SWPER-Measured women’s empowerment and mental health in Bangladesh: a cross-sectional study from 2022 demographic and health survey

BACKGROUND: Women in low- and middle-income nations are disproportionately afflicted by depression and anxiety, which are contributing factors to the worldwide disease burden. The purpose of this study is to measure the prevalence of anxiety and depression in Bangladeshi women aged 15-49 years and to evaluate the associations between these mental health outcomes and three aspects of empowerment (attitudes toward violence, social independence, and decision-making autonomy). METHODS: This study analyzed cross-sectional data from the 2022 Bangladesh Demographic and Health Survey. Empowerment was measured with the survey-based women's empowerment (SWPER) index and categorized as low, medium or high for each domain. Bivariate analysis via chi-square tests was used to identify significant covariates associated with the outcomes. Survey-weighted logistic regressions were performed to estimate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULTS: High anxiety and depression affected 8.1% and 10.4% of the women, respectively. Low empowerment in the attitudes toward violence was associated with high anxiety (AOR = 1.42, 95% CI: 1.07-1.89) and depression (AOR = 1.54, 95% CI: 1.19-1.99). Social independence empowerment was significantly associated with anxiety (low: AOR = 1.38, 95% CI: 1.12-1.69; medium: AOR = 1.24, 95% CI: 1.02-1.51), whereas in the decision-making section, medium and high empowerment increased anxiety risk (medium: AOR = 1.47, 95% CI: 1.17-1.86; high: AOR = 1.44, 95% CI: 1.15-1.82). Compared with women aged 15-24 years, those aged 25-34 years had increased risks of both anxiety (AOR = 1.69, 95% CI: 1.37-2.07) and depression (AOR = 1.43, 95% CI: 1.19-1.74), as did women aged 35-49 years (anxiety: AOR = 1.96, 95% CI: 1.56-2.47; depression: AOR = 1.55, 95% CI: 1.27-1.89). Agricultural work was protective against anxiety (AOR = 0.75, 95% CI: 0.64-0.88), whereas skilled/professional employment increased anxiety (AOR = 1.23, 95% CI: 1.01-1.49). Husband unemployment amplified both outcomes (anxiety: AOR = 1.88, 95% CI: 1.45-2.43; depression: AOR = 1.59, 95% CI: 1.25-2.02). Poverty heightened anxiety (AOR = 1.21, 95% CI: 1.03-1.42), whereas a lack of internet use elevated depression (AOR = 1.28, 95% CI: 1.09-1.52). Muslim women had increased risks of anxiety (AOR = 1.63, 95% CI: 1.24-2.13) and depression (AOR = 1.43, 95% CI: 1.12-1.83). Divisional disparities were also a significant risk factor for both anxiety (Rangpur: AOR = 1.66, 95% CI: 1.19-2.31; Khulna: AOR = 1.40, 95% CI: 1.02-1.93) and depression (Rangpur: AOR = 1.86, 95% CI: 1.43-2.40; Khulna: AOR = 1.34, 95% CI: 1.02-1.76). Conversely, having one to two children was protective against depression (AOR = 0.75, 95% CI: 0.61-0.92). CONCLUSIONS: Women's empowerment affects mental health in opposite ways: rejecting violence and gaining social independence lowers anxiety and depression, but more decision-making power can increase anxiety. Age, employment status, poverty, internet use, religion, region, and number of children also influence women's mental health. Effective policies must pair gender-norm changes and economic opportunities with easily accessible, stigma-free mental health support so that empowerment consistently benefits Bangladeshi women's well-being.