This document discusses adolescent depression in Bangladesh. It provides definitions of depression and its types. It notes that depression is a leading cause of disability worldwide. In Bangladesh, adolescents comprise 22.5% of the population and face early marriage, pregnancy, malnutrition and drug addiction—all contributing to depression. Key findings include lack of sexual health knowledge and risky behaviors among youth. The document outlines existing Bangladesh government programs and NGO activities to address adolescent health issues. It recommends strengthening protective factors like education and reducing risk factors. WHO technical support for policies, strategic planning, and integrating mental health into general healthcare is also suggested.

1. North South University
Department of Public Health
Adolescent Depression
Sumitted to
Dr. Arifu Bari Chowdhury
Prepared by
Dr. Rehnuma Haq Sarah
ID # 121 1280 580
Adolescent Health
Spring 2013

2. 1
Table of Content
Introduction……………………………………………….....4
What is depression…………………………………………..…5
Types of depression……………………………………………5-6
Depression Scenario……………………………………..…6
Worldwide: DALY…………………………………………….7
Bangladesh……………………………………………………..8
Contributing factors…………………………………………….9
Key Findings………………………………………….10
Existing Policies & Programs………………………..11
GoB and NGO activities……………………………………….11-13
Discussion……………………………………………..14
Recommendation……………………………………..15-16
Conclusion…………………………………………….16

3. 2
Glossary
AFLE Adolescent Family Life Education
AHI Assistant Health Inspector
AIDS Acquired Immune Deficiency Syndrome
ASD Assistance for Slum Dwellers
BCC Behaviour Change Communication
BDHS Bangladesh Demographic and Health Survey
BPHC Bangladesh Population Health Consortium
BRAC Bangladesh Rural Advancement Committee
BWHC Bangladesh Women's Health Coalition
CDS Centre for Development Studies
CMES Centre for Mass Education in Science
CWFP Concerned Women for Family Planning
DFP Directorate of Family Planning
ESP Essential Services Package
FDSR Family Development Services and Research
FPAB Family Planning Association of Bangladesh
FP Family Planning
FPHP Fourth Population and Health Programme
GoB Government of Bangladesh
H&FWC Health and Family Welfare Centre
HIV Human Immuno-deficiency Virus
HPSP Health and Population Sector Programme
ICPD International Conference on Population and Development
ICDDR,B International Centre for Diarrhoeal Disease Research, Bangladesh
IEC Information, Education and Communication
ILO International Labor Organization
INACG International Nutritional Anaemia Consultative Group
IUD Intra-uterine Device
MA Medical Assistant

4. 3
MCH-FP Maternal and Child Health and Family Planning
NCTB National Curriculum and Textbook Board
NFPE Non-formal Primary Education
NGO Non-government Organization
NIPORT National Institute of Population Research and Training

5. 4
INTRODUCTION
Depression is a significant contributor to the global burden of disease and affects
people in all communities across the world. Today, depression is estimated to affect 350
million people. The World Mental Health Survey conducted in 17 countries found that on
average about 1 in 20 people reported having an episode of depression in the previous
year. Depressive disorders often start at a young age; they reduce people’s functioning
and often are recurring. For these reasons, depression is the leading cause of disability
worldwide in terms of total years lost due to disability. The demand for curbing
depression and other mental health conditions is on the rise globally. A recent World
Health Assembly called on the World Health Organization and its member states to take
action in this direction (WHO, 2012).
While depression is the leading cause of disability for both males and females, the
burden of depression is 50% higher for females than males (WHO, 2008).
Infact,depression is the leading cause of disease burden for women in both high-income
and low- and middle-income countries (WHO, 2008). Research in developing countries
suggests that maternal depression may be a risk factor for poor growth in young children
(Rahman et al, 2008). This risk factor could mean that maternal mental health in low-
income countries may have a substantial influence on growth during childhood, with the
effects of depression affecting not only this generation but also the next.

