Prevalence and risk factors of mental disorders during the COVID-19 pandemic in Bangladesh: a systematic review

The newly incepted Coronavirus Disease 2019 (COVID-19) has become a global public health threat, subsequently impacting individuals’ psychological wellbeing along with the risk of physical complications. Under the circumstance, it is essential to synthesize the existing evidence on psychological consequences regarding potential implications for policymaking and practice. Thus, a systematic attempt was compiled to review the Bangladeshi literature related to common mental health problems (i.e., depression, anxiety and stress) conducted during the COVID-19 pandemic. study. Literature searches were conducted between 20 December 2020 and 5 March 2021, using a group of bounded keywords in the relevant databases. The searching keywords included three types of items, (i) exposure (e.g., ‘COVID-19’, ‘Coronavirus’, SARS-Cov-2, ‘COVID-19 pandemic’), (ii) outcome of interest (e.g., ‘mental health’, ‘mental disorder’, ‘psychological impact’, ‘depressive disorders’, ‘depression’, ‘anxiety disorder’, ‘anxiety’, ‘stress’, ‘stress disorders’), and (iii) country (e.g., ‘Bangladesh’). The searches were conducted with the combination of these three types of keywords. 10.6–81.8% and 11.1–85.6%, respectively, across diverse Bangladeshi cohorts. The higher rates of depression, anxiety, and stress was 82.4%, 81.8%, and 85.6%, respectively, in the university students (both anxiety and depression) and the general population (stress); whereas all of the lower rates were found among bankers (that is, 12.1%, 10.6% and 11.1%, respectively).

observed that people under these measures reported substantial mental health impacts, which led to people disliking the importance of social restriction measures suppressing the viral infection (11).
In Bangladesh, the rst COVID-19 case was identi ed on 8 March 2020 (12). After some of that point, Bangladesh's authority seized countrywide lockdown with the title of 'general holidays' to mitigate the outbreak at the community level, which was a signi cant challenge for a lower-and middle-income country with limited resources in the healthcare settings (12). Under these circumstances, many people became cut down from their jobs and unemployed without the hope of alternative new jobs (1,13). Consequently, the jobless situation led people to suffer from higher rates of mental instabilities (14). Considering the mental problems related to unemployment and economic crisis, self-harm and suicidal incidences are also observed in Bangladesh. For instance, a study reported all but one of the COVID-19 related suicide cases occurred as of economic and nancial problems within the rst three weeks of April 2020 [14]. In addition, the uncertainty about going back to everyday life, fear of being infected, social and economic disruption, rising social negligence, di culties in getting proper treatment as of the overwhelming number of patients etc. generally increase psychological suffering, including post-traumatic stress disorder (PTSD), insomnia, phobia, fear, anxiety, depression etc. (15)(16)(17).
In Bangladesh, after the rst COVID-19 suicide incidence on 25 March 2020, epidemiological studies concerning mental health problems to identify risky individuals were recommended [19], and many studies have already been conducted across the country. But, there is no beyond a systematic evaluation to better understand the impact of the COVID-19 pandemic on people's psychological health. Therefore, this study attempts to review the Bangladeshi studies concerning the COVID-19 pandemic-related mental health problems such as depression, anxiety and stress (more speci cally, studies reporting the prevalence and/or risk factors of these mental health outcomes); which in anticipated facilitating appropriate mental health strategies.

Data Eligibility Criteria
For being included in the present review, every article must ful l the following requirement of -(i) being a Bangladeshi study, (ii) being conducted after the inception of the COVID-19 pandemic, (iii) being an observational study (cross-sectional or longitudinal) in nature, (iv) being concerned with at least one common mental disorders (i.e., PTSD or stress, depression and anxiety), (v) reporting the prevalence and/or risk factors of these disorders, (vi) being published in peer-reviewed journals or preprint servers, (vii) being published in the English language.

Data Collection Procedure
First of all, a comprehensive literature search was conducted using the databases of Medline or PubMed to identify articles related to the prevalence and/or risk factors of depression, anxiety and stress reported during the COVID-19 pandemic in Bangladesh. Later on, Scopus, PsycINFO, Web of Science, CINAHL, Google Scholar, ResearchGate, and even Google search engine was used to retrieve missing peerreviewed and preprint articles. Along with that, additional missing articles were tried obtaining from the bibliographic references of the retrieved articles. Therefore, after a preliminary search conducted by the principal investigator, other investigators subsequently re-circled the procedure to ensure articles were not excluded from this review. A total of 175 articles were identi ed, whereas the 'titles and abstracts' of the retrieved articles were scanned to adhere to the study inclusion criteria of the present review. To the end, a total of 24 articles were included in this review after con rming all of the requirements (Fig. 1).

