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Persons with Disabilities Living in Rural Areas of Bangladesh: An Exploration of Their Mental Health and Experiences in Accessing Support during the COVID-19 Pandemic

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Title: Persons with Disabilities Living in Rural Areas of Bangladesh: An Exploration of Their Mental Health and Experiences in Accessing Support during the COVID-19 Pandemic
Language: English
Authors: Md. Omar Faruk (ORCID 0000-0001-6401-3861), Christopher Boyle (ORCID 0000-0001-6196-7619), Kelly-Ann Allen (ORCID 0000-0002-6813-0034), Kamal Uddin Ahmed Chowdhury (ORCID 0000-0003-3136-2875), Nazmul Bari, Mohammad Rezaul Alam, Kerrie Lissack, Taslima Akter, Shafayet Hossain, Sumaiya Noor Sanda (ORCID 0000-0003-0864-9683), Parvin Akter, Ben Adams
Source: International Journal of Disability, Development and Education. 2026 73(2):367-381.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 15
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Foreign Countries, COVID-19, Pandemics, Rural Areas, Mental Health, Access to Health Care, Social Bias, At Risk Persons, Barriers, Health Services
Geographic Terms: Bangladesh
DOI: 10.1080/1034912X.2024.2406471
ISSN: 1034-912X
1465-346X
Abstract: The COVID-19 pandemic has presented a major public health challenge across the world, including in Bangladesh. Little scholarly work has explored the mental health experiences of persons with disabilities in rural areas of Bangladesh during the pandemic. A qualitative case study was conducted in the rural areas of Narayanganj, Gazipur, and Narsingdi. A total of 13 in-depth interviews (IDIs) with persons with disabilities and 13 key informant interviews (KIIs) with different stakeholders and caregivers were conducted. Thematic analysis was used to analyse the data. The findings revealed five major themes: "lockdown-induced mental health problems", including fear of infection, symptoms of anxiety and depression, sleep disturbance, suicidal ideation, and domestic violence; "perceived attitude" towards mental health issues, including stigma and discrimination; "perceived vulnerability" was observed in relation to gender, age, and type of disability; "barriers to seeking mental health care" including distance, financial burden, and indifference towards mental health care; and finally, availability of mental health care which reaffirms a lack of mental health care in rural areas. The findings highlight the importance of integrating mental health into the primary healthcare system with a focus on persons with disabilities to minimise mental health repercussions during times of emergency.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1504197
Database: ERIC
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  Value: <anid>AN0191629649;54q01mar.26;2026Feb19.04:40;v2.2.500</anid> <title id="AN0191629649-1">Persons with Disabilities Living in Rural Areas of Bangladesh: An Exploration of Their Mental Health and Experiences in Accessing Support During the COVID-19 Pandemic </title> <p>The COVID-19 pandemic has presented a major public health challenge across the world, including in Bangladesh. Little scholarly work has explored the mental health experiences of persons with disabilities in rural areas of Bangladesh during the pandemic. A qualitative case study was conducted in the rural areas of Narayanganj, Gazipur, and Narsingdi. A total of 13 in-depth interviews (IDIs) with persons with disabilities and 13 key informant interviews (KIIs) with different stakeholders and caregivers were conducted. Thematic analysis was used to analyse the data. The findings revealed five major themes: lockdown-induced mental health problems, including fear of infection, symptoms of anxiety and depression, sleep disturbance, suicidal ideation, and domestic violence; perceived attitude towards mental health issues, including stigma and discrimination; perceived vulnerability was observed in relation to gender, age, and type of disability; barriers to seeking mental health care including distance, financial burden, and indifference towards mental health care; and finally, availability of mental health care which reaffirms a lack of mental health care in rural areas. The findings highlight the importance of integrating mental health into the primary healthcare system with a focus on persons with disabilities to minimise mental health repercussions during times of emergency.</p> <p>Keywords: Bangladesh; persons with disabilities; mental health; rural area; COVID-19 pandemic; qualitative exploration</p> <hd id="AN0191629649-2">Introduction</hd> <p>The pandemic caused by the outbreak of the new coronavirus disease in 2019 (COVID-19) has led to an unprecedented global crisis, with the disease claiming lives and threatening the well-being of people worldwide (Yeasmin et al., [<reflink idref="bib35" id="ref1">35</reflink>]). To prevent the further spread of the virus and to reduce the death toll, many countries imposed nationwide lockdown measures, restricted public movement, shut down non-essential businesses, and closed educational institutions. These restrictions have had pervasive impacts on all areas of people's lives, including their mental health and well-being. Evidence suggests that the pandemic has had a substantial psychological and social impact on all age groups, with an increased risk of developing post-traumatic stress disorder, anxiety, and depression (Saladino et al., [<reflink idref="bib28" id="ref2">28</reflink>]). The pandemic has also led to heightened feelings of helplessness and loss of freedom, separation from loved ones, uncertainty about the transmission of the disease, and increased incidence of suicides (Saladino et al., [<reflink idref="bib28" id="ref3">28</reflink>]). Sleep disturbance (Gupta et al., [<reflink idref="bib14" id="ref4">14</reflink>]) and reported incidences of domestic violence and child abuse have also risen (Tazaki, [<reflink idref="bib33" id="ref5">33</reflink>]). Strict social restrictions and stay-at-home orders have posed a substantial risk for the mental health and well-being of all people across the world, particularly those with disabilities.