Assessment of Mental Health Status of Allied Healthcare Professionals in Bangladesh

Tanzina Afroz *¹, Nabeel Mobarok Ali²

1.Dr. TANZINA AFROZ BDS, MPH (UK), FRSPH (London) .

2.Dr. NABEEL MOBAROK ALI BDS, MSc. OMS (UCL).

*Correspondence to: Dr.Tanzina Afroz, BDS, MPH (UK), FRSPH (London).

Copyright

© 2024 Dr. Tanzina Afroz. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 08 February 2024

Published: 20 February 2024

Introduction

Mental health disorders are among the most important public health issues globally. Estimates of the global burden of disease place mental illness in the top three conditions in terms of years lost due to disability.^2,3 The problems that adolescents and young people encounter interfere with the way they think, feel, and act. Such problems cause distress and limit their academic achievements and ability to be economically productive. They can also lead to family conflicts, substance abuse, violence, eating disorders and sometimes suicide. Mental health problems are also expensive for families, communities, and healthcare and social systems.³

According to the definition by WHO, “Mental Health is a state of well being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” Mental, neurological, and substance use disorders make a substantial contribution to the global burden of disease (GBD).⁴ This is a global measure of so-called disability-adjusted life years (DALY's) assigned to a certain disease/disorder, which is a sum of the years lived with disability and years of life lost due to this disease within the total population. Neuropsychiatric conditions account for 14% of the global burden of disease. Among non-communicable diseases, they account for 28% of the DALY's — more than cardiovascular disease or cancer. However it is estimated that the real contribution of mental disorders to the global burden of disease is even higher, due to the complex interactions and co-morbidity of physical and mental illness. Around the world, almost one million people die due to suicide every year, and it is the third leading cause of death among young people.⁵

A health professional is an individual who provides preventive, curative, promotional or rehabilitative health care services in a systematic way to people, families or communities. A health professional (also known as a health worker) may operate within medicine, surgery, midwifery (obstetrics), dentistry, nursing, pharmacy, psychology or allied health professions.

Allied Health Professions are a distinct group of health professionals who apply their expertise to prevent disease transmission, diagnose, treat and rehabilitate people of all ages and all specialties. Together with a range of technical and support staff they may deliver direct patient care, rehabilitation, treatment, diagnostics and health improvement interventions to restore and maintain optimal physical, sensory, psychological, cognitive and social functions." Allied health professions are health care professions distinct from nursing, medicine and pharmacy.¹Allied health professionals include dental hygienists, diagnostic medical sonographers, dietitians, medical technologists, occupational therapists, physical therapists, radiographers, respiratory therapists, and speech language pathologists. Allied health professionals comprise nearly 60% of the healthcare workforce.²

The concept of stress has been widely discussed in relation to healthcare students and reports of high levels of perceived stress amongst these groups are common.^8,9,10All students experience the demands of course work, a new environment and new people, and for those living away from home for the first time learning to manage financially, emotionally and socially by themselves. In addition, healthcare students, encounter other potential sources of stress such as the emotions involved in dealing with patients and the learning of applied clinical skills.^8,11 Too much stress can cause physical and mental health problems, reduce self-esteem and may affect student’s academic achievement. Stress in healthcare students has been associated with increased levels of depression use of drugs and alcohol and increased anxiety and attrition.^{12, 13}

The global prevalence and the explanation offered by the renowned experts often show that the estimate of prevalence of Mental Health Disorders is practically pretty high in reality. Currently there is no reliable data on the prevalence of mental illness in Bangladesh. It shows that this area is largely neglected, unexplored, underserved and underfinanced yet one of the most crucial sectors to be taken care of. The current situation of mental health facilities is pathetic compared to the disease burden to the community. The amount of money spent for mental health services by the government health department in 2005 was BDT 106,254, 224 which was less than 0.5% of health care expenditures by the government. No human rights review body exists in the country to oversee regular inspections in mental health facilities. There are 50 outpatient mental health facilities available in the country of which 4% are for children and adolescents only. These facilities treat about 26 users per 100,000 general populations. Of all users treated in mental health outpatient facilities, 44% are female and 7% are children or adolescents.¹⁴