Data Extraction
In Microsoft Excel, a data extraction le was designed to make necessary changes from the recruited articles. After that, data were demonstrated by following records: information about the author and publication year, study design, sampling and data collection method, speci c group and sample size, time for data collection, assessments tool along with cutoff value and the prevalence and risk factors of PTSD, stress, depression and anxiety by the principal investigator. After the independent investigation and cross-checking by all the investigators, the disagreements were solved in the nal le as presented in Table 1.  Description of the Included Studies in the Review A total of 24 studies were encompassed in the present review after con rming the aforementioned inclusion criteria, whereas a total of 49,806 respondents participated autonomously, including a range of sample size 114 to 15,543; whereas the mean age of the participants ranged between 21.4 (± 2) and 31.41 (± 8.73) years. All of the included studies were cross-sectional and were conducted through online media and platforms. Most of the studies were surveyed among general population (n = 9) including different cohorts e.g., students (n = 7), healthcare professionals (n = 4), quarantined individuals (n = 1), wage-earners (n = 1), SARS-CoV-2 infected individuals (n = 1), and bankers (n = 1). In addition, utmost of the participants belonged to younger adult age groups. Different diagnostic tools were used to detect mental health problems, whereas most of the studies utilized the DASS-21 (n = 7). There are also disparities in the prevalence cutoff values; that is, some of the studies (n = 8) considered 'mild to severe or extremely severe conditions' for identifying prevalence rates, whereas 'moderate to severe or extremely severe' in 6 studies, and nine studies did not report (or self-considered) the cutoff points. The overall description of the recruited articles can be found in Table 1.

Distribution of Mental Disorders across Different Cohorts
The included articles assessed the ranges of mental health problems into a total of 7 distinct groups (e.g., general population, students, healthcare professionals, bankers, quarantined people, wage earners, and SARS-CoV-2 infected people), whereas each group has shown huge uctuation in case of the prevalence of the mental health outcomes. However, higher rates of anxiety (81.8%) were observed among university students, whereas the lower was for bankers (10.6%). Similarly, this rate was 82.4% among university students and 12.1% for bankers, and 85.6% among general people and 11.1% for bankers, respectively, for higher and lower prevalence rates of depression and stress. Surprisingly, all of the lower rates of mental health outcomes were observed among bankers.
a. Prevalence of mental disorders: General population As of observing a total of 9 studies, the prevalence rate of anxiety, depression and stress among the general population ranged from 33.  (19,28,(32)(33)(34)(35)41). All of the studies were conducted during the month of April and May in 2020, where studies reported the rate had shown a considerable uctuation, which might be due to the utilization of separate cutoff scores along with separate assessment tools.
c. Prevalence of mental disorders: Healthcare professionals Due to close contact with the COVID-19 infected and/or suspected patients, the healthcare professionals generally experience higher psychological distresses. Only four studies were conducted focusing on the mental health of the healthcare professionals, whereas the prevalence of depression and anxiety ranged from 34.2-48.5% and 32.5-69.5%, respectively (22,24,25,40). Nevertheless, stress was not reported in any of the studies.

d. Prevalence of mental disorders: Bankers
During the COVID-19 pandemic, banks were not closed down, which might in uence the bankers attaining higher mental health problems as they had to go to banks through public transportation mostly. Therefore, fear of being infected also increases their risk of being affected mentally. Nevertheless, only a study was directed among bankers regarding the level of anxiety, depression and stress, which includes 10.6%, 12.1% and 11.1%, respectively; the lowest prevalence rates as identi ed across all of the cohorts included in this review (39).

e. Prevalence of mental disorders: Quarantined people
Quarantine or restriction of movement had been introduced to switch the transmission of SARS-CoV-2 during the COVID-19 pandemic, wherever strategies associated with quarantine were constantly washing hands, wearing masks, and departing to the hospital when experiencing any complications related to COVID-19 symptoms (23). Nevertheless, these effective measures had been reported impacting psychologically on the quarantined people by evolving personalized trauma, fear and uncertainty of their natural life etc. Following the situation, only a study was conducted among the quarantined people, whereas the quarantined people reported experiencing 24% and 35% depression and PTSD, respectively (23).