</p> <p>The impact of the pandemic has also had a heavy toll on Bangladeshi people's mental health amid the enforcement of a countrywide lockdown aimed at preventing the transmission of the disease. For example, research showed that the pandemic and the subsequent lockdown have had a considerable impact on the mental health of the population across all age groups, including a higher prevalence of sleep disturbance (Ara et al., [<reflink idref="bib4" id="ref6">4</reflink>]), anxiety, depression, and stress (Abir et al., [<reflink idref="bib1" id="ref7">1</reflink>]; Banna et al., [<reflink idref="bib7" id="ref8">7</reflink>]; Begum et al., [<reflink idref="bib9" id="ref9">9</reflink>]; Faisal et al., [<reflink idref="bib13" id="ref10">13</reflink>]; Islam et al., [<reflink idref="bib18" id="ref11">18</reflink>]; Mina et al., [<reflink idref="bib23" id="ref12">23</reflink>]; Sayeed et al., [<reflink idref="bib29" id="ref13">29</reflink>]; Shafiq et al., [<reflink idref="bib30" id="ref14">30</reflink>]; Yeasmin et al., [<reflink idref="bib35" id="ref15">35</reflink>]), suicidal ideation (Mamun et al., [<reflink idref="bib22" id="ref16">22</reflink>]), decreased wellbeing (Ali et al., [<reflink idref="bib3" id="ref17">3</reflink>]), and increased social isolation (Rahman, Afroze, et al., [<reflink idref="bib27" id="ref18">27</reflink>], [<reflink idref="bib27" id="ref19">27</reflink>]). While persons without disabilities have experienced a significant impact on their mental health during the pandemic, the impact on persons with disabilities living in rural areas, where mental health services are scarce, is likely to be exacerbated. The institutions and hospitals offering specialised mental health care are in the principal cities and there are no follow-up care facilities or day treatment services for mental health care available at a community level in rural areas, thus excluding rural populations, including persons with disabilities, from mental health care (Alam et al., [<reflink idref="bib2" id="ref20">2</reflink>]) especially during emergencies. While the impact of the pandemic has been investigated amongst the broader population in Bangladesh including students, children, and adolescents, little research has shed light on the mental health experiences of persons with disabilities.</p> <p>It is estimated that approximately 15% of the global population are living with disabilities and that 80% of this group reside in low- and middle-income countries (LMICs) (Nuri et al., [<reflink idref="bib24" id="ref21">24</reflink>]). Persons with disabilities can encounter numerous challenges in their daily lives, including barriers to everyday mobility, restricted access to public transport and healthcare facilities, as well as difficulties with communication (Lebrasseur et al., [<reflink idref="bib20" id="ref22">20</reflink>]). Persons with disabilities are more prone to mental health difficulties – such as depression, loneliness, and lower life satisfaction – compared to the general population (Lebrasseur et al., [<reflink idref="bib20" id="ref23">20</reflink>]). Given the significance of the adversities encountered by persons with disabilities, they have been viewed as a marginalised group (Lebrasseur et al., [<reflink idref="bib20" id="ref24">20</reflink>]), and the ongoing pandemic has accelerated the mental health crises they face. For example, evidence suggests that people with limited access to socioeconomic resources and supportive social networks (e.g. persons with disabilities) are more likely to experience adverse mental health issues (e.g. mass trauma) during the pandemic ([<reflink idref="bib16" id="ref25">16</reflink>].). Research conducted during previous pandemics showed that persons with disabilities experience increased difficulty in accessing medical supplies compared to the general population, and this is further exacerbated when such resources become limited ([<reflink idref="bib16" id="ref26">16</reflink>].). O'Sullivan and Bourgoin ([<reflink idref="bib25" id="ref27">25</reflink>]) demonstrated that during a pandemic, persons with disabilities experience a disproportionate degree of social isolation compared to persons with no disabilities. Such negative experiences may ignite a heightened sense of loneliness and social isolation, and eventually lead to a rise in physiological complaints such as heart disease, dementia, and other health complications ([<reflink idref="bib16" id="ref28">16</reflink>].). Persons with disabilities are also more prone to experiencing discriminatory attitudes during healthcare crises, which can lead to further impacts on mental health and well-being ([<reflink idref="bib16" id="ref29">16</reflink>].).</p> <p>It is estimated that the prevalence of disability in Bangladesh ranges from 1.4% to 17.5%, and persons with disabilities can often be deprived of their basic human rights and subjected to widespread stigma and discrimination (Nuri et al., [<reflink idref="bib24" id="ref30">24</reflink>]). To address this, the government of Bangladesh has introduced numerous service care provisions, such as disability allowances, reserved seats with subsidised transport fees on public transport, and rehabilitation services (including physiotherapy, occupational therapy, and speech and language therapy), particularly for children with disabilities, across 64 districts in the country (Nuri et al., [<reflink idref="bib24" id="ref31">24</reflink>]).</p> <p>Studies related to the mental health experiences of persons with disabilities during the pandemic in Bangladesh are limited. However, a recent study conducted by Innovation to Inclusion (2020), which aimed to gather views from people with physical, intellectual, and multiple disabilities (<emph>n</emph> = 312), showed that 100% of respondents in Bangladesh reported their lives to have been adversely affected by the pandemic. Respondents also reported experiencing exclusion from government COVID-19 responses due to inaccessibility, leading to widespread stress and anxiety (The Impact of Covid-19 on Persons with Disabilities, [<reflink idref="bib17" id="ref32">17</reflink>]). However, the extent to which the pandemic impacted the mental health of persons with disabilities in rural areas of Bangladesh has been explicitly studied. In addition, the barriers faced by persons with disabilities in rural areas in accessing mental health services during the pandemic have largely been unaddressed in previous research. Therefore, the present study sought to explore the mental health crises and services available in rural areas for persons with disabilities.