There are 31 community psychiatric inpatient units available in the country for a total of 0.58 bed per 100,000 populations. Two percent of these beds in community based inpatient units are reserved for children and adolescents only. About 42% of patients are female and 12% are children/adolescents. There are 11 community residential facilities in the country and 55% of the beds in these facilities are for children and adolescents and 81% of admitted patients are female and 73% of them are children. There is 1 mental hospital available in the country for a total of 0.4 beds per 100,000 populations. There is no bed (0%) in mental hospital reserved for children and adolescents only. While this is the current scenario of Bangladesh, it is virtually not possible for the health policy makers to go for a comprehensive plan to meet the unmet health care facilities in the context of mental health as there is no reliable data on the same in hand.

 

 Justification of Study

Adolescents and young adults are widely considered by the psychological establishment to be prone to recklessness and risk taking behaviors which can lead to substance abuse, car accidents, unsafe sex and youth crime. No counseling center/ specific mental health service for health care professional students. Previously limited number of study was done to find out the health care professional student’s mental health status.

Medical science courses are often stressful. This course demand continuous learning process. The whole course is full of tests/ exams, one after another. In medical studies, practical and oral examination is most stressful. Uncertainty always prevails in health care professional student’s mind regarding ‘Pass’or‘Fail’. Once a student fails they have to wait 6 months for supplementary examination. Drop out, defaulter student are often seen in medical colleges. Students, who are staying at hostels or other places for the first time, take it as a stress being away from family life. Accommodation and food-habit creates problem among new comers. Students who are physically and mentally strong enough can adjust themselves in medical colleges and hostels. Those who are not like them become depressed easily.

Students are subjected to different kinds of stressors such as the pressure of academics with an obligation to succeed, an uncertain future and difficulties of integrating into the system. The students also face social, emotional, physical and family problems which may affect their learning ability and academic performance. Too much stress can cause physical and mental health problems, reduce self-esteem and may affect students’ academic achievement.

In addition to educating in a professional course it is also important to take into account the quality of life of the students during the years of health care professional training. Delaying in minimizing stressful life events is associated with more damage to the students.  Keeping these considerations in view, the current study was undertaken to assess the mental health status among allied health care professional students of Bangladesh. As health care professional students will likely have influence on patient health outcomes in the future, the presence of mental health disorder may potentially affect the quality and type of care they provide to their patients. The researchers hope that a supervisory committee will conduct continuous study to find out the causes of stress and depression among health care professional students through longitudinal study, to bring out their actual physical and mental status.

 

Operational definitions

Mental Health:

• It is not just the absence of mental disorder
• A state of well-being in which every individual realizes his own potential
• Can cope with the normal stresses of life
• Can work productively as well as fruitfully
• Able to make a contribution to his community

 

3 domains of Mental Health

 1. Sleeping pattern

  2. Suicidal tendency 

  3. Dep1.ression

 

Mental illness:

It is defined as “collectively all diagnosable mental disorders” or “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”

Allied health professionals:

They are health care practitioners with formal education and clinical training who are credentialed through certification, registration and/or licensure. They collaborate with physicians and other members of the health care team to deliver high quality patient care services for the identification, prevention, and treatment of diseases, disabilities and disorders. Allied health professionals are expert in a multitude of therapeutic, diagnostic, and preventive health interventions and function in several diverse settings including disease prevention and control, dietary and nutritional services, mental and physical health promotion, rehabilitation, and health systems management.

The allied health professions fall into two broad categories: technicians (assistants) and therapists/technologists. Technicians are trained to perform procedures, and their education lasts less than two years. They are required to work under the supervision of technologists or therapists. This part of the allied health field includes physical therapy assistants, medical laboratory technicians, radiological technicians, occupational therapy assistants, recreation therapy assistants and respiratory therapy technicians.

