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rna
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l J
o
urna
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P
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bli
c
H
ea
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h Science
(
I
J
P
H
S)
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
2
0
2
5
,
p
p
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1
45
9
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s
.
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e.
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Chro
nic st
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elf
-
e
ff
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cy
,
a
nd
menta
l healt
h:
a
cr
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a
l s
tudy
a
m
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g
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y
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tude
nts i
n
Ba
n
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la
des
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Ra
s
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Ch
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o
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t
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u
n
d
e
rst
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so
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r
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ts.
We
a
im
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o
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f
y
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p
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ts
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t
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3
9
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st
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ts
we
re
i
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terv
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th
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g
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stru
c
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ir
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e
twe
e
n
Ap
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6
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n
d
M
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8
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2
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3
.
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tco
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su
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th
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14
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e
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lan
a
t
o
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riab
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s
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n
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ra
p
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ra
c
teristics
with
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fo
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n
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th
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t
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3
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’
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sig
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se
lf
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term
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imp
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p
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ic strain
s.
K
ey
w
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d
s
:
B
an
g
lad
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C
h
r
o
n
ic
s
tr
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s
Me
n
tal
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ea
lth
Self
-
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f
icac
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Un
iv
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s
ity
s
tu
d
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ts
T
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s
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c
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rticle
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n
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CC B
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li
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C
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r
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p
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A
uth
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:
R
ash
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Ho
s
s
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Dep
ar
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,
J
atiy
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Kab
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lam
Un
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ity
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My
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h
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4
7
@
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1.
I
NT
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Me
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v
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[
1
]
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[
2
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m
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5
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.
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ity
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c
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I
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Sci
,
Vo
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14
,
No
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3
,
Sep
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20
25
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4
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r
t
ed
s
t
r
es
s
a
m
o
n
g
s
t
u
d
e
n
ts
we
r
e
p
r
im
a
r
il
y
li
n
k
e
d
wit
h
f
a
m
il
y
a
n
d
t
e
ac
h
e
r
e
x
p
ec
t
ati
o
n
s
,
co
m
p
eti
ti
o
n
,
w
o
r
k
lo
a
d
,
s
o
ci
al
g
at
h
er
i
n
g
s
,
c
o
n
f
l
icts
,
l
o
n
eli
n
e
s
s
,
c
u
lt
u
r
al
ad
ju
s
tm
en
ts
,
r
el
ati
o
n
s
h
i
p
is
s
u
es,
s
e
lf
-
ass
u
r
a
n
c
e,
f
i
n
an
cia
l
s
u
p
p
o
r
t,
an
d
b
u
d
g
e
ti
n
g
[
1
4
]
.
I
n
N
am
i
b
ia
,
s
t
r
ess
o
r
s
a
m
o
n
g
u
n
iv
e
r
s
it
y
s
t
u
d
e
n
ts
i
n
c
lu
d
ed
h
i
g
h
e
x
p
e
cta
ti
o
n
s
,
h
ea
v
y
s
y
ll
ab
u
s
,
m
a
n
y
ass
ig
n
m
e
n
ts
a
n
d
test
s
,
n
u
m
e
r
o
u
s
c
lass
es,
li
m
it
ed
r
eso
u
r
c
es,
b
ei
n
g
awa
y
f
r
o
m
h
o
m
e
,
l
ac
k
o
f
f
a
m
il
y
s
u
p
p
o
r
t
,
r
e
lat
io
n
s
h
i
p
is
s
u
es
,
b
u
ll
y
i
n
g
,
a
n
d
f
i
n
a
n
cial
p
r
o
b
l
em
s
[
1
5
]
.
I
n
B
an
g
la
d
esh
,
m
aj
o
r
s
t
r
ess
o
r
s
f
o
r
u
n
i
v
e
r
s
it
y
s
tu
d
en
ts
i
n
cl
u
d
e
d
wo
r
r
y
a
b
o
u
t
t
h
e
f
u
t
u
r
e
(
8
6
%)
an
d
e
x
a
m
te
n
s
i
o
n
(
7
0
.
5
%
)
,
al
o
n
g
w
it
h
n
ew
p
e
o
p
le
,
g
r
o
u
p
w
o
r
k
,
r
ela
ti
o
n
s
h
i
p
tr
o
u
b
les
,
l
o
w
g
r
a
d
es,
f
i
n
a
n
cial
cr
is
is
,
l
ac
k
o
f
co
m
p
u
te
r
k
n
o
wle
d
g
e
,
m
is
u
n
d
e
r
s
ta
n
d
i
n
g
l
ec
tu
r
es
,
wei
g
h
t
is
s
u
es,
a
n
d
p
a
r
e
n
t
al
c
o
n
f
l
ict
[
1
6
]
.
Stre
s
s
f
u
l
s
itu
atio
n
s
in
cr
ea
s
e
v
u
ln
er
ab
ilit
y
to
m
e
n
tal
illn
ess
.
R
esear
ch
s
h
o
ws
th
at
cr
is
es
lik
e
jo
b
lo
s
s
an
d
c
u
ltu
r
al
a
d
ju
s
tm
en
t
r
aise
m
o
r
tality
r
is
k
[
1
7
]
.
I
n
T
h
ai
s
tu
d
en
ts
,
s
tr
ess
o
v
e
r
lo
ad
le
d
to
p
s
y
ch
o
lo
g
ical
p
r
o
b
lem
s
s
u
ch
as
an
x
iety
an
d
p
an
ic
attac
k
s
[
1
8
]
.
E
v
i
d
en
ce
s
h
o
wed
th
at
s
tr
ess
an
d
d
e
p
r
ess
io
n
as
well
as
an
x
iety
h
a
v
e
p
o
s
itiv
e
ass
o
ciatio
n
[
1
9
]
,
[
2
0
]
.
T
h
e
co
n
d
itio
n
o
f
m
e
n
tal
h
ea
lth
is
v
ar
ied
b
y
s
o
cio
-
d
em
o
g
r
ap
h
ic
f
ac
to
r
s
s
u
ch
as
ag
e,
g
en
d
er
,
r
esid
en
ce
,
y
ea
r
o
f
s
tu
d
y
,
f
ac
u
l
ty
en
r
o
llm
e
n
t,
s
elf
-
ef
f
icac
y
,
a
n
d
in
c
o
m
e.
Ma
m
u
n
et
a
l.
[
2
1
]
co
n
d
u
cted
a
s
tu
d
y
at
J
ah
an
g
ir
n
a
g
ar
Un
iv
er
s
ity
,
B
an
g
lad
esh
,
an
d
f
o
u
n
d
th
at
l
o
wer
class
s
tu
d
en
ts
wer
e
m
o
r
e
p
r
o
n
e
to
a
f
f
ec
t
d
ep
r
ess
io
n
th
an
o
th
er
s
.