</p> <hd id="AN0191629649-3">Methods</hd> <p>The present study, conducted between January 2021 and February 2021, is a qualitative exploration of the mental health experiences of persons with disabilities and the services available to them during the pandemic in rural areas of Bangladesh. The study used a semi-structured interview guide. The development of the topic guide, data collection, transcription, and analysis was conducted in the same period.</p> <hd id="AN0191629649-4">Study Setting</hd> <p>The study was conducted in two rural areas of Narayanganj (Rupganj and Shastapur) and two rural areas of Gazipur (Kunia) and Narsingdi (Aiyubpur).</p> <hd id="AN0191629649-5">Study Design</hd> <p>A topic guide was produced which included two major dimensions: mental health experiences of persons with disabilities living in rural areas during the pandemic and the services available for mental health care in these rural areas. Thematic analysis using an inductive approach was carried out to analyse the data. Key benefits of thematic analysis include its usefulness and flexibility in allowing the identification of recurring patterns or themes of meaning within the same data set in relation to different epistemological and ontological positions (Braun & Clarke, [<reflink idref="bib10" id="ref33">10</reflink>]).</p> <hd id="AN0191629649-6">Study Participants</hd> <p>A total of 13 in-depth interviews (IDIs) were conducted with persons with disabilities (Male, <emph>N</emph> = 6, Mean age: 34.67; Female, <emph>N</emph> = 7, Mean age: 29.57). The participants were recruited using purposive sampling. In addition, 13 key informant interviews (KIIs) (Male, <emph>N</emph> = 5, Mean age: 37.4; Female, <emph>N</emph> = 8, Mean age: 32.13) with 8 different stakeholders (4 peer responders, 4 health care providers) and 5 caregivers were also conducted. Caregivers and peer responders helping people with the distribution of relief and primary mental health care during the pandemic and healthcare workers providing services on the frontline were purposively selected. The majority (more than half) of the participants had attended secondary school. The socioeconomic status of participants recruited for the IDIs ranged from poor (53.84%) to lower-middle-income (46.15%) groups, whereas the remaining participants in the KIIs belonged to the poor (61.53%) and middle-income groups (38.46%). Most of the participants (<emph>N</emph> = 21) were Muslim. Nine participants in the IDIs were found to have a physical disability, while the remaining three had a visual disability, and one had a speech and hearing disability.</p> <hd id="AN0191629649-7">Data Collection Technique</hd> <p>Participants were first approached by peer responders in the rural areas of Gazipur, Narayanganj, and Narsingdi and had received foundational training in identifying primary mental health problems. KIIs were carried out with five caregivers of participants with disabilities who were also recruited using purposive sampling. The remaining eight stakeholders were selected for their expert knowledge of the population. Researchers continued sampling until the data revealed that no new information or concepts were arising, eventually leading to data saturation. A topic guide with open-ended questions was produced, and semi-structured interviews lasted approximately 40 minutes each. An example of one question is '<emph>What are the mental health issues you have experienced during the pandemic?</emph>' The interviews were carried out by the principal researcher. A sign language interpreter assisted in interviewing the participant with a speech and language disability. The interviews were recorded and transcribed by the research team, with the performance of frequent checks on the transcribed files to ensure the accuracy of the meaning was maintained.</p> <hd id="AN0191629649-8">Data Storage</hd> <p>In accordance with the approved study plan, data were stored in such a way as to ensure confidentiality. Data were recorded digitally and then encrypted. Paper files were kept in secure storage. Identification numbers were used to label and anonymise the data gathered from the participants, and the remaining information deemed identifiable was stored separately from the data.</p> <hd id="AN0191629649-9">Data Analysis</hd> <p>The study used thematic analysis, which allows back-and-forth movement within the data set. At the outset, the interview recordings were transcribed, and the transcriptions were checked several times to ensure the rigour of the process and its accuracy. Transcripts were visited and re-visited by the principal researcher to identify initial codes. The codes identified were then reviewed and renamed by other researchers involved in the study. The research team discussed and verified the appropriateness of participants' accounts in relation to the initial codes. Triangulation was used to indicate the varying experiences and perspectives of each group, as well as dynamic contrasts within the data (Braun & Clarke, [<reflink idref="bib10" id="ref34">10</reflink>]). The final phase of the analysis involved identifying data extracts that harmonised with the central themes. The quotes identified were also reviewed by the research team to ensure their compatibility with the themes.</p> <hd id="AN0191629649-10">Reflexivity</hd> <p>Reflexivity is a goal-directed action that attempts to improve practice through continuously engaging in, reflecting upon, and declaring the standpoint of the researcher and the context within which the research is taking place (Barrett et al., [<reflink idref="bib8" id="ref35">8</reflink>]). Reflexivity also necessitates consideration of social and cultural influences, as well as dynamics impacting the research context. Barrett et al. ([<reflink idref="bib8" id="ref36">8</reflink>]) thus argue that reflexivity should be considered as a collective, rather than as an individual, process within a research team. The influence of the researcher's own projections, attachments, assumptions, agendas, and biases was considered in the present study.</p> <hd id="AN0191629649-11">Ethical Considerations</hd> <p>The study was approved by the ethical review committee at the Department of Clinical Psychology, University of Dhaka (project ID: IR201201). An informed consent form explaining the nature and purpose of the study was given to all participants before the data collection. A thumb mark was used to indicate consent for participants with no literacy. An accessible informed consent form in braille format for those with visual disability was also implemented. The participants were provided with a list of mental healthcare institutions and hospitals in case any potential mental health problems arose. A mental health professional was made available through a helpline number to address any mental health problems that occurred during and after the interviews. No reimbursement was provided for taking part in the study.