{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:27:51Z","timestamp":1791246471673,"version":"4.1.0"},"reference-count":44,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"BRAC James P Grant School of Public Health, BRAC University"},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["16\/136\/68"],"award-info":[{"award-number":["16\/136\/68"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,20]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"\n Objective<\/jats:title>\n The rising burden of non-communicable diseases (NCDs), including mental health disorders (MHDs) such as anxiety and depression, poses a significant public health challenge globally. Evidence suggests that both diabetes and hypertension, the two most prevalent NCDs, are linked to a higher prevalence of MHDs. However, there is a lack of evidence on prevalence of generalised anxiety disorder (GAD) and depression among adults living with both diabetes and hypertension in Bangladesh. We aimed to assess the prevalence of GAD and depression and explore the associated factors among adults living with diabetes and hypertension comorbidity in rural Bangladesh.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n We implemented a cross-sectional study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n The study was conducted in Chirirbandar, a sub-district of Dinajpur, Bangladesh.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n We interviewed a total of 387 adults living with diabetes and hypertension comorbidity.<\/jats:p>\n <\/jats:sec>\n \n Primary outcome measures<\/jats:title>\n We had two primary outcome measures: GAD and depression. Individuals scoring \u226510 on the General Anxiety Disorder-7 scale were considered as having GAD and individuals scoring \u226510 on the Patient Health Questionnaire-9 scale were considered as having depression. The outcome variables were dichotomised based on these scores.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The prevalence of GAD was 7.24% (95% CI 5.04 to 10.29). Education level (grades 5\u20139) (adjusted OR (AOR): 3.40, 95%\u2009CI 1.26 to 9.19) and household wealth status (highest wealth tertile) (AOR: 0.12, 95%\u2009CI 0.02 to 0.62) were associated with GAD. The prevalence of depression was 17.83% (95% CI 14.32 to 21.98). Socioeconomic factors associated with depression included unemployment (AOR: 3.26, 95%\u2009CI 1.05 to 10.10) and household wealth status (highest wealth tertile) (AOR: 0.45, 95%\u2009CI 0.21 to 0.98). Higher odds of depression were also observed among participants with controlled hypertension (AOR: 3.88, 95%\u2009CI 1.81 to 8.35). Other factors, such as tobacco use, dietary diversity and physical activity, were not associated with GAD or depression.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n A high prevalence of GAD and depression was observed among adults living with diabetes and hypertension comorbidity. The findings from the study emphasise the need for integration of mental health services into the existing non-communicable disease care. The identified factors associated with GAD or depression should be considered to develop targeted interventions for people with hypertension and diabetes comorbidity in Bangladesh.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102000","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T13:15:37Z","timestamp":1757078137000},"page":"e102000","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Factors associated with generalised anxiety disorder and depression among adults living with diabetes and hypertension comorbidity in rural Bangladesh: findings from a cross-sectional study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9174-3551","authenticated-orcid":false,"given":"Meghna","family":"Chakravartty","sequence":"first","affiliation":[{"name":"Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Mashuk Shahriar","family":"Shuvo","sequence":"additional","affiliation":[{"name":"Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sita","family":"Kumari","sequence":"additional","affiliation":[{"name":"Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7747-1460","authenticated-orcid":false,"given":"Tanni Chakma","family":"Jhilik","sequence":"additional","affiliation":[{"name":"Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanmoy","family":"Sarker","sequence":"additional","affiliation":[{"name":"Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9294-265X","authenticated-orcid":false,"given":"Fahmida","family":"Akter","sequence":"additional","affiliation":[{"name":"Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8058-4776","authenticated-orcid":false,"given":"Md Mokbul","family":"Hossain","sequence":"additional","affiliation":[{"name":"Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Ahsan","sequence":"additional","affiliation":[{"name":"Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahbub","family":"Latif","sequence":"additional","affiliation":[{"name":"Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh"},{"name":"Statistical Research and Training, Dhaka University, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9226-457X","authenticated-orcid":false,"given":"Malay Kanti","family":"Mridha","sequence":"additional","affiliation":[{"name":"Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"2025090506152382000_15.9.e102000.1","unstructured":"World Health Organization . 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hospital","volume":"13","author":"Igwe","year":"2013","journal-title":"Af Hlth Sci"},{"key":"2025090506152382000_15.9.e102000.25","article-title":"Prevalence of depression among clients with diabetes and hypertension in selected hospital at Mangaluru, India","volume":"12","author":"Vadeo","year":"2023","journal-title":"J Educ Health Promot"},{"key":"2025090506152382000_15.9.e102000.26","first-page":"490","article-title":"Depression and its association with socio-demographic characteristics among type 2 diabetes mellitus patients of Bangladesh","volume":"21","author":"Rahman","year":"2012","journal-title":"Mymensingh Med J"},{"key":"2025090506152382000_15.9.e102000.27","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s13410-017-0592-z","article-title":"Factors affecting risk of anxiety and depression among diabetic and hypertensive patients who refer to family health centers","volume":"38","author":"Emre","year":"2018","journal-title":"Int J Diabetes Dev 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Unemployment and mental health: a global study of unemployment\u2019s influence on diverse mental disorders. Front Public Health 2024;12. doi:10.3389\/fpubh.2024.1440403","DOI":"10.3389\/fpubh.2024.1440403"},{"key":"2025090506152382000_15.9.e102000.34","first-page":"792","article-title":"Antihypertensive Medications and Depression","volume":"40","author":"Beers","year":"1990","journal-title":"Drugs (Abingdon Engl)"},{"key":"2025090506152382000_15.9.e102000.35","doi-asserted-by":"crossref","unstructured":"Li Y , Fan Y , Sun Y , et al . n.d. Antihypertensive Drug Use and the Risk of Depression: A Systematic Review and Network Meta-analysis. 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