f. Prevalence of mental disorders: Wage-earners
As of the COVID-19 related lockdown (e.g., movement restriction and earning losses), the wage-earning people became unable to bear the basic family needs, which effect on them being psychologically more vulnerable. Thus, as reported in a study, higher mental disorders were reported to this cohort; that is, 58.6% and 55.9% were the prevalence of anxiety and depression (14).

g. Prevalence of mental disorders: COVID-19 infected people
People infected with the COVID-19 generally experience a higher level of psychological problems, including depression and anxiety as a fear of mortality. As a vulnerable cohort, higher mental health problems were observed in this group, e.g., 63.5% and 56.6% for anxiety and depression. Hence, only a study was directed among this vulnerable cohort (37).

Risk Factors Associated with Mental Disorders
The risk factors for mental disorders can be divided into three major categories, that is, (i) socio-demographic, (ii) behavior and health,  (20) reported that being aged between 24 and 39 than ≥ 40 years had a lower risk of being anxious, but those aged ≤ 23 years compared to ≥ 40 years had experienced higher depressive symptoms. Similarly, Mamun et al. (30) reported that younger people develop depressive symptoms mostly. Besides, Islam et al. (29) found that participants aged 13 to 20 and 21 to 30 years were at a lower risk of anxiety than more than 30 years. Another study reported that participants' being younger were at greater risk of developing psychological sufferings (35). Furthermore, respondents aged below 25 years were approximately 2.29 times more prone to depression suffering than those more than 35 years old (14). The included studies to this review randomly utilized different age ranges; hence, concluding age-based mental health risk factors can be limited.

b. Gender
Gender was found to be a signi cant predictor of mental disorders in a large number of studies (8, 14,[19][20][21][22][24][25][26]29,30,32,35,36,[38][39][40]. A study found that females were suffering mostly from depression, anxiety, and stress, respectively, where it was 3.4-, 3.4-and 4.5 times higher than males (19). Similarly, al Banna et al. (20) reported that male participants were reported signi cantly less vulnerable to stress, anxiety and depression. Consistent with this, other studies also con rmed that female participants were at greater risk of suffering from mental disorders (25,26,29,30,32). However, no studies considered transgender concerning mental health in Bangladesh; although Mamun et al. (30) collected data on it, transgender was excluded from the analyses concerning the presentation of mental health problems.

c. Family monthly income
Only 2-studies found family income as a signi cant factor in psychological sufferings (14,19). Participants' monthly family income ≤ 2,7000 BDT [Bangladeshi Taka (currency)] was at approximately 2.56-and 2.62-folds higher risk of developing anxiety and depressive symptoms, respectively, than ≥ 27,000 BDT (19). However, another study concerning the wage-earning participants reported that the average monthly family income to be associated with both symptoms of anxiety and depression; that is, 3.31 and 4.12-times higher risk, respectively, were observed for less than 30,000 BDT compared to more than 70,000 BDT (14).

d. Marital status
Marital status had been found signi cant in a total of 6-studies (21,26,29,36,39,40), which depicted that a married person was at approximately 2-times higher risk of suffering from anxiety than an unmarried person (29). But heterogeneity of depression rate distribution with marital status was also found in a comparative study among the general population and healthcare professionals; that is, the divorced participants reported the highest depression rate followed by those who were unmarried and married (53.5%, 33.6%, and 23.7%, respectively) (36). Similarly, physicians being either unmarried or divorced or widowed or separated compared to married ones experiencing 3-times higher depressive symptoms (40).

e. Education
Education has been a signi cant factor in mental disorders in some of the studies (8, 14,19,20,26,29,42). A study claimed that participants with higher secondary and undergraduate education were at less risk of stress than the graduate (20). Contradictorily, respondents with secondary and undergraduate education were approximately 12.87-fold times and 1.12-fold times higher risk of anxiety symptoms than the graduates (20). Additionally, the secondary education cohort was at 2.30 times higher risk of suffering from depression than the graduates (20). Another study reported that participants with higher secondary education were more prone to develop depression and anxiety (26). Anxiety symptoms were less in having intermediate (11th -12th grade) education (about 0.5 times) and having bachelor education (approximately 0.64 times) than those with having higher education (above bachelor) (29).

f. Residence and family size
Living areas and the size of families were independently found as the risk factors for mental health suffering among individuals (19,35,41,42). Living in an urban area and families with more than 5 members reported having signi cant psychological issues (35,38,42). In contrast, another study reported that having children less than ve in a family experienced more mental health outcomes (19).

g. Having elderly and children in the family
Having elderly and children in the family increased the risk of mental health problems (19,20,36). For instance, student participants having children less than ve years in the family had experienced higher levels of depression and stress (19). Similarly, other studies reported that elderly > 50-year old's in the participants' families who were at high risk of COVID-19 experienced higher anxiety and depression symptoms (20,36).