</p> <hd id="AN0191629649-12">Findings</hd> <p>Qualitative findings of the study produced five key themes: lockdown-induced mental health issues; perceived attitude towards mental health issues; perceived vulnerability with respect to gender, age, and type of disability; barriers to seeking mental health care; and availability of mental health services.</p> <hd id="AN0191629649-13">Lockdown-Induced Mental Health Issues</hd> <p></p> <hd id="AN0191629649-14">Accounts of People with Disabilities (IDIs)</hd> <p>Persons with disabilities reported experiences of profound sadness, boredom, anger, hopelessness, stress, domestic violence, and fear of infection, as well as – in extreme cases – death. This resulted in reduced sleep and an increased sense of isolation. Some people lost hope and viewed lockdown as a never-ending burden, resulting in reduced freedom and social interaction with others. One person with a physical disability reported that hearing the news of the sudden death of a colleague as a result of coronavirus triggered a heightened fear of death that eventually escalated into a sense of over-responsibility to protect others in the family, including the children. The person (male) said,</p> <p>When I heard the news, I could not believe what I was hearing, and I couldn't speak for the next few minutes due to the shock. I was worried about what would happen if I got infected, too, and die like him. I had problems sleeping and nightmares when I did. We were the same age. It made me realize that I can die too if I'm not cautious enough.</p> <p>One participant mentioned that she was feeling angry because her husband displaced his own anger onto her daughter, who had a speech sound disorder impacting the ability to produce sounds in speech and difficulty passing urine. Her husband had recently lost his job because the company he worked for was experiencing significant financial losses due to lockdown measures. This caused her to feel extreme stress, eventually leading to hopelessness. She said,</p> <p>We lost our source of income as soon as the factory closed down, as my husband was the sole bread winner. He was so worried and was not easy to talk to at that time. He used to beat up my daughter and accused her of causing this trouble with her deformities and misfortunes. We were having frequent fights over this. I am angry and feeling so hopeless, thinking that my daughter and I will continue to suffer like this.</p> <p>The indefinite lockdown confined people and compelled them to stay at home for a prolonged period of time, leading to boredom and a sense of isolation.</p> <p>One person (male) with speech and hearing disability reported,</p> <p>... my family members told me not to go outside and to stay home. I could not understand why I couldn't go out. It felt like the people around us had abandoned us. I was feeling isolated from the rest.</p> <p>The uncertainty over the duration of the lockdown and the reopening of educational institutions and factories created stress among persons with disabilities. Some participants reported having difficulty managing their children with regard to their increased use of mobile phones and television. This led to sudden outbursts of anger when they were denied the use of their devices and decreased their motivation to study. Major sources of stress were reported to include discontinued therapy, lack of assistive devices (e.g. hearing aids), lack of provision of relief for people with disabilities, financial burden, and a lack of access to caregivers.</p> <hd id="AN0191629649-15">Accounts of Caregivers, Peer Responders, and Healthcare Providers (KIIs)</hd> <p>The reported mental health issues experienced by persons with disabilities resonated with the accounts of their caregivers, peer responders, and healthcare providers. Caregivers reported observing hopelessness, stress, sadness, fear of death, suicidal ideation, and behavioural disturbances along with inappropriate behaviours. Peer responders also reported experiences of sadness, uncertainty, anger, hopelessness, and domestic violence in persons with disabilities. Stress, fear of infection, and hopelessness were the most frequently observed mental health issues reported by healthcare providers.</p> <p>A peer responder (male) reported witnessing violent behaviour towards a female participant with a disability (physical) during the pandemic. He said,</p> <p>... she was having discord with her husband as her husband stayed at home losing his job due to the lockdown. The husband sometimes beats her up. She wants to commit suicide".</p> <p>Healthcare providers also reported seeing persons with disabilities experiencing stress, isolation, and suicidal ideation when seeking primary care in healthcare facilities. Persons with disabilities who used to be busy with work were now compelled to stay home without any social interaction with friends and colleagues. This produced boredom and a sense of isolation. One healthcare provider (male) said,</p> <p>I saw many people with disabilities who had mental health issues. For example, two days ago, I saw a person with a disability whose elder brother was mentally unstable. That made him feel anxious and hopeless.</p> <hd id="AN0191629649-16">Perceived Attitude Toward Mental Health Issues</hd> <p>The findings also indicated how stigma and discriminatory behaviours towards mental health were experienced by persons with disabilities, their caregivers, peer responders, and healthcare providers.</p> <p>Persons with disabilities experiencing mental health issues reported negative attitudes and discriminatory behaviour towards their conditions. The conditions were attributed to possession by evil spirits, black magic, the curse of the almighty, and misfortune. The discriminatory behaviour included labelling individuals with derogatory terms (mad, <emph>pagol</emph> in Bangla), beating, neglect, humiliation, and shouting.</p> <p>One person (male) with a visual disability said,</p> <p>I was working in an office, where I used to proofread the materials produced in braille format. When the lockdown was imposed, after a few days, I got a notice that I was terminated from the job. A colleague of mine said to me that it all happened due to the misfortune I brought upon them. I was so sad and crying. I never thought people could point out my disability like this.