T
h
e
f
i
n
d
in
g
s
o
f
an
o
th
er
s
tu
d
y
,
co
n
d
u
cted
in
I
n
d
ia,
also
s
h
o
wed
t
h
at
f
em
ale
s
tu
d
en
ts
an
d
1
st
as
well
as
2
nd
y
ea
r
s
t
u
d
en
ts
wer
e
m
o
r
e
lik
ely
to
s
h
o
w
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
[
2
2
]
.
Self
-
ef
f
icac
y
,
o
r
o
n
e'
s
ab
ilit
y
to
co
p
e
with
d
ail
y
h
ass
les,
m
ed
iates
s
tr
es
s
'
s
im
p
ac
t
o
n
m
en
tal
h
ea
lth
[
2
3
]
.
I
n
Pak
is
tan
,
lo
w
s
e
lf
-
ef
f
icac
y
was lin
k
ed
to
h
ig
h
e
r
d
ep
r
ess
io
n
a
n
d
an
x
iety
[
2
4
]
.
Gu
ll [
2
5
]
c
o
n
d
u
cted
a
s
tu
d
y
a
m
o
n
g
1
0
0
s
tu
d
en
ts
o
f
Alig
ar
h
Mu
s
lim
Un
iv
er
s
ity
w
h
o
attac
h
ed
with
jo
b
s
an
d
r
e
v
ea
led
in
v
e
r
s
e
ass
o
ciatio
n
b
e
twee
n
s
elf
-
ef
f
icac
y
an
d
a
n
x
iety
(
r
=
-
.
0
5
3
)
as
well
as
s
elf
-
ef
f
icac
y
an
d
d
e
p
r
ess
io
n
(
r
=
-
.
0
0
8
)
.
A
n
o
th
er
s
tu
d
y
,
co
n
d
u
cted
in
Yo
r
k
Un
iv
er
s
ity
,
C
an
ad
a,
d
is
co
v
er
ed
th
at
s
elf
-
ef
f
icac
y
an
d
s
tate
an
x
iety
n
eg
ativ
ely
c
o
r
r
elat
ed
(
r
=
-
.
4
2
)
[
2
6
]
.
Xie
et
a
l.
[
2
7
]
co
n
d
u
cted
a
s
tu
d
y
am
o
n
g
C
h
in
ese
o
n
co
lo
g
y
n
u
r
s
es
an
d
also
d
is
co
v
er
ed
t
h
at
s
elf
-
ef
f
icac
y
is
n
eg
ativ
ely
ass
o
ci
ated
with
d
ep
r
ess
io
n
(
r
=
-
0
.
2
5
2
)
.
Sev
er
al
lead
in
g
p
u
b
lic
an
d
p
r
iv
ate
u
n
iv
er
s
ities
o
f
B
an
g
lad
esh
h
av
e
co
u
n
s
elin
g
s
ec
tio
n
th
at
g
iv
es
ess
en
tial
m
en
tal
h
ea
lth
s
u
p
p
o
r
t
to
th
e
s
tu
d
en
ts
.
Desp
ite
co
u
n
s
elin
g
s
u
p
p
o
r
t,
th
e
p
r
ev
ale
n
ce
r
ate
o
f
s
u
icid
al
th
o
u
g
h
t
a
m
o
n
g
s
tu
d
en
ts
d
u
e
to
th
e
s
tr
ess
is
in
cr
ea
s
in
g
alar
m
in
g
ly
.
Sev
e
r
al
s
tu
d
ies
ca
lcu
lated
th
e
r
ate
o
f
s
u
icid
al
id
ea
tio
n
an
d
r
ev
ea
le
d
th
at
1
3
.
4
%
[
2
8
]
,
1
3
.
8
%
[
2
9
]
,
an
d
1
4
.
7
%
[
3
0
]
o
f
th
e
s
tu
d
y
p
ar
ticip
an
ts
r
ep
o
r
ted
s
u
icid
al
id
ea
tio
n
in
last
o
n
e
y
e
ar
wh
ich
d
ep
icted
t
h
e
l
im
itatio
n
s
o
f
th
e
co
u
n
s
elin
g
t
h
at
g
iv
en
b
y
th
e
u
n
iv
er
s
ity
au
th
o
r
ity
.
T
h
er
ef
o
r
e,
r
ec
en
t
e
m
p
ir
ical
s
tu
d
y
s
h
o
u
ld
b
e
c
o
n
d
u
cted
to
i
d
en
tify
t
h
e
r
o
le
o
f
ch
r
o
n
ic
s
tr
ain
s
,
s
elf
-
ef
f
icac
y
o
n
m
en
tal
h
ea
lth
.
T
o
o
u
r
k
n
o
wled
g
e,
n
o
s
tu
d
i
es
h
av
e
e
x
am
in
ed
ch
r
o
n
ic
s
tr
ain
s
’
im
p
ac
t
o
n
m
en
tal
h
ea
l
th
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
en
ts
in
B
an
g
la
d
esh
alth
o
u
g
h
th
ey
a
r
e
p
er
ce
iv
ed
v
u
ln
e
r
ab
le
b
ec
a
u
s
e
o
f
a
ca
d
em
ic
p
r
ess
u
r
e,
f
am
ily
,
en
v
ir
o
n
m
en
tal
,
an
d
c
ar
ee
r
r
elate
d
is
s
u
es.
W
e
th
er
ef
o
r
e
co
n
d
u
cte
d
th
is
s
tu
d
y
to
id
en
tify
p
r
im
a
r
y
ch
r
o
n
ic
s
tr
ain
s
am
o
n
g
Dh
a
k
a
Un
iv
er
s
ity
s
tu
d
e
n
ts
an
d
ex
a
m
in
e
th
eir
im
p
ac
t
o
n
m
en
tal
h
ea
lth
ad
ju
s
ted
f
o
r
p
o
ten
tial
co
n
f
o
u
n
d
er
s
.
T
h
e
f
in
d
in
g
s
o
f
th
e
c
u
r
r
e
n
t
s
tu
d
y
s
h
o
u
ld
b
e
h
el
p
f
u
l
to
c
o
m
p
r
e
h
en
d
th
e
r
o
le
o
f
c
h
r
o
n
ic
s
tr
ain
s
o
n
m
en
tal
h
ea
lth
a
n
d
p
r
o
v
id
e
c
o
m
p
r
e
h
en
s
iv
e
id
ea
s
a
b
o
u
t
o
t
h
er
ass
o
ciate
d
f
ac
to
r
s
o
f
m
en
tal
h
ea
lth
.