Behavior and Health-related Risk Factors a. Smoking and alcohol use
Smoking and alcohol use signi cantly in uenced the risk of mental health problems such as stress, depression and anxiety a few studies (25,30,35,39). Mamun et al. (30) reported that 15.6% of the participants were depressed who were involved with smoking, whereas this rate was 3.3% for alcohol users. Besides, another study reported that those who were smoking more frequently signi cantly experience a high score for stress and depression (39).
b. Social media exposure Propaganda, falsehood, conspiracy theories etc., related to the pandemic were increased, whereas social media was found to be one of the prime sources for collecting COVID-19 related information (24). Therefore, constantly using social media was a signi cant risk factor for mental health sufferings, which was also found in some studies (24,27). For instance, 56.0% anxiety was found, with these participants reporting more than 4 hours of social media exposure, whereas it was 42.1% for ≤ 2 hours (27). Similarly, a higher depression prevalence rate was observed in those physicians who reported it too hard to stay away from social media (58.3% vs. 47.8%) The physical exercise patterns had been changed after the inception of the COVID-19 pandemic, which was reported signi cantly associated with psychological burdens. For instance, participants who were not involved or inadequately involved with physical exercise generally experienced higher levels of depression and anxiety (25,33,35).

d. Physical health conditions
Comorbidities were found to be a signi cant risk factor during the COVID-19 pandemic, leading to higher mental health problems. In contrast, the presence of several chronic diseases (i.e., hypertension, asthma, diabetes, heart diseases, chronic kidney disease, thyroid disorder) were also signi cantly in uenced mental health issues (8, 22,30,36). Besides, due to more physical health problems, more severe psychological disorders were observed; for instance, it was reported among general people (30).

e. Psychological problems
A few studies reported other psychological problems associated with depression, anxiety, and stress. For instance, insomnia had been reported to have in uenced the risk of mental health sufferings among university students and general people (30,35). However, the physicians who reported sleeping less than 6 hours had signi cantly associated higher depression and anxiety symptoms (24).

COVID-19 related Risk Factors a. Insu cient protective resources
The shortage of protective tools was a risk factor for psychological distresses during the COVID-19 pandemic. Few studies reported that the lack of personal protection equipment, inadequate or insu cient training, and other incentives related to protection in uenced the risk of mental health problems among healthcare professionals (22,24,25). Besides, Sakib et al. (36) found that only 15.9% of the healthcare professionals were satis ed with the quality of the PPE provided by the authorities, and the prevalence of depression was higher among HCPs who were dissatis ed with PPE (30.2% vs. 18.0%). However, no studies that reported PPE-related issues in respect to mental health were conducted in other cohorts.

b. COVID-19 related perceptions
Peoples' perception of the COVID-19 pandemic signi cantly impacted their mental health. A study found that participants who had the lowest con dence in their current living place due to the COVID-19 pandemic and were highly concerned about their earning showed enormously signi cant associations with higher mental disorders (8). Whereas, in the case of perception of the current social life, satis ed respondents were less likely to have depression, anxiety and stress (8). In addition, perceptions related to (i) normal life disruption caused by the COVID-19 pandemic, (ii) its negative mental health effect of the pandemic, (iii) its effects on the healthcare system, leading people not be able to get enough medical care, (iv) for Bangladesh, the COVID-19 pandemic does/will not be a major problem, (v) its negative impact on education etc. had been observed being associated with mental health problems (19,21).

c. Fear of COVID-19 infection
Most of the studies reported fear of COVID-19 infection in uencing the risk of mental health problems, whereas fear of getting infected by the SARS-CoV-2 either themselves or their family members or relatives were the risk factors (30)(31)(32)(33)(34)39,42). For instance, bankers reported that they were fearful of getting infected by the SARS-CoV-2 as their colleagues became infected, which later developed mental health problems (more speci cally depression) among the other bankers (39).