</p> <p>Caregivers also described mental health difficulties being accentuated by the negative attitudes towards mental health. Neglect, physical beating, devaluation, and humiliation were frequently observed. A mother said,</p> <p>... people don't talk to my son and keep a distance from him. They often call him pagol (mad) and laugh at him, beats him up as he sometimes displays outbursts of anger. My son wants to talk to the neighbours and wants to play with other kids of his age. Yet they still don't play with him even after the lockdown had lifted.</p> <p>Peer responders' experiences regarding attitudes towards mental health issues also indicated stigma and discrimination.</p> <p>A female peer responder said,</p> <p>People often don't endorse it (mental health) and they don't want to talk about it. And this pandemic has made them get it all wrong. Since they are not aware, therefore, if someone experiences mental health problems during the period, they call it madness, losing their mind, and don't let that person seek help.</p> <p>Frontline health workers offering primary care in the healthcare facilities expressed similar accounts regarding attitudes towards mental health. A health worker (male) said,</p> <p>... when the pandemic broke out and they started experiencing mental health issues, they called it a curse of the Almighty. They believed that they were being punished ... they usually go to traditional healers for any behaviours which they consider unusual and disproportionate.</p> <hd id="AN0191629649-17">Perceived Vulnerability with Respect to Gender, Age, and Type of Disability</hd> <p>Type of disability was found to have a varying impact on the experience of mental health issues during the pandemic. While participants with physical disabilities shared mental health issues, three participants with visual disability described more intense mental health issues and symptoms including sadness, anger, behavioural disturbances, suicidal ideation, and determinants of mental health, such as domestic violence. A male participant with a visual disability said,</p> <p>... sometimes I thought of committing suicide due to the helplessness. I am dependent on my family members for almost everything. I can't move alone without their help.</p> <p>Gender differences were found to impact escalating mental health issues in persons with disabilities. For example, female participants reported more mental health issues compared to their male counterparts. A total of 15 female participants were recruited in the study, including persons with disabilities. Female participants with disabilities, caregivers, peer responders, and healthcare workers reported experiencing sadness (<reflink idref="bib12" id="ref37">12</reflink>), stress (<reflink idref="bib13" id="ref38">13</reflink>), isolation (<reflink idref="bib4" id="ref39">4</reflink>), anger (<reflink idref="bib9" id="ref40">9</reflink>), hopelessness (<reflink idref="bib11" id="ref41">11</reflink>), sleep disturbance (<reflink idref="bib6" id="ref42">6</reflink>), and suicidal ideation (<reflink idref="bib6" id="ref43">6</reflink>) more often than male participants' sadness (<reflink idref="bib6" id="ref44">6</reflink>), stress (<reflink idref="bib4" id="ref45">4</reflink>), isolation (<reflink idref="bib6" id="ref46">6</reflink>), anger (<reflink idref="bib6" id="ref47">6</reflink>), hopelessness (<reflink idref="bib5" id="ref48">5</reflink>), sleep disturbance (<reflink idref="bib4" id="ref49">4</reflink>), suicidal ideation (<reflink idref="bib2" id="ref50">2</reflink>). However, feelings of being isolated were observed more frequently in male (<reflink idref="bib6" id="ref51">6</reflink>) participants than in females (<reflink idref="bib4" id="ref52">4</reflink>). In addition, eight female participants reported domestic violence, compared to two male participants. Domestic violence has been shown to increase during times of crisis such as the pandemic, while also being a determinant of mental health for the victim.</p> <p>Older participants with disabilities and caregivers expressed negative mental health symptoms more intensely than younger participants and caregivers. The symptoms included loneliness, isolation, and suicidal ideation. A male participant with a physical disability (age 64) said,</p> <p>... I could hardly manage the expenses with my income. Now that the shop is closed, I see no hope. I have chest pains and sleep problems; I need to buy medications regularly, which are expensive. They say that older people die if they get affected by this (the virus). I don't know how I am going to survive this.</p> <hd id="AN0191629649-18">Barriers to Seeking Mental Health Care</hd> <p>A few participants with an understanding of mental health literacy (<reflink idref="bib3" id="ref53">3</reflink>) reported several barriers to seeking mental health care. The barriers included unavailability of mental health care in the area, distance from the service facilities, transportation cost, financial burden, and unwillingness to help. Indifference from family members, stigma, and perceived inefficacy of the care were also reported as major barriers to receiving mental health care. A female participant with a physical disability said,</p> <p>I heard that there is a treatment available suicidal ideation. But since there is no such treatment in our area, nor does our UHC (Upazila Health Complex) provide one, I couldn't seek treatment. And the hospitals (in Dhaka) where the help is available is very far from here. Besides, we don't have money for this.</p> <p>Peer responders and healthcare providers also indicated stigma associated with mental health problems as the primary reason for the reluctance to seek mental health care. Additional barriers included the concentration of mental health services in principal cities and the unavailability of mental health services at the grassroots level. A healthcare provider said,</p> <p>When any psychological issues come up, they first go to see kabiraj or shaman, instead of doctors at UHC where mental healthcare is also unavailable. Services are in big cities. Then comes the financial burden.