2.
M
E
T
H
O
D
2
.
1
.
Study
s
et
t
ing
s
a
nd
des
ig
n
W
e
co
n
d
u
cted
a
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
f
r
o
m
Ap
r
il
6
to
Ma
y
2
8
,
2
0
2
3
,
at
th
e
Un
i
v
er
s
ity
o
f
Dh
ak
a,
B
an
g
lad
esh
.
T
h
e
u
n
iv
e
r
s
ity
was
ch
o
s
en
d
u
e
to
its
p
o
s
itio
n
as
th
e
lar
g
est
an
d
o
ld
est
in
s
titu
t
io
n
in
B
an
g
lad
esh
,
attr
ac
tin
g
s
tu
d
en
ts
f
r
o
m
d
iv
er
s
e
s
o
cio
-
d
em
o
g
r
ap
h
ic
b
ac
k
g
r
o
u
n
d
s
ac
r
o
s
s
th
e
co
u
n
tr
y
.
Sit
u
ated
in
th
e
h
ea
r
t
o
f
Dh
ak
a,
th
e
ca
p
ital
city
,
th
e
u
n
iv
er
s
ity
b
o
asts
1
3
f
ac
u
lties
,
8
3
d
ep
ar
tm
en
ts
,
1
2
in
s
titu
tes,
2
0
r
esid
en
tial
h
alls
,
3
h
o
s
tels
,
an
d
o
v
er
5
6
r
esear
ch
ce
n
ter
s
,
ca
ter
in
g
to
a
s
tu
d
en
t
b
o
d
y
o
f
m
o
r
e
th
an
3
7
,
0
0
0
s
tu
d
en
ts
(
in
clu
d
in
g
ap
p
r
o
x
im
ately
2
0
,
7
7
3
m
ales
an
d
1
2
,
0
2
8
f
em
ales)
.
T
h
e
q
u
a
n
titativ
e
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
was
em
p
l
o
y
ed
in
th
e
cu
r
r
e
n
t stu
d
y
d
u
e
to
u
n
d
e
r
s
tan
d
th
e
s
o
u
r
ce
s
o
f
s
tr
ess
o
b
jectiv
ely
an
d
to
p
r
o
v
e
th
e
ass
o
ciatio
n
s
tatis
tical
ly
.
2
.
2
.
Sa
m
pli
n
g
T
h
e
s
u
r
v
e
y
tar
g
eted
b
o
t
h
m
a
s
ter
s
an
d
h
o
n
o
r
s
lev
el
s
tu
d
e
n
ts
,
en
s
u
r
in
g
a
r
ep
r
esen
tativ
e
s
am
p
le
b
y
weig
h
tin
g
p
ar
ticip
atio
n
ac
co
r
d
in
g
to
th
e
r
elativ
e
s
izes
o
f
in
s
titu
tio
n
s
an
d
f
ac
u
lties
.
T
h
e
r
eq
u
ir
ed
s
am
p
le
s
ize
was d
eter
m
in
ed
u
s
in
g
t
h
e
C
o
c
h
r
an
’
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(
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8
8
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6
C
h
r
o
n
ic
s
tr
a
in
s
,
s
elf
-
eff
ica
cy
,
a
n
d
men
ta
l
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lth
:
a
cro
s
s
-
s
ec
tio
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a
l stu
d
y
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(
R
a
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Ho
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)
1461
0
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1
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96
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(
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5
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×
(
.
5
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/
(
.
05
)
2
=
385
(
1
)
W
h
er
e
:
n
0
=
T
h
e
d
esire
d
s
am
p
le
s
ize
;
p
=
Po
p
u
latio
n
esti
m
ate
(
.
5
wa
s
m
ax
im
u
m
v
a
r
iab
ilit
y
)
;
q
= 1
-
p
;
Z
=
T
h
e
s
tan
d
ar
d
n
o
r
m
al
d
e
v
iate
(
u
s
u
ally
s
et
at
1
.
9
6
wh
ich
co
r
r
esp
o
n
d
ed
to
th
e
9
5
% c
o
n
f
i
d
en
ce
lev
el)
; a
n
d
E
=
T
h
e
m
ar
g
in
o
f
er
r
o
r
(
a
lev
el
o
f
9
5
% wa
s
ch
o
s
en
)
.
W
e
th
en
ad
ju
s
ted
th
e
esti
m
ated
s
am
p
le
s
ize
f
o
r
th
e
f
in
ite
p
o
p
u
latio
n
u
s
in
g
(
2
)
.
=
0
/
1
+
{
(
0
−
1
)
/
}
=
385
/
1
+
{
(
385
−
1
)
/
37000
}
=
381
(
2
)
W
h
er
e:
n
=
S
am
p
le
s
ize
;
N
=
P
o
p
u
l
a
t
i
o
n
s
i
z
e
(
b
a
s
e
d
o
n
t
h
e
U
n
i
v
e
r
s
i
t
y
o
f
D
h
a
k
a
'
s
o
f
f
i
c
i
a
l
w
e
b
s
i
t
e
,
e
x
c
e
e
d
i
n
g
3
7
,
0
0
0
r
e
g
u
l
a
r
s
t
u
d
e
n
t
s
)
;
a
n
d
n
₀
=
P
r
ev
io
u
s
ly
ca
lc
u
lated
s
am
p
le
s
ize
(
3
8
5
)
.
T
h
is
r
esu
lted
in
a
f
in
al
tar
g
et
s
am
p
le
s
ize
o
f
3
8
1
s
tu
d
en
ts
.
T
o
ac
co
u
n
t
f
o
r
a
p
o
ten
tia
l
2
0
%
n
o
n
-
r
esp
o
n
s
e
r
ate
o
b
s
er
v
ed
in
p
r
e
v
io
u
s
B
an
g
lad
esh
i
s
tu
d
ies,
we
ad
ju
s
ted
o
u
r
tar
g
et
s
am
p
le
s
i
ze
f
r
o
m
3
8
1
to
4
5
7
p
ar
ticip
an
ts
.
W
e
th
en
r
an
d
o
m
ly
in
v
ited
4
5
7
s
tu
d
en
ts
f
r
o
m
th
e
u
n
iv
er
s
ity
to
p
ar
ticip
ate
i
n
th
e
s
u
r
v
e
y
.
Data
co
llectio
n
was c
o
n
d
u
cte
d
th
r
o
u
g
h
f
ac
e
-
to
-
f
ac
e
in
ter
v
iews u
s
in
g
a
p
r
e
-
d
ev
el
o
p
ed
a
n
d
p
r
e
-
te
s
ted
q
u
esti
o
n
n
air
e.
2
.
3
.