d. COVID-19 related symptoms
People feeling or suffering from the COVID-19 related symptoms were at increased risk of mental disorders (8, 19). A study among the students found having more than one symptom had higher odds of stress and anxiety levels compared to those with one symptom (3.06 vs 1.60, and 4.96 vs. 3.02, respectively; reference: no symptom]) (19). Correspondingly, another study observed that participants who had COVID-19 like symptoms, including fever, fatigue, and dry cough in the last 14 days, were signi cantly prone to suffering from depression, anxiety and stress (8).
e. Being suspected/infected with the COVID-19 Individuals who suspected or con rmed that they had close or indirect contact with the con rmed cases of COVID-19 were signi cantly suffered from higher levels of anxiety, depression and stress (8). Similarly, 3.17-and 3.99-times higher risk of anxiety and stress suffering were observed to these participants reporting contact with individuals with con rmed cases of COVID-19 (19).
f. Being quarantined or isolated Quarantine and isolation are the situations that generally increase the higher risk of mental health problems through developing trauma among the quarantined or isolated individuals. A study found that participants reporting to be quarantined 3.67-fold anxious than those who were not quarantined (19). Another study by Ripon et al. (23) reported that females generally developed a 4.7-and 4.8-times higher risk of PTSD and depression among home-quarantined people than male-quarantined people.
g. Healthcare facility and patient-related information Physicians reporting inadequate resource to deal with the COVID-19 infected patients were at increased risk of depression and/or anxiety; that is, 2.28-, 5.30-, and 2.99-times higher risk were predicted for the mild, moderate and severe levels of depression and/or anxiety, respectively (22). Thus, healthcare professionals were being reported restlessness while examining the patients with u-like symptoms, whereas a double depression rate was identi ed to these physicians compared to those who were not restless (36). Consequently, physicians who reported to be ready to deal with a COVID-19 positive patient had experienced higher levels of depression and anxiety (24).

