Prevalence and associated factors of anxiety and depression among women seeking digital mental health services in Bangladesh

Online mental health services (MH) are playing a pivotal role by increasing MH literacy, enabling accessibility, and reducing logistical barriers, especially for women from developing nations like Bangladesh. However, the psychological burden and service needs of women using online MH platforms remain understudied despite their heightened vulnerability. Therefore, this study investigated the prevalence and determinants of anxiety and depression among women who received counseling from the online MH service platform,Women Support Initiative Forum (WSIF)through a cross-sectional study conducted between 5th September 2023 and 26th August, 2024. Data were collected by WSIF psychologists using a structured client information form covering socio-demographics, history of MH condition, health conditions, and presenting MH symptoms. Anxiety and depression levels were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Multivariate logistic regression was used to identify associated factors. Out of 375 women, 59.2% and 58.1% had experienced mild to severe anxiety and depression, respectively, with 25.6% having both conditions. Women with graduate-level education had 66% lower, and those with one or more siblings had 50-54% lower likelihoods of anxiety compared with women without graduate-level education and siblings. In contrast, women with graduate-level or postgraduate-level education and reporting hormonal conditions had 3.41 times, 2.63 times and over 10 times higher likelihoods of depression, respectively, compared with women who were not graduates and without a hormonal condition. Conversely, women with a history of MH and reported migraine, headache and allergic conditions had 52% and 65% lower odds compared with women without these conditions. Distress, negative thinking, and feelings of worry were highly prevalent among women with anxiety and among those with depression. Our findings highlight a significant MH burden among women who accessed online psychological counseling, indicating the importance of targeted actions in designing MH interventions by relevant stakeholders and policymakers.