Study
pa
rt
icipa
nts
Ou
t
o
f
th
e
4
5
7
s
tu
d
en
ts
in
v
ited
to
p
a
r
ticip
ate,
3
9
3
co
m
p
leted
th
e
s
u
r
v
ey
.
T
h
e
r
es
u
lted
in
a
co
m
m
en
d
a
b
le
r
esp
o
n
s
e
r
ate
o
f
8
6
%.
T
h
is
n
u
m
b
er
ex
ce
e
d
e
d
th
e
m
i
n
im
u
m
s
am
p
le
s
ize
r
eq
u
ir
em
en
t
o
f
3
8
1
,
p
r
o
v
id
i
n
g
a
s
tatis
tically
r
o
b
u
s
t sam
p
le
f
o
r
o
u
r
a
n
aly
s
is
.
2
.
4
.
O
utc
o
m
e
v
a
ria
bles
W
e
as
s
es
s
e
d
k
e
y
m
e
n
t
a
l
h
e
a
l
th
o
u
t
c
o
m
e
s
e
m
p
l
o
y
e
d
t
h
e
G
e
n
e
r
a
l
H
e
a
lt
h
Q
u
e
s
ti
o
n
n
a
i
r
e
(
GH
Q
-
2
8
)
f
o
r
t
h
i
s
p
u
r
p
o
s
e
.
T
h
is
q
u
es
t
i
o
n
n
a
ir
e
c
o
m
p
r
i
s
es
a
t
o
t
al
2
8
i
t
e
m
s
,
o
f
t
h
e
m
f
i
r
s
t
1
4
i
te
m
s
w
e
r
e
u
s
e
d
f
o
r
m
e
as
u
r
i
n
g
m
e
n
t
a
l
h
e
a
lt
h
c
o
n
d
i
t
i
o
n
s
a
s
p
e
r
p
r
e
v
i
o
u
s
s
t
u
d
ie
s
as
s
h
o
w
n
i
n
T
a
b
l
e
1
.
D
a
t
a
f
o
r
e
a
c
h
i
t
e
m
w
as
c
o
l
l
e
c
t
e
d
t
h
r
o
u
g
h
a
4
p
o
i
n
t
L
i
k
e
r
t
s
c
a
l
e
,
w
h
e
r
e
h
i
g
h
e
r
s
c
o
r
e
s
i
n
d
i
c
a
te
g
r
e
a
t
e
r
s
e
v
e
r
i
t
y
o
f
s
y
m
p
t
o
m
s
.
T
h
e
s
c
o
r
e
r
a
n
g
e
d
f
r
o
m
0
t
o
4
2
w
h
e
r
e
a
s
l
o
w
e
s
t
s
c
o
r
e
i
n
d
i
c
a
te
d
a
b
e
t
t
e
r
m
e
n
t
al
h
e
a
l
t
h
a
n
d
h
i
g
h
e
s
t
s
c
o
r
e
i
n
d
i
c
at
e
a
p
o
o
r
e
r
m
e
n
t
a
l
h
e
a
l
t
h
.
2
.
5
.
E
x
pla
na
t
o
r
y
v
a
ria
bles
T
h
e
p
r
im
ar
y
in
d
ep
en
d
en
t
v
ar
i
ab
le
o
f
in
ter
est
was
ch
r
o
n
ic
s
tr
ain
s
.
W
e
m
ea
s
u
r
ed
ch
r
o
n
ic
s
tr
ain
s
b
y
an
aly
zin
g
r
esp
o
n
d
en
ts
’
an
s
we
r
s
o
n
a
s
et
o
f
1
9
q
u
esti
o
n
n
air
es
as
p
r
esen
ted
in
T
a
b
le
2
with
r
esp
o
n
s
e
o
p
tio
n
s
was 5
p
o
in
ts
L
ik
er
t (
0
-
4
)
s
ca
le.
As
s
u
ch
th
e
v
alu
e
o
f
th
e
r
esp
o
n
s
es wa
s
f
o
u
n
d
v
ar
ied
b
etwe
en
0
an
d
7
6
.
B
ased
o
n
p
r
ev
io
u
s
liter
atu
r
e,
th
e
g
e
n
er
ated
s
co
r
e
was
ca
teg
o
r
ized
in
to
th
r
ee
lev
els:
lo
wer
s
tr
a
in
(
0
-
2
5
)
,
m
o
d
er
ate
s
tr
ain
(
2
6
-
5
0
)
,
a
n
d
h
ig
h
er
s
tr
ain
(
5
1
-
7
6
)
[
3
1
]
,
[
3
2
]
.
Hig
h
e
r
s
co
r
es
in
d
icate
g
r
ea
ter
lev
el
s
o
f
ch
r
o
n
ic
s
tr
ain
,
wh
ile
lo
wer
s
co
r
es
r
ep
r
esen
t
l
ess
s
tr
ain
.
T
h
e
v
ar
iab
le
‘
c
h
r
o
n
ic
s
tr
ain
s
’
tr
an
s
f
o
r
m
s
in
to
a
d
u
m
m
y
v
ar
ia
b
le
with
2
ca
teg
o
r
ies s
u
ch
as lo
wer
s
tr
a
in
s
an
d
h
ig
h
er
s
tr
ain
s
d
u
e
t
o
p
er
f
o
r
m
m
u
ltiv
ar
iab
le
lin
ea
r
r
e
g
r
ess
io
n
.
W
e
als
o
c
o
n
s
id
er
e
d
s
el
f
-
e
f
f
ica
cy
as
a
n
i
n
d
e
p
e
n
d
e
n
t
v
a
r
ia
b
l
e
w
h
e
r
e
g
e
n
e
r
ali
ze
d
s
el
f
-
ef
f
i
ca
cy
s
ca
l
e
[
3
3
]
was
u
s
e
d
.
T
h
e
i
n
s
t
r
u
m
e
n
t
c
o
n
s
is
ts
o
f
1
0
ite
m
s
.
Hi
g
h
e
r
s
c
o
r
e
i
n
d
ic
at
es
m
o
r
e
s
el
f
-
ef
f
ic
ac
y
,
a
n
d
l
o
we
r
s
co
r
e
i
n
d
ic
ates
less
s
el
f
-
e
f
f
ic
a
cy
.
B
as
e
d
o
n
s
c
o
r
es
,
s
el
f
-
ef
f
i
c
ac
y
w
as
ca
t
eg
o
r
i
ze
d
i
n
t
o
t
h
r
e
e
g
r
o
u
p
s
i
n
c
lu
d
i
n
g
lo
w
(
0
-
1
3
)
,
m
o
d
e
r
a
te
(
1
4
-
2
6
)
,
a
n
d
h
i
g
h
(
2
7
-
4
0
)
.