6. 5
What is depression?
Depression is a common mental disorder that presents with depressed mood, loss
of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed
sleep or appetite, and poor concentration. Moreover, depression often comes with
symptoms of anxiety. These problems can become chronic or recurrent and lead to
substantial impairments in an individual’s ability to take care of his or her everyday
responsibilities. At its worst, depression can lead to suicide. Almost 1 million lives are
lost yearly due to suicide, which translates to 3000 suicide deaths every day. For every
person who completes a suicide, 20 or more may attempt to end his or her life(WHO,
2012).
Variety of depression
There are multiple variations of depression that a person can suffer from, with the
most general distinction being depression in people who have or do not have a history of
manic episodes.
I. Depressive episode involves symptoms such as
Depressed mood
Loss of interest and enjoyment
Increased fatigability etc.
Depending on the number and severity of symptoms, a depressive episode can be
categorized as mild, moderate and severe.
An individual with a mild depressive episode will have some difficulty in
continuing with ordinary work and social activities, but will probably not cease to
function completely. During a severe depressive episode, on the other hand, it is very
unlikely that the sufferer will be able to continue with social, work, or domestic activities,
except to a very limited extent

7. 6
II. Bipolar affective disorder typically consists of both manic and depressive episodes
separated by periods of normal mood. Manic episodes involve elevated mood and
increased energy, resulting in over-activity, pressure of speech and decreased need for
sleep.2
ADOLESCENT DEPRESSION WORLDWIDE
Children and adolescents constitute almost a third (2·2 billion individuals) of the
world’s population and almost 90% live in low-income and middle-income countries
(LMIC), where they form up to 50% of the population.
1 For young people, neuropsychiatric disorders are a leading cause of health-
related burden, accounting for 15–30% of the disability-adjusted life-years (DALYs) lost
during the first three decades of life.

8. 7
Disability adjusted life years (DALY):
The total number of incident DALYs in those aged 10–24 years was about 236
million, representing 15.5% of total DALYs for all age groups. Africa had the highest
rate of DALYs for this age group, which was 2.5 times greater than in high-income
countries (208 vs. 82 DALYs per 1000 population). Across regions, DALY rates were
12% higher in girls than in boys between 15 and 19 years (153 vs. 137). Worldwide, the
three main causes of YLDs for 10–24-year-olds were neuropsychiatric disorders (45%),
unintentional injuries (12%), and infectious and parasitic diseases (10%).4
Risk factors
The main risk factors for DALYs in 10–24-year-olds were:
Alcohol (7% Of DALYS)
Unsafe Sex (4%)
Iron Deficiency (3%)
Lack of Contraception (2%)
Illicit Drug Use (2%)

9. 8
BANGLADESH SCENARIO
 Adolescents –22.5%
 young people — 40% of population
 Early age at marriage – 48% of 15-19 years old girls are married
 54% of them have had first child
 MMR in adolescents double than national figure
 IMR 30 percent higher for adolescents
 Information, services and life skills crucial
 Adolescents fertility High: 135

10. 9
Contributing factors
Problems Experiences Implications for mental health
leading towards suicide
Teenage love -Parents disagree to establishment-
Unwanted pregnancy
-Depression -Emotional distress
Sexual violence -Social insecurity-Unwanted
pregnancy-Isolation from family
members and society
-Depression -Emotional distress
-Addiction -Hopelessness
Unexpected
academic results
-Isolation from family members
and society-feeling of guilty
-Stress, -Hopelessness -
Addiction
Low
socioeconomic
status and
unemployment
-Decline in social status -Persistent
insecurity, -Feeling of
discrimination-Social instability -
Addiction to cannabis, heroin
-Emotional distress -
Depression-Anger and hostility
-Hopelessness -Cannabis
psychosis
Religious -Perceived injustice -Restriction to
move freely and to express their
opinion
-Mental instability -Emotional
distress -Anger-Loss of
autonomy
a number of
brother and sister
-Persistent quarrel,-Feeling of
discrimination-Family disharmony
-Emotional distress -Depression
-Anger and hostility-Addiction-
boys
Dowry -Domestic violence -Shame, helplessness,
humiliation -Depression
Social isolation -Restricted opportunities-Broken
social and cultural ties
-Hopelessness, disappointment,
and demoralization -Addictions
― Bokhate chelae‖ -Feeling of discrimination-social
Insecurity -financial crisis
-Helplessness, humiliation-
Depression-addiction

