Association between household environment and the risk of depression and anxiety among women in Bangladesh: analysis of the Bangladesh Demographic and Health Survey (2022)

Abstract

Summary Background Depression and anxiety are common mental disorders globally but often overlooked in low- and middle-income countries (LMICs), with limited population-level evidence on the role of household environmental conditions (HECs), especially for women. This study examined associations of HECs with depression and anxiety among women in Bangladesh. Methods This cross-sectional study analysed data from ever-married women in the 2022 Bangladesh Demographic and Health Survey. Depression and anxiety symptoms were measured using validated PHQ-9 and GAD-7 scales. Exposures included seven HEC indicators—housing materials, overcrowding, household air pollution (HAP), water source and treatment, sanitation, and handwashing facilities—and a cumulative HEC score. Associations were assessed using multinomial logistic regression and reported as adjusted risk ratios (aRR) with 95% confidence intervals (95% CI), adjusting for age, education, employment, place and duration of residence, etc. Findings Among 19,012 women, prevalence of probable depression and generalised anxiety disorder (GAD) was 5·0% and 4·4%, respectively. More than half of households had ≥3 poor HECs. Compared with women in households with ≤1 poor HEC, those with three (aRR: 1·30, 95% CI: 1·13–1·83) or ≥4 poor HECs (aRR: 1·31, 95% CI: 1·02–1·67) had higher risk of depression but not GAD. High HAP exposure was associated with both depression (aRR: 1·58, 95% CI: 1·01–2·45) and GAD (aRR: 1·61, 95% CI: 1·02–2·57). Overcrowding was associated with probable GAD (aRR: 1·32, 95% CI: 1·07–1·63), and poor sanitation with depression (aRR: 1·21, 95% CI: 1·05–1·39) only. Interpretation Poor HECs are potential contributors to depression and anxiety among Bangladeshi women. Integrating environmental improvements, particularly reducing HAP, improving sanitation, and reducing household overcrowding, into mental health prevention strategies may complement existing efforts to reduce the burden of common mental disorders in Bangladesh and other similar LMICs. Funding The work was supported by UKRI Medical Research Council grant (grant no: MC_UU_00032/6).