C
r
o
n
b
a
ch
’
s
al
p
h
a
v
al
u
e
(
0
.
8
2
6
)
s
u
p
p
o
r
ts
t
h
e
v
ali
d
it
y
a
n
d
r
el
ia
b
il
it
y
o
f
t
h
e
s
ca
l
e.
T
h
e
v
a
r
i
a
b
le
‘
s
el
f
-
e
f
f
i
ca
c
y
’
als
o
t
r
a
n
s
f
o
r
m
s
i
n
t
o
a
d
u
m
m
y
v
ar
ia
b
le
wit
h
2
c
ate
g
o
r
ies
s
u
c
h
as
p
o
o
r
s
e
lf
-
e
f
f
ic
ac
y
a
n
d
g
o
o
d
s
el
f
-
e
f
f
ica
c
y
b
e
ca
u
s
e
o
f
p
e
r
f
o
r
m
i
n
g
m
u
l
ti
v
a
r
i
ab
le
li
n
e
a
r
r
e
g
r
ess
i
o
n
.
W
e
also
co
n
s
id
er
ed
s
ev
er
al
s
o
cio
-
d
em
o
g
r
ap
h
ic
v
ar
iab
le
s
,
in
clu
d
in
g
r
esp
o
n
d
en
t’
s
ag
e,
g
en
d
e
r
,
f
am
ily
’
s
m
o
n
th
ly
in
co
m
e,
y
ea
r
o
f
s
tu
d
y
,
p
lace
o
f
r
esid
en
ce
,
an
d
f
ac
u
lty
o
f
s
tu
d
y
as
ex
p
lan
ato
r
y
v
ar
iab
les.
Fo
r
th
e
p
u
r
p
o
s
e
o
f
d
ata
an
al
y
s
is
,
we
p
r
esen
ted
th
ese
ex
p
lan
ato
r
y
v
ar
iab
les
in
clu
d
in
g
a
g
e
(
1
8
-
2
0
/
2
1
-
2
3
/
2
4
-
2
6
)
,
g
en
d
er
(
Fem
ale/M
al
e)
,
f
am
ily
’
s
m
o
n
th
ly
in
co
m
e
(
L
ess
th
an
T
K.
3
,
0
0
0
/
T
k
.
3
,
0
0
0
-
L
ess
th
an
T
K.
6
0
,
0
0
0
/
T
K.
6
0
,
0
0
0
-
L
ess
th
an
T
K.
9
0
,
0
0
0
/
Mo
r
e
th
an
T
K.
9
0
,
0
0
0
)
,
y
ea
r
o
f
s
tu
d
y
(
1
st
/2
nd
/3
rd
/4
th
/Ma
s
ter
s
)
,
p
lace
o
f
r
esid
en
ce
(
At
p
ar
en
ts
/I
n
r
en
te
d
ac
co
m
m
o
d
ati
o
n
/On
ca
m
p
u
s
)
,
an
d
f
ac
u
lt
y
o
f
s
tu
d
y
(
So
cial
s
cien
ce
s
/
B
u
s
in
es
s
s
tu
d
ies/
Scien
ce
/Ar
ts
/La
w/E
n
g
in
ee
r
in
g
an
d
tech
n
o
lo
g
y
/B
io
lo
g
ical
s
cien
ce
s
/Ea
r
th
an
d
en
v
ir
o
n
m
en
tal
s
cien
ce
s
/I
n
s
titu
te
o
f
s
o
cial
welf
ar
e/I
n
s
titu
te
o
f
ed
u
ca
tio
n
an
d
r
esear
c
h
)
with
d
if
f
er
e
n
t
ca
teg
o
r
ies.
T
h
ese
v
ar
iab
les we
r
e
s
elec
ted
b
y
r
e
v
iewin
g
th
e
ex
is
tin
g
liter
atu
r
e
[
7
]
,
[
2
1
]
,
[
2
2
]
.
2
.
6
.
Da
t
a
a
na
ly
s
is
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wn
in
T
ab
le
2
.
On
ce
w
e
class
if
ied
th
em
as
p
er
lev
el,
6
0
(
1
5
.
3
%)
r
esp
o
n
d
en
ts
wer
e
class
if
ied
as
h
av
i
n
g
lo
w
lev
els
o
f
ch
r
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n
ic
s
tr
ain
s
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o
llo
wed
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y
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2
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8
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r
esp
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n
d
e
n
ts
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o
r
ted
h
av
in
g
h
ig
h
lev
el
o
f
ch
r
o
n
ic
s
tr
ain
s
,
an
d
2
6
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6
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r
esp
o
n
d
e
n
ts
r
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o
r
ted
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av
in
g
m
o
d
er
ate
le
v
els o
f
ch
r
o
n
ic
s
tr
ain
s
as p
r
esen
ted
in
T
a
b
le
3
.
3
.
1
.
3
.
Self
-
ef
f
ica
c
y
:
ca
pa
bil
it
y
t
o
a
cc
o
m
pli
s
h a
t
a
s
k
T
h
e
f
in
d
i
n
g
s
o
f
t
h
e
cu
r
r
en
t
s
tu
d
y
r
e
v
ea
led
th
at
m
o
s
t
o
f
th
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tu
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en
ts
(
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0
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r
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o
r
ted
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ig
h
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o
f
s
elf
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ef
f
icac
y
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ils
t
ap
p
r
o
x
im
ately
4
o
u
t
o
f
1
0
s
tu
d
en
ts
(
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8
.
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r
ep
o
r
ted
m
o
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er
ate
lev
els o
f
s
elf
-
ef
f
icac
y
.
On
th
e
o
th
er
h
an
d
,
o
n
ly
0
.
5
% (
n
=
2
)
o
f
r
e
s
p
o
n
d
e
n
ts
r
ep
o
r
ted
lo
w
s
elf
-
ef
f
icac
y
as sh
o
wn
in
T
a
b
le
4
.
T
h
e
f
in
d
in
g
s
in
d
icate
d
th
at
alm
o
s
t a
ll o
f
th
e
p
ar
ticip
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ts
(
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%)
r
e
p
o
r
te
d
m
o
d
er
ate
an
d
h
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h
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elf
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ef
f
icac
y
wh
ich
g
en
er
ate
d
lo
w
an
d
m
o
d
er
ate
ch
r
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n
ic
s
tr
a
in
s
am
o
n
g
th
e
s
tu
d
y
p
ar
ticip
an
ts
.
T
ab
le
3
.