11. 10
KEY FINDINGS
They reach adulthood with little knowledge about their physical and mental
changes. The majority of youths (aged between 10 and 25 years) have no correct
knowledge about sexually transmitted infections, including HIV/AIDS, and risky sexual
behavior is common among them (National AIDS and Sexual Transmitted Disease
Programme [NASP] 2006). One out of every three girls aged 15-19 experience teenage
pregnancy (BDHS 2004) and face the concomitant risks of childbearing before attaining
physical maturity. A large number of adolescents, especially girls, suffer from
malnutrition. Many young adolescents get addicted to drugs because of lack of awareness
and peer pressure. All this factor are responsible to develop depression. The National
Adolescent Strategy has been finalized and adolescent-friendly health services have been
introduced recently to meet the special needs of this group. The failure of formal and
informal education in dealing with sensitive health issues and cultural sensitivities are
key factors that prevent adolescents from making full use of the health-care system.
Mental health problems affect 10–20% of children and adolescents worldwide and
account for a large portion of the global burden of disease
Although only 10% of trials come from low-income and middle-income countries
(LMIC; where 90% of children and adolescents live), sufficient evidence exists to justify
the set-up of services
The development of services is hampered by lack of government policy,
inadequate funding, and a dearth of trained clinicians.
Support of child and adolescent mental health research is needed, particularly in
LMIC, including prevalence and longitudinal studies, high-quality clinical trials, and
cost-effectiveness analyses.5

12. 11
EXISTING POLICIES & PROGRAMS
GoB Programs
Health and Population Sector Program (HPSP)
a. Behavior change communication (BCC) through effective information, education and
communication. (The school health education program will be strengthened. Health and
FP workers, will conduct counseling and health education sessions, in the community and
in schools, and refer suspected cases of anemia, malnutrition, and RTI/STD to the nearby
healthcarecenter
b. Postponing the first birth or preventing unwanted pregnancy through proper IEC and by
increasing the use of contraceptives by the newly-married couples. C Prevention of
unsafe abortion due to unwanted pregnancy by giving training to service providers.
c. Special antenatal and safe-delivery care to pregnant women aged less than 24 years.
d. Creation of awareness among adolescents about RTI/STD and availability of high-quality
services for management of STD/RTI.
e. Involvement of private and NGO sectors in promoting adolescent health.
f. Inter-sectorial coordination among the various concerned sectors, i.e. education, law,
labor, social welfare, and youth welfare.
The Government of Bangladesh is planning to allocate sufficient funds for improving
adolescent health, and also to train service providers with regard to adolescent health
[47]. In 1997, the GoB held four workshops on adolescent health in different parts of the
country. The health and FP program managers of both GoB and NGOs participated in
these workshops.
School Health Pilot Project (SHPP)
In addition to train school-aged children and adolescents to properly care for
themselves and to promote a healthy lifestyle within their families, communities, and
peer groups, the Ministry of Health and Family Welfare began the 'School Health Pilot
Project' (SHPP) in 1996, following the design of the 1993 National School Health Plan.3

13. 12
Name of the
organization s
Target
groups
Activities Coverage
ASD Boys and
girls (9-19
years)
AFLE, skill development credit
programme, and health services
250 boys and girls
BRAC Boys and
girls (12-16
years)
AFLE 21 secondary
schools, 210
adolescent clubs and
202 NFPE schools
BWHC Girls (11-18
years)
AFLE, health services,
leadership and skill
development training, and
cultural activities
40 schools, 99 class
groups (6,600
adolescents)
CDS Girls (9-19
years)
AFLE 6,100 girls
CMES Girls (11-19
years)
AFLE 3,200 girls
CWFP Girls (9-19
years)
AFLE, health services (TT),
skills training, savings, and
credit activities
1,492 girls
Dipshikha Girls (12-18
years)
AFLE 3,000 girls
FDSR Boys (15-25
years) Girls
(12-18
years)
Better life education, indoor
games, growth monitoring, skill
development and leadership
training, income-generation
activities
54 unions of 7
selected thanas
(3,348 girls and 532
boys)
FPAB Boys (15-30
years) Girls
(9-20 years)
AFLE 21,000 youths in 70
unions of 30 districts
NM Girls (9-19
years)
AFLE, adolescent health clinics,
income-generating activities,
skills training, and credit
programme
316 girls
OMI Girls (11-18
years)
AFLE, adolescent health clinics,
and income-generating activities
350 girls