</p> <hd id="AN0191629649-19">Availability of Mental Health Services</hd> <p>An exploration of the availability of mental health services revealed that no such services were available in the local areas. Collective accounts of participants with disabilities, caregivers, peer responders, and healthcare providers noted the scarcity of mental health care in the areas where the study took place. Government and non-governmental facilities serving as the main sources of primary health care were not equipped with mental health professionals (e.g. psychiatrists and psychologists). Healthcare providers indicated that material support (e.g. relief materials such as food and blankets) was provided by government representatives. Peer responders and healthcare providers mentioned the availability of mental health services in Dhaka, but financial difficulties and the distance to and from the city had kept people away from accessing these services. No participants reported having access to mental health services in these rural areas, nor did they hear of any doctors prescribing medication or providing psychosocial support to people in need.</p> <p>A healthcare provider (female) noted,</p> <p>... and without the support in the locality, people continue to suffer, especially in times of emergency.</p> <p>A person (male) with a communication and hearing disability said,</p> <p>... poor people always have problems. They suffer from anxiety, sadness, stress, and so on. They don't consider seeking treatment for it, as they think this is not for them. That's why we don't have the treatment here.</p> <hd id="AN0191629649-20">Discussion</hd> <p>The present study aimed to explore the mental health experiences faced by persons with disabilities and the services available to them in four rural areas of Bangladesh. A total of 13 participants were recruited for IDIs and 13 participants, comprised of caregivers, peer responders, and healthcare providers, participated in KIIs. A range of mental health symptoms and determinants were reported by the participants as occurring during the lockdown, including sadness, stress, anxiety, uncertainty, fear of infection, anger, hopelessness, sleep disturbance, suicidal ideation, and domestic violence.</p> <p>Results obtained from the present study mirror those found in a study conducted by Lebrasseur et al. ([<reflink idref="bib20" id="ref54">20</reflink>]) in relation to changes in mood caused by the various measures enforced to contain the spread of the virus. Sadness was frequently reported as the immediate impact of the lockdown by all participants. Stress, fear of infection, uncertainty over access to healthcare services, fear of death, and isolation were also reported among persons with disabilities, regardless of the type of mental health determinants (e.g. domestic violence) experienced during the pandemic (Lund et al., [<reflink idref="bib21" id="ref55">21</reflink>]).</p> <p>Persons with physical disabilities reported fear of infection, anxiety, and depression (Summaka et al., [<reflink idref="bib32" id="ref56">32</reflink>]). Our study does not conclusively declare the presence of depression in participants, as no diagnostic measure was used during the assessment. However, symptoms indicative of depression were reported by the participants, such as marked sadness, hopelessness, and suicidal ideation. Research on previous pandemics (e.g. H1N1 in 2003 and the SARS outbreak in 2003) suggests that persons with disabilities experience greater social isolation and loneliness due to physical distancing measures when compared to persons without disabilities (O'Sullivan & Bourgoin, [<reflink idref="bib25" id="ref57">25</reflink>]). Increased age has been reported as intensifying the fear of infection (Summaka et al., [<reflink idref="bib32" id="ref58">32</reflink>]), suicidal ideation, isolation, and loneliness (Wand et al., [<reflink idref="bib34" id="ref59">34</reflink>]). Similarly, our findings indicated that older participants reported more intense feelings of loneliness and isolation when compared to younger participants.</p> <p>Our study has also revealed an increase in the number of incidents of domestic violence during the pandemic, which has been reported as contributing to the mental health crisis among people with disabilities (Tazaki, [<reflink idref="bib33" id="ref60">33</reflink>]). In addition to age, gender was found to have played a role in determining the extent to which mental health issues were perceived. A study (Ausín et al., [<reflink idref="bib6" id="ref61">6</reflink>]) found that a greater proportion of female participants reported symptoms of anxiety, loneliness, and depression than was the case for male participants, thus indicating a greater mental health toll on women than men. In parallel, findings from the present study show that the pandemic has affected women more adversely than men.</p> <p>The present study provides an important insight into the mental health experiences of persons with varying types of disabilities. For example, persons with visual disabilities expressed more intense mental health symptoms than persons with physical disabilities, although persons with disabilities are, in general, more vulnerable to mental health problems (Lebrasseur et al., [<reflink idref="bib20" id="ref62">20</reflink>]). More research is needed to shed light on the varying accounts of vulnerabilities across different types of disabilities, especially in the context of an emergency. Further research exploring mental health experiences during and after the pandemic is, thus, strongly recommended.</p> <p>The study also reflected on the prevailing attitudes towards mental health issues of persons with disabilities, caregivers, and other stakeholders during the pandemic. Widespread stigma regarding mental health problems was found to have influenced treatment-seeking behaviour. For example, visits to traditional healers and shamans, an attitude of nonchalance towards seeking mental health care, and discriminatory behaviour, such as physical violence towards people with mental health difficulties, were reported.