T
h
e
lev
el
o
f
ch
r
o
n
ic
s
tr
ain
s
am
o
n
g
t
h
e
s
tu
d
y
p
ar
ticip
an
ts
in
Un
iv
er
s
ity
o
f
Dh
ak
a,
B
an
g
lad
esh
,
2
0
2
3
(
n
=
3
9
3
)
Le
v
e
l
o
f
c
h
r
o
n
i
c
st
r
a
i
n
s
F
r
e
q
u
e
n
c
y
P
e
r
c
e
n
t
a
g
e
Lo
w
c
h
r
o
n
i
c
st
r
a
i
n
s
60
1
5
.
3
M
o
d
e
r
a
t
e
c
h
r
o
n
i
c
s
t
r
a
i
n
s
2
6
1
6
6
.
4
H
i
g
h
c
h
r
o
n
i
c
s
t
r
a
i
n
s
72
1
8
.
3
To
t
a
l
3
9
3
1
0
0
T
ab
le
4
.
L
e
v
el
o
f
Self
-
e
f
f
icac
y
am
o
n
g
th
e
s
tu
d
y
p
ar
ticip
a
n
ts
in
Un
iv
er
s
ity
o
f
Dh
ak
a,
B
an
g
lad
esh
,
2
0
2
3
(
n
=
3
9
3
)
Le
v
e
l
o
f
s
e
l
f
-
e
f
f
i
c
a
c
y
F
r
e
q
u
e
n
c
y
P
e
r
c
e
n
t
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g
e
Lo
w
s
e
l
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c
a
c
y
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5
M
o
d
e
r
a
t
e
se
l
f
-
e
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c
a
c
y
1
5
2
3
8
.
7
H
i
g
h
se
l
f
-
e
f
f
i
c
a
c
y
2
3
9
6
0
.
8
To
t
a
l
3
9
3
1
0
0
3
.
1
.
4
.
Ass
o
cia
t
io
n
bet
wee
n
s
o
cio
-
dem
o
g
r
a
ph
ic
v
a
ria
bles
,
chro
nic
s
t
ra
ins
a
s
well
a
s
s
elf
-
ef
f
ica
cy
a
nd
m
ent
a
l hea
lt
h c
o
nd
it
io
ns
Mu
ltiv
ar
iab
le
lin
ea
r
r
eg
r
ess
io
n
an
aly
s
is
was
u
s
ed
to
i
d
en
tif
y
f
ac
to
r
s
ass
o
ciate
d
with
m
e
n
tal
h
ea
lth
co
n
d
itio
n
s
as
p
r
esen
ted
i
n
T
ab
le
5
.
Am
o
n
g
th
ese
v
ar
iab
les,
c
h
r
o
n
ic
s
tr
ain
s
,
s
elf
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ef
f
icac
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,
g
en
d
er
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in
c
o
m
e,
a
n
d
p
lace
o
f
r
esid
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ce
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n
d
s
ig
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if
ican
tly
ass
o
ciate
d
with
m
en
tal
h
ea
lth
c
o
n
d
itio
n
s
.
W
e
f
o
u
n
d
th
at
s
tu
d
e
n
ts
with
h
ig
h
er
lev
els
o
f
ch
r
o
n
ic
s
tr
ain
s
wer
e
3
.
9
5
tim
es
m
o
r
e
lik
ely
to
p
er
ce
iv
e
th
e
m
s
elv
es
as
h
av
in
g
m
en
tal
h
ea
lth
p
r
o
b
lem
s
(
9
5
%
C
I
=
2
.
2
4
,
5
.
6
7
;
p
<
0
.
0
0
1
)
c
o
m
p
a
r
ed
to
th
o
s
e
with
lo
wer
le
v
els
o
f
c
h
r
o
n
ic
s
tr
ain
s
.
C
o
n
v
er
s
ely
,
s
tu
d
en
ts
with
h
ig
h
s
elf
-
ef
f
icac
y
wer
e
6
.
1
5
tim
es
less
h
av
in
g
m
en
ta
l
h
ea
lth
p
r
o
b
lem
s
(
9
5
%
C
I
=
-
9
.
7
1
,
-
2
.
6
0
;
p
<
0
.
0
0
1
)
.
Ma
le
s
tu
d
en
ts
wer
e
3
.
4
1
tim
es
les
s
m
en
tal
h
ea
lth
p
r
o
b
lem
s
th
an
f
em
ale
s
tu
d
en
ts
(
9
5
%
C
I
=
-
5
.
3
9
,
-
1
.
4
3
;
p
<0
.
0
0
1
)
.
R
e
s
i
d
e
n
ti
a
l
s
t
u
d
e
n
t
s
w
e
r
e
3
.
5
3
t
i
m
e
s
l
es
s
t
o
h
a
v
i
n
g
p
o
o
r
m
e
n
t
a
l
h
e
a
l
t
h
c
o
n
d
i
t
i
o
n
t
h
a
n
n
o
n
-
r
e
s
id
e
n
t
i
a
l
s
t
u
d
e
n
t
s
(
9
5
%
C
I
=
-
5
.
5
4
,
-
1.
5
2
;
p
<
0
.
0
0
1
)
.
A
d
d
i
t
i
o
n
a
l
l
y
,
s
t
u
d
e
n
ts
f
r
o
m
f
a
m
i
l
i
es
w
i
t
h
a
m
o
n
t
h
l
y
i
n
c
o
m
e
o
f
3
0
,
0
0
0
t
o
le
s
s
t
h
a
n
6
0
,
0
0
0
t
a
k
a
w
e
r
e
3
.
1
3
ti
m
e
s
l
es
s
a
f
f
e
c
t
e
d
b
y
m
e
n
t
al
h
e
a
l
t
h
p
r
o
b
l
e
m
s
(
9
5
%
C
I
=
-
5
.
1
7
,
-
1
.
0
9
;
p
<
0
.
0
0
3
)
c
o
m
p
a
r
e
d
t
o
t
h
o
s
e
f
r
o
m
f
a
m
i
l
i
e
s
w
i
t
h
a
m
o
n
t
h
l
y
i
n
c
o
m
e
o
f
3,
0
0
0
t
o
l
e
s
s
t
h
a
n
3
0
,
0
0
0
t
a
k
a
.
3
.
2
.
Dis
cus
s
io
n o
f
t
he
re
s
ults
T
h
e
aim
o
f
th
is
s
tu
d
y
was
to
ex
p
lo
r
e
th
e
ef
f
ec
ts
o
f
ch
r
o
n
ic
s
tr
ain
s
,
s
elf
-
ef
f
icac
y
,
an
d
s
o
cio
-
d
em
o
g
r
a
p
h
ic
f
ac
to
r
s
o
n
m
en
tal
h
ea
lth
.