 

Adolescence:

A phase which involves -

-Progression from appearance of secondary sexual characteristics (puberty) to sexual and reproductive maturity

-Development of adult mental process and identity

-Transition from total social-economic dependence to relative independence

-No longer a child but not yet an adult

WHO Defines-

• Adolescents- 10-19 years
• Youth - 15 – 24 Years
• Young People – 10 – 24 Years

 

PHQ-9:

The Patient Health Questionnaire (PHQ) is a multiple-choice self-report inventory copyrighted by Pfizer Inc, that is used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform. The PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression. This is calculated by assigning scores of 0, 1, 2, and 3, to the response categories of “not at all,” “several days,” “more than half the days,” and nearly every day, respectively. PHQ-9 total score for the nine items ranges from 0 to 27.

 

PHQ-9 Scores and Proposed Treatment Actions:

PHQ-9 score	Depression Severity	Proposed Treatment Actions
0-4	None-minimal	None
5-9	Mild	Watchful waiting; repeat PHQ-9 at follow-up
10-14	Moderate	Treatment plan, considering counseling, follow-up and/or pharmacotherapy
15-19	Moderately severe	Active treatment with pharmacotherapy and/or psychotherapy
20-27	Severe	Immediate initiation of pharmacotherapy and, if severe impairment or poor response to therapy, expedited referral to a mental health specialist for psychotherapy and/or collaborative management

 

* From Kroenke K, Spitzer RL, Psychiatric Annals 2002;32:509-521

 

GHQ-12:

The General Health Questionnaire (GHQ) is a measure of current mental health and since its development by Goldberg in the 1970s it has been extensively used in different settings and different cultures. It has been used and validated extensively both in the UK and worldwide. The questionnaire was originally developed as a 60-item instrument but at present a range of shortened versions of the questionnaire including the GHQ-30, the GHQ-28, the GHQ-20, and the GHQ-12 is available. The scale asks whether the respondent has experienced a particular symptom or behavior recently. Each item is rated on a four-point scale (less than usual, no more than usual, rather more than usual, or much more than usual); and for example when using the GHQ-12 it gives a total score of 36 or 12 based on the selected scoring methods. The most common scoring methods are bi-modal (0-0-1-1) and Likert scoring styles (0-1-2-3). Since the GHQ-12 is a brief, simple, easy to complete, and its application in research settings as a screening tool is well documented; it was decided to translate the GHQ-12 into Bengali (the Bangladeshi language) and to examine the psychometric properties of the questionnaire in a sample of young Bangladeshi adolescents and young adults. There is evidence that the GHQ-12 is a consistent and reliable instrument when used in general population samples.

As an indication of ‘caseness’, it is recommended that these scores are converted into a binary scores, such that 0 or 1 = 0, and 2 or 3 = 1, giving a maximum score of 12. A score of 4 or more has been used as a suitable cut-off point for caseness. Subjects scoring 4 points or higher were considered to have poor mental health status.

 

Substance abuse: 

Substance abuse, also known as drug abuse and substance use disorder, is a patterned use of a drug in which the user consumes the substance in amounts or with methods which are harmful to themselves or others, and is a form of substance-related disorder. Drugs most often associated with this term include: alcohol, substituted amphetamines, barbiturates, benzodiazepines (particularly alprazolam, temazepam, diazepam and clonazepam), cocaine, methaqualone, cannabis and opioids.

Leisure Time:
Leisure, or free time, is time spent away from business, work, domestic chores and education. It also excludes time spent on necessary activities such as eating and sleeping.

Research Question:

What is the mental health status of allied health care students of Dhaka city?

Research  Methodoloy

Study Objectives

General objective:

- To assess the mental health status of allied health care students of Dhaka city.

 

Specific Objectives:

• To identify different degree of depression among the allied health care students.
• To identify suicidal tendency of students.
• To find out the sleeping pattern of allied health care students.
• To relate the socio demographic characteristics & other relevant independent variables with MH status of allied health care students.