14. 13
Name of the
organization s
Target
groups
Activities Coverage
PDAP Girls (10-19
years)
Skill training, credit support, basic
education, and health services
350 girls
PI Newlywed
couples
Reproductive health education 29 NGO project
sites
PSTC Girls (9-19
years)
AFLE Five selected areas
(130 girls)
World Vision,
Bangladesh
Girls (10-19
years)
AFLE 16,000 girls

15. 14
DISCUSSION
Reducing the Burden 0f Depression
While the global burden of depression poses a substantial public health challenge,
both at the social and economic levels as well as the clinical level, there are a number of
well-defined and evidence based strategies that can effectively address or combat this
burden. For common mental disorders such as depression being managed in primary care
settings, the key interventions are treatment with generic antidepressant drugs and brief
psychotherapy. Economic analysis has indicated that treating depression in primary care
is feasible, affordable and cost-effective. The prevention of depression is an area that
deserves attention. Many prevention programs implemented across the lifespan have
provided evidence on the reduction of elevated levels of depressive symptoms. Effective
community approaches to prevent depression focus on several actions surrounding the
strengthening of protective factors and the reduction of risk factors. Examples of
strengthening protective factors include school-based programs targeting cognitive,
problem-solving and social skills of children and adolescents as well as exercise
programs for the elderly. Interventions for parents of children with conduct problems
aimed at improving parental psychosocial well-being by information provision and by
training in behavioral childrearing strategies may reduce parental depressive symptoms,
with improvements in children’s outcomes.

16. 15
RECOMMENDATION
1. WHO technical support to policy makers and service planners
WHOs three most important recommendations for the development of policy,
strategic plans and for organizing services are to deinstitutionalize mental health care; to
integrate mental health into general health care; and to develop community mental health
services. Support to countries is provided at multiple levels and includes, but is not
limited to, the following:
2. Mental health situational analysis and needs assessment
Helping countries to analyze in as comprehensive way as possibletheir mental health
situation and needs. What are the priority mental health problems, what are the major
needs, what are the available resources to address needs? What are the service and
resource gaps?
3. Facilitating stakeholder consultations within countries
Facilitating discussions and consultations between the different stakeholders within
the country interested in mental health reform.
4. Analysis, drafting and implementation of mental health policies, strategic
plans and proposals for service organization
Working closely with the MOH and committees to analyses and draft mental health
policies and strategic plans and advice on their implementation.
5. Assistance to improve capacity of mental health systems and services
Ongoing technical assistance to policy makers to improve overall functioning of the
mental health system and services. Two core related issues that always assume
importance in countries where we work are service development and human resource

17. 16
development and training. Primary health care is nearly always featured in countries
requests for assistance.
6. Building knowledge and skills of policy makers, health planners and service
providers
Providing the opportunity to policy makers, health planners and service providers to
gain more knowledge and skills through training workshops in a number of areas critical
to policy making and service planning (developing policies and plans; developing law;
improving access to psychotropic drugs, developing mental health information systems,
implementing quality improvement strategies, budgeting and financing for mental health,
mental health monitoring and evaluation).
CONCLUSION
Mental disorders also rise sharply during the adolescent years. Many risk
processes that lead to chronic non-communicable diseases in later life, including tobacco,
alcohol, and illicit substance misuse, unsafe sex, obesity, and lack of physical activity,
typically emerge around this time. Depression is a mental disorder that is pervasive in the
world and affects us all. Unlike many large scale international problems, a solution for
depression is at hand. Efficacious and cost-effective treatments are available to improve
the health and the lives of the millions of people around the world suffering from
depression. On an individual, community, and national level, it is time to educate
ourselves about depression and support those who are suffering from this mental
disorder.