A
d
d
itio
n
ally
,
th
e
cu
r
r
en
t
s
tu
d
y
s
o
u
g
h
t
to
id
en
tify
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e
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o
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r
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f
ch
r
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d
th
e
le
v
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o
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ch
r
o
n
ic
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s
,
as
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as
s
elf
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ef
f
icac
y
.
W
e
f
o
u
n
d
"ten
s
io
n
f
o
r
f
u
t
u
r
e
ca
r
ee
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s
"
to
b
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ig
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Un
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Asi
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Pacif
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d
J
ah
an
g
ir
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a
r
Un
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s
ity
in
B
an
g
lad
esh
[
1
6
]
,
[
3
4
]
.
I
n
co
n
tr
ast,
s
tu
d
ies
f
r
o
m
C
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p
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Hea
lth
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So
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Sci
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Un
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,
T
u
r
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[
3
5
]
,
Un
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C
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lleg
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Scien
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d
T
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o
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Un
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C
alcu
tta
[
3
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]
an
d
f
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r
Ma
lay
s
ian
p
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lic
u
n
iv
e
r
s
ities
[
3
4
]
id
en
tifie
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test
s
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x
am
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s
as
th
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p
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ee
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a
t
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d
if
f
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e
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Evaluation Warning : The document was created with Spire.PDF for Python.
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3
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Sep
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er
20
25
:
1
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1464
s
ev
er
al
f
ac
to
r
s
s
p
ec
if
ic
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.
T
h
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h
ig
h
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r
u
n
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ate
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B
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cr
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tes
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ig
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t
an
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am
o
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o
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f
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titu
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Stu
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f
o
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d
in
its
s
u
r
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th
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Natio
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Un
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g
r
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u
ates,
6
6
%
r
em
ain
s
u
n
em
p
l
o
y
ed
[
3
7
]
.
W
ith
lim
ited
jo
b
o
p
p
o
r
tu
n
ities
in
b
o
th
th
e
p
u
b
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c
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p
r
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s
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to
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s
,
s
tu
d
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f
ac
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te
n
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m
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etitio
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f
o
r
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ailab
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o
s
itio
n
s
.
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h
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city
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tain
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ed
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ess
ab
o
u
t
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Ad
d
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o
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r
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u
r
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o
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ts
to
ac
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f
in
a
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tab
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d
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u
p
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t
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a
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,
f
u
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a
m
p
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g
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ce
r
n
s
ab
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t
f
u
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E
la
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[
3
8
]
f
o
u
n
d
th
at
p
ar
e
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ts
o
f
lo
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s
o
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-
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o
n
o
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ic
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m
ilies
ex
p
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ted
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tu
d
en
ts
w
ill g
iv
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s
u
p
p
o
r
t t
h
eir
f
am
ilies
af
ter
co
m
p
letin
g
th
e
ir
s
tu
d
ies.
T
ab
le
5
.
Ass
o
ciatio
n
o
f
m
en
ta
l h
ea
lth
co
n
d
itio
n
s
with
ch
r
o
n
i
c
s
tr
ain
s
an
d
s
elf
-
ef
f
icac
y
a
d
ju
s
ted
f
o
r
s
o
cio
-
d
em
o
g
r
ap
h
ic
f
ac
to
r
s
,
B
an
g
lad
esh
,
2
0
2
3
(
n
=
393)
V
a
r
i
a
b
l
e
s
C
o
e
f
f
i
c
i
e
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t
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t
d
.
Er
r
.
T
p
>
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t
|
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9
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%
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o
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f
.
i
n
t
e
r
v
a
l
]
C
h
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c
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P
l
a
c
e
o
f
r
e
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e
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r
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i
d
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a
l
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e
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i
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l
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5
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4
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1
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5
2
W
e
also
f
o
u
n
d
a
h
i
g
h
er
le
v
e
l
o
f
ch
r
o
n
ic
s
tr
ain
s
am
o
n
g
1
8
.
3
%
o
f
th
e
to
tal
s
tu
d
e
n
ts
f
o
llo
wed
b
y
1
6
.
7
%
r
ep
o
r
ted
lo
w
lev
el
o
f
ch
r
o
n
ic
s
tr
ain
s
an
d
6
6
.
4
%
r
ep
o
r
ted
m
o
d
er
ate
lev
el
o
f
ch
r
o
n
ic
s
tr
ain
s
.
T
h
e
f
in
d
in
g
s
wer
e
s
u
p
p
o
r
ted
b
y
[
7
]
,
[
2
0
]
.
I
n
co
n
tr
ast,
s
ev
er
al
s
tu
d
ies
d
is
co
v
er
ed
th
at
o
n
ly
5
%
o
f
th
e
r
esp
o
n
d
en
ts
r
ep
o
r
ted
s
ev
er
e
o
r
ex
tr
e
m
ely
s
ev
er
e
s
tr
ess
[
9
]
,
[
1
1
]
.
T
h
e
f
i
n
d
in
g
s
u
r
g
e
n
ee
d
f
o
r
u
n
iv
er
s
i
ty
f
o
cu
s
to
en
s
u
r
e
b
etter
h
ea
lth
o
f
th
e
s
tu
d
en
ts
th
r
o
u
g
h
ar
r
a
n
g
in
g
m
o
r
e
ef
f
ec
tiv
e
co
u
n
s
elin
g
s
ess
io
n
b
y
r
ep
u
te
d
p
s
y
ch
o
l
o
g
is
ts
.
W
e
f
o
u
n
d
th
at
h
ig
h
er
ch
r
o
n
i
c
s
tr
ain
s
an
d
lo
w
er
s
elf
-
ef
f
ic
ac
y
wer
e
s
ig
n
if
ican
tly
co
r
r
elate
d
with
p
o
o
r
er
m
e
n
tal
h
ea
lth
,
co
n
s
is
ten
t
with
p
r
ev
io
u
s
s
tu
d
ies
wo
r
ld
wid
e
[
1
8
]
,
[
2
4
]
,
[
3
9
]
,
[
4
0
]
.
C
h
r
o
n
ic
s
tr
ain
s
ca
n
lead
to
s
u
s
tain
ed
p
s
y
ch
o
lo
g
ic
al
p
r
ess
u
r
e,
m
ak
in
g
i
n
d
iv
id
u
als
m
o
r
e
v
u
ln
er
a
b
le
to
p
s
y
ch
o
lo
g
ical
p
r
o
b
lem
s
.
T
h
is
ex
ten
s
iv
e
ex
p
o
s
u
r
e
to
s
tr
ain
s
ca
n
d
ec
r
ea
s
e
co
g
n
itiv
e
r
e
s
o
u
r
ce
s
,
lead
in
g
to
an
x
iety
,
d
e
p
r
ess
io
n
,
an
d
o
th
e
r
m
en
tal
h
ea
lth
p
r
o
b
lem
s
.