</p> <p>Another study (Priestley & Hemingway, [<reflink idref="bib26" id="ref63">26</reflink>]) explored the links between disability and disaster, particularly the recovery needs of persons with disabilities following two case study events: the Asian tsunami and Hurricane Katrina. As in the present study, this research found that persons with disabilities are at increased risk of being subjected to discriminatory attitudes. In more general terms, research has shown that negative attitudes exist towards the treatment of people experiencing mental health issues (Hossain et al., [<reflink idref="bib15" id="ref64">15</reflink>]), ranging from cases in which help is sought from traditional healthcare providers to cases in which help is sought from homoeopathic practitioners (Arafat et al., [<reflink idref="bib5" id="ref65">5</reflink>]). People in rural areas of Bangladesh experience a burden of mental health problems, yet a substantial proportion of those living in these areas do not receive timely treatment (Khan, [<reflink idref="bib19" id="ref66">19</reflink>]) or support. Stigma, discrimination, poor mental health literacy, and cultural beliefs about mental health problems place a limit on people's acceptance of and access to mental health care (Sharma, [<reflink idref="bib31" id="ref67">31</reflink>]).</p> <p>Barriers to seeking mental healthcare during the pandemic were also investigated. Financial burden, unavailability of mental healthcare in the vicinity, transport costs to and from the specialised hospitals, stigma, and discrimination were found to be the most frequently reported barriers in pursuing mental healthcare. Healthcare services are largely concentrated in tertiary hospital settings in capital cities, and mental healthcare is not a priority in healthcare delivery (Hossain et al., [<reflink idref="bib15" id="ref68">15</reflink>]), despite the World Health Organisation's (WHO) recommendation of integrating mental healthcare into primary healthcare systems (Arafat et al., [<reflink idref="bib5" id="ref69">5</reflink>]). Research on the impact of the influenza pandemics suggests that persons with disabilities had trouble accessing medical treatment amid the dearth of resources (Campbell et al., [<reflink idref="bib11" id="ref70">11</reflink>]). While the government of Bangladesh has stressed the importance of the provision of mental healthcare, its integration into the primary healthcare system has yet to occur, due to a shortage of mental health professionals and an insufficient budget dedicated to mental healthcare. Researchers argue that access to universal and inclusive healthcare, including mental health, should become the new normal (Ebuenyi et al., [<reflink idref="bib12" id="ref71">12</reflink>]). Therefore, the present study recommends swift integration of the provision of inclusive mental healthcare, taking persons with disabilities into consideration at the grassroots level, to improve the psychological well-being of people living in rural areas, especially during times of crisis.</p> <hd id="AN0191629649-21">Limitations and Recommendations</hd> <p>One limitation of this study is the lack of psychometric tools used, which could have added a quantitative component to the results. The purposive sampling method used can also lead to several biases, such as response bias and researchers' bias. In addition, as participants with physical disability outnumbered participants with other forms of disabilities, therefore, it is reasonable to assume that the voices of other types of disabilities were weakly represented. Finally, ongoing field observations and biographic accounts would have strengthened the credibility and trustworthiness of the findings.</p> <p>The study recommends that a nationwide survey is needed to document the prevalence of mental health problems of persons with disabilities. Qualitative studies exploring the varying mental health needs of persons with disabilities irrespective of types, gender, and age groups during the pandemic are also recommended to support the design of suitable and inclusive community-based mental health interventions.</p> <hd id="AN0191629649-22">Conclusion</hd> <p>The present study provided important insights into the mental health difficulties of persons with disabilities living in rural areas, in Bangladesh. The pandemic seems to have had an impact on the mental health status of persons with disabilities, and no provision of mental healthcare was found to be in place in rural areas. Participants reported that health-seeking behaviours and mental health literacy could have been improved had there been mental healthcare services available in the primary healthcare settings. We recommend the implementation of an inclusive community-based mental healthcare approach, particularly during emergencies, at the grassroots level in Bangladesh to address mental health difficulties.</p> <hd id="AN0191629649-23">Acknowledgments</hd> <p>The study was conducted as part of a project entitled 'Collective Efforts of Organizations of Persons with Disabilities on Inclusive COVID-19 humanitarian Actions in Bangladesh' implemented by the Centre for Disability in Development (CDD) and supported by CBM. We would like to thank the organisations of persons with disabilities (OPD) involved in the study. We also thank the participants who willingly took part in the study and CBM for the funding.</p> <hd id="AN0191629649-24">Disclosure Statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0191629649-25">Authors' Contributions</hd> <p>MOF and NB conceptualised the study. MOF collected the data and transcribed the recordings alongside PR. MOF drafted the manuscript. MRA, TA, SH, and SN contributed to the coding and reviewed and revised the manuscript. CB, KAA, KUAC, NB, BA, MT, and KL reviewed and revised the manuscript.</p> <hd id="AN0191629649-26">Disclaimer</hd> <p>The views expressed in the article are those of the authors and not those of any institution or the funding organisation.</p> <p>Correction Statement</p> <p>This article has been corrected with minor changes. 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Omar Faruk; Christopher Boyle; Kelly-Ann Allen; Kamal Uddin Ahmed Chowdhury; Nazmul Bari; Mohammad Rezaul Alam; Kerrie Lissack; Taslima Akter; Shafayet Hossain; Sumaiya Noor Sanda; Parvin Akter and Ben Adams</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib35" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib28" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib14" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib33" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib13" firstref="ref10"></nolink> <nolink nlid="nl6" bibid="bib18" firstref="ref11"></nolink> <nolink nlid="nl7" bibid="bib23" firstref="ref12"></nolink> <nolink nlid="nl8" bibid="bib29" firstref="ref13"></nolink> <nolink nlid="nl9" bibid="bib30" firstref="ref14"></nolink> <nolink nlid="nl10" bibid="bib22" firstref="ref16"></nolink> <nolink nlid="nl11" bibid="bib27" firstref="ref18"></nolink> <nolink nlid="nl12" bibid="bib24" firstref="ref21"></nolink> <nolink nlid="nl13" bibid="bib20" firstref="ref22"></nolink> <nolink nlid="nl14" bibid="bib16" firstref="ref25"></nolink> <nolink nlid="nl15" bibid="bib25" firstref="ref27"></nolink> <nolink nlid="nl16" bibid="bib17" firstref="ref32"></nolink> <nolink nlid="nl17" bibid="bib10" firstref="ref33"></nolink> <nolink nlid="nl18" bibid="bib12" firstref="ref37"></nolink> <nolink nlid="nl19" bibid="bib11" firstref="ref41"></nolink> <nolink nlid="nl20" bibid="bib21" firstref="ref55"></nolink> <nolink nlid="nl21" bibid="bib32" firstref="ref56"></nolink> <nolink nlid="nl22" bibid="bib34" firstref="ref59"></nolink> <nolink nlid="nl23" bibid="bib26" firstref="ref63"></nolink> <nolink nlid="nl24" bibid="bib15" firstref="ref64"></nolink> <nolink nlid="nl25" bibid="bib19" firstref="ref66"></nolink> <nolink nlid="nl26" bibid="bib31" firstref="ref67"></nolink>
