What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Undiagnosed depressive and anxiety disorders (n=3348). Intervention: Widowhood vs. Married/cohabiting. Primary outcome: Undiagnosed depressive and/or anxiety disorders (DAD) (AOR 2.04, 95% CI 1.40-2.99, p=<0.001).

What does this research mean for the field?

Undiagnosed depressive and anxiety disorders affect 44.8% of women in Bangladesh and 60.0% in Nepal, with sociodemographic vulnerabilities such as widowhood, poverty, and marginalized ethnicity significantly increasing the likelihood of remaining undiagnosed. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 21, 2025Open Access

Undiagnosed depressive and anxiety disorders in a nationally representative sample of Bangladeshi and Nepali women: prevalence and associated factors

Q: What are the key findings of this study?

The prevalence of undiagnosed depressive and/or anxiety disorders was 44.8% in Bangladesh and 60.0% in Nepal, with factors such as widowhood significantly increasing the odds of remaining undiagnosed in Bangladesh (AOR 2.04).

Q: What does this research mean for the field?

Undiagnosed depressive and anxiety disorders affect 44.8% of women in Bangladesh and 60.0% in Nepal, with sociodemographic vulnerabilities such as widowhood, poverty, and marginalized ethnicity significantly increasing the likelihood of remaining undiagnosed. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

SPSupa PengpidAsia University KPKarl PeltzerAsia University MHM. Tasdik HasanState University of Bangladesh

Key Result

The prevalence of undiagnosed depressive and/or anxiety disorders was 44.8% in Bangladesh and 60.0% in Nepal, with factors such as widowhood significantly increasing the odds of remaining undiagnosed in Bangladesh (AOR 2.04).

Study Design

Type

Cross-Sectional (n=3,348)

Multicenter

Yes

Structured PICO

Population

3,348 women aged 15-49 years from Bangladesh and Nepal with depressive and/or anxiety disorders were assessed to determine the prevalence and factors associated with remaining undiagnosed.

Outcome

Prevalence of undiagnosed depressive and/or anxiety disorders (DAD) and associated factorspatient reported

Nearly half of women in Bangladesh and 60% in Nepal with depressive or anxiety disorders are undiagnosed, highlighting a significant mental health treatment gap associated with socioeconomic and healthcare access barriers.

Main Result

Odds Ratio: 2.04 (95% CI 1.4–2.99)

p-value: p=<0.001

Limitations

Cross-sectional design limits the ability to establish causal relationships.
Reliance on self-reported screening tools (PHQ-9, GAD-7) rather than clinical diagnoses by healthcare providers.
The PHQ-9 and GAD-7 screening tools have not been validated in Bangladesh.
Potential for recall bias and social desirability bias due to self-reported measures.
Certain variables, such as domestic violence and body mass index, were excluded from the main analysis.

Abstract

BACKGROUND: Undiagnosed depressive and anxiety disorders may be widespread. The study aimed to assess the prevalence and associated factors of undiagnosed depressive and/or anxiety disorders (DAD) among women in two low-resource countries, Bangladesh and Nepal. METHODS: Data were analyzed from 19,987 women (aged 15-49 years) in the 2022 Bangladesh Demographic and Health Survey and 7,442 women (aged 15-49 years) in the 2022 Nepal Demographic and Health Survey who completed the interview-administered nationally representative sub-survey component on mental health. DAD was categorized as either 'undiagnosed DAD' (meeting symptom criteria on the PHQ-9 and/or GAD-7 but without a prior diagnosis or treatment) or 'diagnosed DAD' (having a prior diagnosis and/or current treatment). Relative to diagnosed DAD, associations with undiagnosed DAD were estimated using logistic regression. RESULTS: The analytic sample included 2,388 women in Bangladesh and 960 women in Nepal with undiagnosed DAD and diagnosed with DAD. The prevalence of undiagnosed DAD was 44.8% in Bangladesh and 60.0% in Nepal. In Bangladesh, in adjusted logistic regression analysis, having a big problem with permission to go to a health facility (Adjusted Odds Ratio-AOR: 1.53, 95% Confidence Interval (CI): 1.21-1.93, p < 0.001), being widowed (AOR: 2.04, 95% CI: 1.40-2.99, p < 0.001) and being divorced or separated (AOR: 2.30, 95% CI:1.40-3.77, p < 0.001) were significantly positively associated with undiagnosed DAD. Having secondary or higher education (AOR: 0.75, 95% CI: 0.58-0.97, p = 0.028) was significantly negatively associated with undiagnosed DAD. In Nepal, compared to the rich or richest wealth status, poor or poorest wealth status (AOR: 1.55, 95% CI: 1.09 to 2.21), compared to Bramin/Chhetri ethnicity, being Dalit (AOR: 1.77, 95% CI: 1.08-2.89) and being Janajati (AOR: 1.72, 95% CI: 1.17-2.54) were positively associated with undiagnosed DAD. Increasing age (AOR: 0.97, 95% CI: 0.96-0.99) was negatively associated and history of cervical cancer screening (AOR: 0.57, 95% CI 0.32-1.02) was marginally negatively associated with undiagnosed DAD. CONCLUSION: Nearly half of the women in Bangladesh and three in five women in Nepal had undiagnosed DAD. Targeted interventions addressing these factors are needed to improve mental health screening and access to care for women in Bangladesh and Nepal.

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