 

Conceptual Framework:

List of Variables:

 

 

Study Design:

Descriptive Cross sectional study

Target Population and Sample Population

Students (Medical Assistant, Dental Assistant, Pharmacy Technology, Laboratory Technology) from first to third year of Medical Assistant Training School.

Study Site and Area

The Medical Assistant Training School (MATS)

Trauma Medical Assistant Training School

SAIC Medical Assistant Training School

Shemoli Medical Assistant Training School 

Study Period        

Study period will be from February 2015 to June 2015.

Sample Size

Sample size was calculated using the following formula

 n= z²pq/d²

Here,

z =1.96 for 95% CI

p = anticipated proportion suffering from mental illness 50% or 0.50

q = proportion of person not suffering from mental illness 0.50 

d = tolerable amount of error =5% =0.05

Since the value of P is not known in Bangladesh, so it is considered as 50% or 0.50

using this formula, here sample size n = 384.

 

Inclusion Criteria:        

• Bangladeshi Medical Assistant students
• Willingly agree to answer the pre-formed questionnaire

 

Exclusion Criteria:

• Pregnant female student
• Physically/mentally not fit or disabilities
• Chronic illness
• Known alcohol/drug abuser

Sampling Technique     

• 50 students from each Medical Assistant Training School are selected. Students from 4 Medical Assistant Training Schools are selected by Convenient sampling technique. All the available students who are willing to participate in the study will be interviewed.

Data Collection Tools   

• A pre-tested structured questionnaire will be used to collect data.
• The questionnaire is prepared by following GHQ-12 to assess mental health status and PHQ-9 to assess depression with the help of mental health experts from National Institute of Mental Health (NIMH).
• It is prepared in English & translated to Bengali consisting of 51 questions.

 

Data Management and Analysis Plan        

• Data will be collected by interviewer-administered questionnaire with the respondents by taking informed written consent.
• At the end of each day of data collection each questionnaire will be checked to see whether the questionnaire is filled completely and consistently. Then they will be stored after giving appropriate identification number. The data will be analyzed in computer with SPSS 19.0 version.

 

 Quality Control and Quality Assurance   

• Pre testing of questionnaire was made to assess the validity in out of the study area.
• On spot-check & review of the filled up questionnaires on daily basis  to ensure completeness and consistency

                                               

Ethical Considerations 

Ethical Approval was obtained from Research Committee of ICDDR’B, The Medical Assistant Training School (MATS), Trauma Medical Assistant Training School, SAIC Medical Assistant Training School, Shemoli Medical Assistant Training School

Informed written consent of the study subject will be obtained.

The information will be dealt with highest confidentiality and used only for this study.

Privacy of the respondents will be maintained.

 

Limitation of the study 

At the time of conducting the study, some problems were experienced. The limitations of the study are given below:

-Sample size is too small to assess the mental health status of allied health care students of Dhaka city.

-Data collection procedure carried out in the class by gathering all students together at the same time while filling self administrated questionnaire, student’s respond can be influenced by the others. 

-The previous study about mental health status of allied health care students are not available so the findings couldnot compare with the national data or some other different depression measurement.

-Because of time and budget constrain, the study assessed 200 students out of 385 students and the study was conducted in one institute that cannot be representation of allied health care students of entire Dhaka city. A number of government medical assistant schools did not give permission for collection of data since none of the respective class teachers agreed to spare their scheduled classes for the purpose of data collection. Therefore, the investigator was unable to collect data from government medical assistant training schools.  

 

Result

A cross sectional study was conducted among 200 allied health care students from 4 Medical Assistant Training School, to assess the mental health status by General Health Questionnaire (GHQ-12) and depression level by Patient Health Questionnaire (PHQ-9), followed by a semi-structured questionnaire. The questionnaires were distributed to 200 medical assistant students among which 89 (44.5%) students were male and 111 (55.5%) students were female. The collected data was analyzed using SPSS version 20.

Please click here to view complete article