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  Data: Persons with Disabilities Living in Rural Areas of Bangladesh: An Exploration of Their Mental Health and Experiences in Accessing Support during the COVID-19 Pandemic
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  Data: <searchLink fieldCode="AR" term="%22Md%2E+Omar+Faruk%22">Md. Omar Faruk</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6401-3861">0000-0001-6401-3861</externalLink>)<br /><searchLink fieldCode="AR" term="%22Christopher+Boyle%22">Christopher Boyle</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6196-7619">0000-0001-6196-7619</externalLink>)<br /><searchLink fieldCode="AR" term="%22Kelly-Ann+Allen%22">Kelly-Ann Allen</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-6813-0034">0000-0002-6813-0034</externalLink>)<br /><searchLink fieldCode="AR" term="%22Kamal+Uddin+Ahmed+Chowdhury%22">Kamal Uddin Ahmed Chowdhury</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-3136-2875">0000-0003-3136-2875</externalLink>)<br /><searchLink fieldCode="AR" term="%22Nazmul+Bari%22">Nazmul Bari</searchLink><br /><searchLink fieldCode="AR" term="%22Mohammad+Rezaul+Alam%22">Mohammad Rezaul Alam</searchLink><br /><searchLink fieldCode="AR" term="%22Kerrie+Lissack%22">Kerrie Lissack</searchLink><br /><searchLink fieldCode="AR" term="%22Taslima+Akter%22">Taslima Akter</searchLink><br /><searchLink fieldCode="AR" term="%22Shafayet+Hossain%22">Shafayet Hossain</searchLink><br /><searchLink fieldCode="AR" term="%22Sumaiya+Noor+Sanda%22">Sumaiya Noor Sanda</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-0864-9683">0000-0003-0864-9683</externalLink>)<br /><searchLink fieldCode="AR" term="%22Parvin+Akter%22">Parvin Akter</searchLink><br /><searchLink fieldCode="AR" term="%22Ben+Adams%22">Ben Adams</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22International+Journal+of+Disability%2C+Development+and+Education%22"><i>International Journal of Disability, Development and Education</i></searchLink>. 2026 73(2):367-381.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22COVID-19%22">COVID-19</searchLink><br /><searchLink fieldCode="DE" term="%22Pandemics%22">Pandemics</searchLink><br /><searchLink fieldCode="DE" term="%22Rural+Areas%22">Rural Areas</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Health+Care%22">Access to Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Bias%22">Social Bias</searchLink><br /><searchLink fieldCode="DE" term="%22At+Risk+Persons%22">At Risk Persons</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Services%22">Health Services</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Bangladesh%22">Bangladesh</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/1034912X.2024.2406471
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1034-912X<br />1465-346X
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The COVID-19 pandemic has presented a major public health challenge across the world, including in Bangladesh. Little scholarly work has explored the mental health experiences of persons with disabilities in rural areas of Bangladesh during the pandemic. A qualitative case study was conducted in the rural areas of Narayanganj, Gazipur, and Narsingdi. A total of 13 in-depth interviews (IDIs) with persons with disabilities and 13 key informant interviews (KIIs) with different stakeholders and caregivers were conducted. Thematic analysis was used to analyse the data. The findings revealed five major themes: "lockdown-induced mental health problems", including fear of infection, symptoms of anxiety and depression, sleep disturbance, suicidal ideation, and domestic violence; "perceived attitude" towards mental health issues, including stigma and discrimination; "perceived vulnerability" was observed in relation to gender, age, and type of disability; "barriers to seeking mental health care" including distance, financial burden, and indifference towards mental health care; and finally, availability of mental health care which reaffirms a lack of mental health care in rural areas. The findings highlight the importance of integrating mental health into the primary healthcare system with a focus on persons with disabilities to minimise mental health repercussions during times of emergency.
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  Data: As Provided
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  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1504197
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1504197
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      – Type: doi
        Value: 10.1080/1034912X.2024.2406471
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 367
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: COVID-19
        Type: general
      – SubjectFull: Pandemics
        Type: general
      – SubjectFull: Rural Areas
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Access to Health Care
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      – SubjectFull: Social Bias
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      – SubjectFull: At Risk Persons
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      – SubjectFull: Barriers
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      – SubjectFull: Health Services
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      – SubjectFull: Bangladesh
        Type: general
    Titles:
      – TitleFull: Persons with Disabilities Living in Rural Areas of Bangladesh: An Exploration of Their Mental Health and Experiences in Accessing Support during the COVID-19 Pandemic
        Type: main
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