Discussion
To the best of the author's knowledge, this is the rst systematic review on common mental health problems during the COVID-19 pandemic in Bangladesh (43,44), which has potential implications for mental health policymaking and practice. It is anticipated that the ndings presented herein can be implemented for (i) developing cost-effective mental health strategies, (ii) prioritizing and integrating mental health in existing healthcare systems, (iii) improving access to information and mental health resources, (iv) addressing mental health disparities across different cohorts, (v) mobilizing social and community resources and organizations, (vi) strengthening mental health systems for the forthcoming public health emergencies etc. (45).
After investigating 24 recruited studies related to the COVID-19 pandemic, the overall range for the prevalence of depression, anxiety, and stress included 12.1-82.4%, 10.6-81.8% and 11.1-85.6%, respectively, across diverse Bangladeshi cohorts. The higher rates of depression, anxiety, and stress was 82.4%, 81.8%, and 85.6%, respectively, in the university students (both anxiety and depression) and the general population (stress); whereas all of the lower rates were found among bankers (that is, 12.1%, 10.6% and 11.1%, respectively). Most importantly, the prevalence rates of mental disorders vary within a speci c group (general population, for example) due to the utilization of separate scales along with discrete cutoff values. Besides this, the sampling method and non-representativeness of the studies may also limit its reproducibility. In addition, there may have an effect of the COVID-19 exposure rate of the participants' area, personal and familiar history of the COVID-19 infection, nancial conditions, and so forth lockdown related issues, which are not possibly identi ed from the included studies for concluding an overall assumption on mental disorders' prevalence rates across the cohorts.
However, despite these limitations of the included studies, this review, for the rst time, estimated the mental health problems' prevalence rates, which are anticipated to be worthy of consideration as a cautious situation rather than factual ndings.
The COVID-19 pandemic has dramatically interchanged the consistent activities of individuals to prevent and control the outbreak. Under this circumstance, existing healthcare facilities in the country transformed into increased demands beyond its existence as competent.
During the normal period, effective and e cient health care services were allegedly absent in Bangladesh (12,46). Along with this, due to the shortage of adequate preventive equipment, frontline healthcare professionals frequently feel unsafe and get scared to be infected as they have to directly take care of the COVID-19 infected patients (24). Besides, many frontline healthcare professionals lost their lives worldwide being infected with the SARS-CoV-2 in their workplaces (47). Later on, this situation also upsurges psychological weight, including suicidal occurrences among the healthcare providers (48). Consistent with the scenario, the physicians who provided services in the Dhaka division were more susceptible to being anxious than other divisional physicians [41], which may be due to being identi ed in most cases and deaths in the Dhaka division.
Applying some of the mandatory restrictions, including social distancing at the earlier period of the pandemic inception, people started grabbing and worrying about their lives and personal safety, fear of getting infected, lost a beloved one, absence of appropriate treatment etc., which in uenced the risk of depression, anxiety and stress (17,45). Thus, participants belonging to general people, students etc. cohorts had to experience mental health problems. Besides this, daily wage-earners were at higher risk of adverse psychological effects as they could not meet their family's livelihood due to the countrywide lockdown and losing their jobs (14). Despite the wage-earners being a risky group, only a study was conducted within this cohort. Similarly, a study was conducted for other vulnerable cohorts, e.g., COVID-19 infected people, COVID-19 suspected people and bankers. Through the RT-PCR test, the individuals diagnosed with the COVID-19 generally got scared about the risk of mortality, which affects their adverse psychological consequences. For similar reasons, the quarantined people were found experiencing detraction of psychological wellbeing (23). In addition, bankers were also at higher risk of being affected psychologically as they had to deal with the clients during the pandemic since the banks were not completely shut down. Therefore, their colleague's news of being infected got scary, although the lower prevalence rates of anxiety, depression, and stress were reported to this cohort (39). Nevertheless, only a study was directed upon this mentally susceptible group (39), which may result in vague pictures concluding bankers compared to other cohorts are not at risk of higher mental health problems as reported in the only study.
This review also revealed the associated risk factors that in uenced the incidence of psychological consequences during the COVID-19 pandemic situation in Bangladesh. Based on the present review, socio-demographic factors including gender (mostly being female), younger people, living in an urban area, family size (more than 5 members), being unemployed, marital and educational status, having children and elderly in a family in uenced the risk of being mentally affected (20,(24)(25)(26)29,35). Furthermore, it was observed that people who had existing physical health-related comorbidities developed higher psychological problems (22,30). Besides this, being physically inactive and constantly using social media and watching news reported increasing the risk of mental instabilities (24,27). In addition, the COVID-19 related perceptions, experiencing the COVID-19 related symptoms, being suspected or infected with the SARS-CoV-2, being contacted with the COVID-19 con rmed cases, being quarantined or isolated etc., were reported as the psychological suffering risk factors. Finally, the fear of being infected with the virus due to the scarcity of appropriate preventive equipment and inadequate resources in healthcare settings to deal with the COVID-19 infected patients were also reported as a risk factor of those psychological consequences (24). In the end, it can be said that any of the COVID-19 related adverse outcomes increased the risk of higher mental health problems.
There are several limitations of the present review to be mentioned. First of all, potential studies that could have met this review inclusion criterion were not included beyond the strategies, which may limit the review by selection bias; although databases like Google Scholar, ResearchGate, even Google search engine were used for screening additional articles, and the research team tried their best to nd out all of the eligible articles. Preprint articles were included in this review in view of disseminating the available relevant information; however, these articles being non-peer-reviewed can be one of the limitations of study inclusion. In addition, no quality assessment was done to this review. Besides this, the overview of mental disorders' prevalence rates reported in this review can be limited; because many of these articles did not follow similar strategies for cutoff point and inter-studies-related limitations as aforementioned. Despite these limitations, the present review provides an overall estimation of the mental health problems (e.g., depression, anxiety, stress) in the context of Bangladesh, which may have potential in uences on adopting preventive mental health strategies including knowledge-exchange and training people through employing online-based intervention programs along with providing psychological cares, implementing cohortbased intervention program, arranging series webinar with a special focus on mental health, telecasting positivity about COVID-19 on media channel by taking as caution rather than factual ndings. In addition, this review's limitations are highly suggested to be addressed in future reviews adopting a more rigorous approach; for instance, for estimating pooled prevalence rates, meta-analytic reviews should be performed.

Conclusions
The COVID-19 pandemic has become a global public health threat due to its devastating effects on peoples' life throughout the world. To facilitate mental health policymaking and practice, there is no beyond integrated information. Therefore, the mental disorders during the COVID-19 pandemic in Bangladesh are reviewed herein for the rst time, which is the major strength to be noted. From this review, the provided baseline information related to prevalence and risk factors of depression, anxiety, and stress across different cohorts can be utilized in the policy levels to adopt appropriate preventive measures and practice to alleviate psychological consequences and physical health problems.

Declarations
Declarations -Ethics approval Not applicable to this study.

Declarations -Consent for publication
Not applicable to this study.