline HCWs. Data were collected using a pre-tested self-administered questionnaire including Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) scale. A coping scale for COVID-19 (CS-COV-19) was developed and validated. To determine the predictors for symptoms of depression and anxiety, multivariable logistic regression analysis was performed, and the associations between key variables are presented as odds ratios (ORs) and 95% CIs. Results: A total of 54.9% (n=389) doctors and 51.4% (n= 207) nurses were found to have mild to severe anxiety status and 47% (n=333) doctors and 39.9% (n= 159) nurses were found to have mild to severe depression. HCWs, family members, neighbors had been affected with COVID-19 and those who experienced extra stresses at work were two times more likely to have anxiety. HCWs who had worried family and friends that they might get infected through them, confronted any negative social attitude or perceptions, decreased monthly income, and depression were 1.57 to 1.8 times more likely to experience anxiety than those who did not go through these experiences. Health workers who confronted negative social attitudes or social perceptions were 1.7 times more likely to have depression. Respondents, who had family members infected with COVID-19 and HCWs who worked for long hours at hospitals were almost two times more likely to have depression. Conclusions: The findings will help promoting advocacy and encourage implementing selective interventions to protect the mental health and wellbeing of HCWs working with COVID-19.

Background: Depression, stress, and anxiety were found in a large number of medical undergraduate students, indicating a neglected aspect of their psychology that required immediate attention. The goal of this study was to find out the prevalence of depression among medical students, as well as potential psychosocial and behavioral predictors for depression. Methods: This cross-sectional study was conducted from July to November 2021 among 840 randomly selected medical students from four medical colleges using stratified random sampling. Data were collected using a semi-structured, self-administered questionnaire and were analyzed through the SPSS v.23 software. Multiple regression was performed to assess the effect of several behavioral and psychosocial factors on depression. Results: Among the 840 study participants, 55.7% (n= 468) were female and 44.3% (n= 372) were male. According to the data, the prevalence of depression, anxiety, perceived stress among medical students was found to be 28.8%, 65% and 85% respectively. A strong link was found between depression and anxiety, stress, poor sleep quality, poor academic performance, and a negative social and romantic relationship status. Conclusions: A significant number of medical students are depressed. In order to prevent and treat depression, medical students should be screened for depression and its associated factors.

Background: During the COVID-19 pandemic the health care workers (HCWs) encountered one of the heaviest blows by saving lives while endangering their own. This study was carried out to investigate risk exposures, risk perceptions, challenges, and coping strategies, leading to anxiety and depression, among HCWs in Bangladesh. Methods: This hospital-based cross-sectional survey was conducted from February to July 2021 among 1,112 frontline HCWs. Data were collected using a pre-tested self-administered questionnaire including Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) scale. A coping scale for COVID-19 (CS-COV-19) was developed and validated. To determine the predictors for symptoms of depression and anxiety, multivariable logistic regression analysis was performed, and the associations between key variables are presented as odds ratios (ORs) and 95% CIs. Results: A total of 54.9% (n=389) doctors and 51.4% (n= 207) nurses were found to have mild to severe anxiety status and 47% (n=333) doctors and 39.9% (n= 159) nurses were found to have mild to severe depression. HCWs, family members, neighbors had been affected with COVID-19 and those who experienced extra stresses at work were two times more likely to have anxiety. HCWs who had worried family and friends that they might get infected through them, confronted any negative social attitude or perceptions, decreased monthly income, and depression were 1.57 to 1.8 times more likely to experience anxiety than those who did not go through these experiences. Health workers who confronted negative social attitudes or social perceptions were 1.7 times more likely to have depression. Respondents, who had family members infected with COVID-19 and HCWs who worked for long hours at hospitals were almost two times more likely to have depression. Conclusions: The findings will help promoting advocacy and encourage implementing selective interventions to protect the mental health and wellbeing of HCWs working with COVID-19.