COVID outbreaks in Bangladesh take heavy mental health toll on the urban poor

The surge of the Omicron variant has pushed several countries to consider reinstating lockdowns, raising concerns about whether current rates of global vaccination can help curtail the spread of the pandemic. Bangladesh is currently on the ebb of a receding wave with a daily positivity rate hovering over 10 percent.

The government has made significant progress in rolling out free vaccines with 70 percent of the adult population vaccinated with at least one dose, and the government is committed to vaccinating the entire population with both doses and a booster dose by the end of 2022.

As evidenced by the COVID-19 Urban Monitoring Survey, the urban poor have, over time, seen improvements in their employment and self-reported measures of food security. However, significant concerns about the long-term impact of the pandemic on the mental health situation of urban residents remain. In addition, recent World Bank studies have explored the linkages between climate change and infectious diseases and mental health issues and found weather influences anxiety and depression.

To gauge the toll that the first COVID wave had on the urban poor, we administered three telephone household surveys over an eight-month period, to two communities in the cities of Sirajganj and Cumilla in Bangladesh . Through three rounds, we surveyed roughly 500 households that were beneficiaries of the World Bank’s Low Income Community Housing Support Project (LICHSP) between July-August, 2020, and most recently between in January-February, 2021.

The findings from the LICHSP survey are sobering: They suggest urban populations continue to experience enduring mental health issues such as high levels of stress, anxiety and depression related to COVID-19. 

Expressing ‘chinta’

The pandemic has had pronounced impacts on the mental health of surveyed communities. Although overall anxiety – or chinta in Bangla – seemed to decrease over time during the course of the survey, a staggering 36 percent of all respondents, and 49 percent of those in Sirajganj, continued to express anxiety about COVID-19 and stated it interfered with their daily activities  (Figure 1). Moreover, around 27.1 percent of people in the final round of the survey stated that the sources of their stress were related to the fear of COVID-19’s impacts on self and family, and 21.8 percent stated that it was related to fear of loss of income.

Figure 1: Percentage of respondents who expressed anxiety/stress due to COVID-19

Concerns around COVID-19 remain most noticeable among the most economically vulnerable households.   In the last round of surveys collected, around 68.8 percent (Figure 2.A) of those households which received assistance – in the form of cash, food, in-kind, or work programs – reported suffering from pandemic-related stress 47.9 percent of households where any member had to eat smaller or fewer meals because there was not enough food in the previous weeks (Figure 2b) also reported greater anxiety. 

Figure 2: Percentage who experienced stress/anxiety/chinta due to COVID-19, and stated it interfered with their day-to-day activities

2.A: by whether household received any assistance from institutions or individuals in last 7 days

2.B: by whether any household member had to eat a smaller meal or fewer meals in a day because there was not enough food in the last 2 weeks

Sustainable plan for support services

Research suggests that the mental health impacts of the pandemic are more likely exacerbated among marginalized populations.  Evidence from a cross-sectional survey in Bangladesh found that, during the pandemic, women, uneducated and unemployed people experienced greater anxiety and poorer mental health. Likewise, another study surveyed over 400 indigenous people in the country and found them to be suffering from high levels of depression, anxiety, and stress.

Governments around the world will need to move to provide comprehensive support services and offer longer term plans to address the long-term mental-health effects of the pandemic on human capital, sustainable green growth, and productivity. For Bangladesh, the country’s passage of the 2018 Mental Health Bill, which protects patients, ensures their overall care and rehabilitation, is a significant step in the right direction . However, the pandemic has demonstrated that Bangladesh requires wraparound high-quality services to prevent and address mental health issues. These should be administered in a way that protects confidentiality and offers dignity. If left unaddressed, then mental health issues will start to take a toll on the economy and the overall well-being of citizens.