Relative contributions of reproductive, behavioral and social vulnerability-related correlates of mental disorder among reproductive aged women in Bangladesh: evidence from nationwide cross-sectional study

Mental well-being of reproductive aged women in low-and middle-income countries like Bangladesh is often overlooked and under-prioritized despite the substantial burden of anxiety and depression. While reproductive and behavioral characteristics, social vulnerability-related factors and demographic characteristics have been recognized as correlates of women’s mental health, their relative contributions to mental disorder have not been assessed within a unified analytical framework in the Bangladeshi context. This study aimed to determine the prevalence of mental disorder and examine its associations with reproductive, behavioral and social vulnerability-related characteristics while simultaneously evaluating their relative contributions among married reproductive-aged women in Bangladesh. Data were retrieved from the Bangladesh Demographic and Health Survey-2022. Anxiety and depressive symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales, respectively. Mental disorder was defined as the presence of anxiety symptoms (GAD-7 cutoff ≥ 6), depressive symptoms (PHQ-9 cutoff ≥ 10), or both, or reporting prescribed medication for a mental health condition in two weeks preceding the survey. Survey-weighted binary logistic regression models were fitted to identify factors associated with mental disorder among 15,991 married reproductive aged women, alongside post-estimation analyses using partial Wald test and average marginal effects to assess the relative contribution of individual predictors. Overall, 21.3% of women experienced symptoms of anxiety and/or depression or reported taking prescribed medication for mental health conditions. Among reproductive and behavioral characteristics, higher parity (two or three children: AOR: 1.288, 95% CI: 1.140–1.455; above three children: AOR: 1.519, 95% CI: 1.264–1.826), history of pregnancy termination (AOR:1.320, 95% CI: 1.190–1.467), and recent sexual activity (AOR: 0.838, 95% CI: 0.743–0.945) were significantly associated with mental disorder in the fully adjusted model. Among social vulnerability-related factors, perception of violence (AOR: 1.412, 95% CI: 1.247–1.599) and rich household wealth status (AOR: 0.841, 95% CI: 0.739–0.957) showed significant independent associations. Relative contribution analyses indicated that pregnancy termination, higher parity and perception on violence were among the strongest individual contributors to mental disorder. The study findings highlight the importance of integrating mental health screening into reproductive health services while concurrently addressing social vulnerability, particularly violence-supportive norms, to inform mental health interventions for reproductive-aged women in Bangladesh.