Depression and Anxiety Touch One in Four Hospitalized Patients in Bangladesh, Study Finds

Roughly one in four adults lying in hospital beds in Dhaka is struggling with clinically significant depressive symptoms, and a similar share is battling anxiety, according to a new multicenter study that offers one of the most detailed portraits yet of the psychological state of hospitalized patients in Bangladesh. The research, published in the journal Discover Mental Health, also reveals a striking pattern: how patients feel about the care they receive—the behavior of the medical staff, the cost of treatment, the quality of the facilities—is measurably entangled with their mental health. The findings arrive at a moment when low- and middle-income countries are being urged to treat mental health not as a luxury add-on to medical care but as an inseparable component of it.

The study was conducted between October 2021 and April 2022, a period that overlapped with the later waves of the COVID-19 pandemic, when hospital systems across South Asia were under exceptional strain. Researchers from Daffodil International University and collaborating institutions in Bangladesh, Australia, the United States, and China recruited 401 adult patients from six tertiary hospitals in Dhaka using a multistage sampling design with systematic random selection at the patient level. Face-to-face interviews were carried out with a structured questionnaire that the authors report demonstrated excellent internal consistency and construct validity, giving the survey results a solid psychometric foundation in a setting where validated instruments are often in short supply.

To measure psychological symptoms, the team used the Hospital Anxiety and Depression Scale, widely known as HADS, a fourteen-item screening instrument developed specifically for medically ill populations and designed to avoid items—such as those concerning fatigue or sleep—that physical illness itself can distort. Respondents rated their experiences over the previous week, and scores were binned into normal, borderline, and abnormal ranges for each of the two subscales. Healthcare satisfaction, meanwhile, was assessed with a thirty-two-item questionnaire spanning five domains: basic facilities, the behavior of medical staff, the perceived quality of care, treatment costs, and the practices of healthcare providers. This dual-instrument design allowed the researchers to examine whether satisfaction with the hospital environment predicted psychological symptom burden after accounting for demographic and clinical factors.

The headline numbers are sobering. Overall, 25.2 percent of participants screened positive for depressive symptoms, with a 95 percent confidence interval running from 21.0 to 29.4 percent, while 27.7 percent showed anxiety symptoms, with a confidence interval of 23.3 to 32.1 percent. In other words, in any given ward of a Dhaka tertiary hospital, roughly one patient in every four is carrying a clinically meaningful burden of depression, and a similar proportion carries anxiety. Because the HADS is a screening rather than a diagnostic tool, these figures represent symptom prevalence rather than formal diagnoses, but the population-level signal is clear and consistent with the broader literature documenting elevated psychological morbidity among medical inpatients worldwide.

When the researchers turned to multivariable logistic regression—a technique that adjusts for multiple variables simultaneously to isolate the independent contribution of each factor—several sociodemographic and clinical patterns emerged. Perhaps counterintuitively, patients from middle-income households faced significantly higher odds of both depression and anxiety than those from higher-income families: the adjusted odds ratio was 2.70 for depression (95 percent CI 1.49–4.89) and 2.84 for anxiety (95 percent CI 1.57–5.11). The authors suggest that middle-income patients may occupy a particularly vulnerable economic position in Bangladesh’s out-of-pocket-heavy health system, where the cost of hospitalization can erode savings without the buffer of either wealth or social safety nets, generating financial stress that translates into psychological distress.

Duration of hospitalization proved to be another powerful correlate. Patients who had spent ten days or fewer in the hospital had dramatically lower odds of depression—by a factor of roughly sixteen, with an adjusted odds ratio of 0.06 (95 percent CI 0.02–0.22)—and substantially lower odds of anxiety, at 0.18 (95 percent CI 0.06–0.56), compared with those hospitalized for longer periods. The direction of causality is inherently ambiguous in a cross-sectional design: prolonged stays may worsen mood through isolation, discomfort, and uncertainty, or sicker patients with more severe and chronic conditions may both stay longer and experience more distress. Either way, the association flags long-stay wards as priority environments for psychological screening and support.

Family structure also mattered. Patients living in nuclear families—households consisting only of parents and children rather than extended kin—had significantly lower odds of anxiety, with an adjusted odds ratio of 0.54 (95 percent CI 0.33–0.87). In the Bangladeshi context, where extended families traditionally provide both emotional and financial support during illness, this finding complicates assumptions about which living arrangements protect mental health. It may reflect that extended-family caregiving obligations, disputes over treatment decisions, or crowded household dynamics add rather than relieve stress for some patients, though the cross-sectional data cannot disentangle these mechanisms definitively.

The most eye-catching result concerned the interplay between satisfaction and mental health. Patients who reported dissatisfaction with the behavior of medical staff had dramatically higher odds of anxiety, with an adjusted odds ratio of 10.45 (95 percent CI 1.29–84.37). The authors themselves urge caution: the confidence interval is extremely wide because only a small number of participants reported dissatisfaction with staff behavior, making the estimate statistically fragile. Even so, the result aligns with a growing international evidence base suggesting that the interpersonal quality of care—whether patients feel heard, respected, and treated with dignity—is not merely a matter of courtesy but a clinically relevant variable intertwined with psychological outcomes.

Technically, the study’s strengths lie in its multicenter design, its use of systematic random sampling within a multistage framework, and its reliance on validated instruments with demonstrated reliability in the study population. Its limitations are those inherent to cross-sectional research: temporal direction cannot be established, depression and anxiety were screened rather than clinically diagnosed, and all six hospitals were tertiary facilities in a single megacity, which may limit generalizability to district hospitals or rural facilities. The authors explicitly call for prospective cohort studies to confirm the relationships and to determine, for example, whether improving patient satisfaction causally reduces psychological symptoms or vice versa.

The practical implications, however, are already actionable. The researchers argue that routine mental health screening should be integrated into hospital care pathways in Bangladesh, particularly for patients with long stays, middle incomes, and extended-family living arrangements, and that patient-centered care training—emphasizing staff communication and respectful behavior—should be treated as part of the mental health infrastructure rather than a peripheral service quality issue. With depressive and anxiety symptoms affecting more than a quarter of hospitalized adults, the study makes the case that a hospital bed in Dhaka treats the body and, too often, leaves the mind unattended. Closing that gap, the authors conclude, requires health systems to measure and manage psychological well-being with the same seriousness they apply to vital signs.

Subject of Research: Prevalence and correlates of depression and anxiety symptoms among hospitalized adults in tertiary hospitals in Bangladesh and their association with healthcare satisfaction.

Article Title: Depression, anxiety, and healthcare satisfaction among hospitalized patients in Bangladesh: a multicenter cross-sectional study

Article References: Chowdhury, A. A., Islam, M. M., Shimul, M. M. H., Ahmed, K., Mahmud, T., BakiBillah, A. H., Muhammad, F., Sultana, S., Shahinuzzaman, M., Harun, M. G. D., & Haque, M. I. (2026). Depression, anxiety, and healthcare satisfaction among hospitalized patients in Bangladesh: a multicenter cross-sectional study. Discover Mental Health. https://doi.org/10.1007/s44192-026-00594-2

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00594-2

Keywords: depression, anxiety, hospitalized patients, healthcare satisfaction, Bangladesh, HADS, patient satisfaction, cross-sectional study, tertiary hospitals, mental health screening, medical staff behavior, public health