Mo
r
eo
v
er
,
lo
wer
s
elf
-
ef
f
icac
y
,
o
r
a
r
ed
u
ce
d
b
elief
in
o
n
e'
s
ca
p
ab
ilit
y
to
co
p
e
with
s
tr
ess
an
d
ch
allen
g
es,
ex
ac
e
r
b
ates
th
e
n
eg
ativ
e
im
p
ac
t
o
f
c
h
r
o
n
ic
s
tr
ain
s
.
I
n
d
iv
id
u
als
with
lo
w
s
elf
-
ef
f
icac
y
m
ay
f
ee
l
less
ca
p
ab
le
o
f
m
an
ag
in
g
th
eir
s
tr
ess
o
r
s
,
wh
ich
c
an
lead
to
a
s
en
s
e
o
f
h
elp
les
s
n
ess
an
d
h
eig
h
ten
ed
em
o
tio
n
al
d
is
tr
ess
.
T
h
is
r
elatio
n
s
h
ip
b
etwe
en
c
h
r
o
n
ic
s
tr
ain
s
,
s
el
f
-
ef
f
icac
y
,
an
d
m
en
tal
h
e
alth
u
n
d
er
s
co
r
es
th
e
im
p
o
r
tan
ce
o
f
b
o
th
ex
ter
n
al
s
tr
ess
o
r
s
an
d
in
ter
n
al
co
p
in
g
m
ec
h
an
is
m
s
in
d
eter
m
in
in
g
m
en
tal
h
ea
lth
o
u
tco
m
es.
T
h
ese
lin
k
a
g
es
h
ig
h
lig
h
t
th
at
in
ter
v
e
n
tio
n
s
aim
e
d
at
r
ed
u
cin
g
ch
r
o
n
ic
s
tr
ain
s
an
d
en
h
a
n
cin
g
s
elf
-
ef
f
ic
ac
y
co
u
ld
b
e
e
f
f
ec
tiv
e
in
i
m
p
r
o
v
i
n
g
m
e
n
tal
h
ea
lth
.
T
h
e
s
tu
d
y
also
f
o
u
n
d
th
at
s
o
cio
-
d
em
o
g
r
a
p
h
ic
v
ar
iab
les
s
u
ch
as
g
en
d
er
,
p
lace
o
f
r
esi
d
en
ce
,
a
n
d
f
am
ily
in
co
m
e
wer
e
s
ig
n
if
ican
tly
ass
o
ciate
d
with
th
e
m
en
tal
h
ea
lth
co
n
d
itio
n
s
o
f
s
tu
d
en
ts
.
T
h
ese
r
esu
lts
alig
n
with
p
r
ev
io
u
s
s
tu
d
ies
in
B
an
g
lad
esh
an
d
I
n
d
ia
[
7
]
,
[
2
1
]
,
[
2
2
]
.
I
n
th
e
co
n
tex
t
o
f
B
an
g
lad
esh
th
ese
s
o
cio
-
d
em
o
g
r
a
p
h
ic
v
ar
iab
les
p
lay
an
ess
en
tial
r
o
le
in
s
h
ap
in
g
p
s
y
ch
o
lo
g
ical
p
r
o
b
lem
s
.
Gen
d
er
d
if
f
er
en
ce
s
in
m
en
tal
h
ea
lth
m
ay
b
e
in
f
lu
e
n
c
ed
b
y
cu
ltu
r
al
ex
p
ec
t
atio
n
s
an
d
s
o
cieta
l r
o
les,
with
f
em
ale
s
t
u
d
en
ts
o
f
ten
f
ac
in
g
ad
d
itio
n
al
p
r
ess
u
r
es
r
elate
d
t
o
f
am
ily
r
esp
o
n
s
ib
ilit
ies
an
d
s
o
cial
n
o
r
m
s
.
Place
o
f
r
esi
d
en
ce
also
im
p
ac
ts
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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N:
2252
-
8
8
0
6
C
h
r
o
n
ic
s
tr
a
in
s
,
s
elf
-
eff
ica
cy
,
a
n
d
men
ta
l
h
ea
lth
:
a
cro
s
s
-
s
ec
tio
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a
l stu
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y
a
mo
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…
(
R
a
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h
e
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Ho
s
s
a
in
)
1465
m
en
tal
h
ea
lth
,
as
s
tu
d
en
ts
f
r
o
m
r
u
r
al
ar
ea
s
m
a
y
e
x
p
er
ien
ce
ad
d
itio
n
al
s
tr
ess
d
u
e
to
t
h
e
c
h
allen
g
es
o
f
ad
ap
tin
g
to
u
r
b
an
en
v
ir
o
n
m
en
ts
an
d
ac
ad
em
ic
d
em
an
d
s
.
Fam
ily
in
co
m
e
is
a
s
ig
n
if
ican
t
d
eter
m
in
an
t,
as
s
tu
d
en
ts
f
r
o
m
lo
wer
-
in
co
m
e
f
am
ilies
m
ay
f
ac
e
f
in
an
cial
p
r
ess
u
r
es
th
at
ad
d
to
th
eir
ac
ad
em
ic
an
d
p
er
s
o
n
al
s
tr
ess
.
I
n
B
an
g
lad
esh
,
lim
ited
ac
ce
s
s
to
m
en
tal
h
ea
lth
r
eso
u
r
ce
s
a
n
d
s
u
p
p
o
r
t
s
y
s
tem
s
ex
ac
er
b
ates
th
e
im
p
ac
t
o
f
th
ese
s
o
cio
-
d
em
o
g
r
ap
h
ic
v
ar
iab
les.
T
h
is
s
tu
d
y
h
as
s
ev
er
al
s
tr
en
g
th
s
an
d
a
f
ew
lim
itatio
n
s
.
T
h
e
m
ajo
r
s
tr
en
g
th
lies
in
th
e
r
ig
o
r
o
u
s
d
ata
co
llectio
n
p
r
o
ce
s
s
,
wh
ich
f
o
l
lo
wed
p
r
o
p
e
r
s
am
p
l
in
g
m
eth
o
d
s
.
An
ad
eq
u
ate
n
u
m
b
er
o
f
d
ata
p
o
in
ts
wer
e
co
llected
an
d
an
aly
ze
d
u
s
in
g
co
m
p
r
eh
e
n
s
iv
e
s
tatis
tical
tech
n
iq
u
es.
C
o
n
s
eq
u
e
n
tly
,
th
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
ca
n
b
e
u
s
ed
to
in
f
o
r
m
p
o
licies
an
d
p
r
o
g
r
am
s
.
Ho
wev
er
,
th
e
s
tu
d
y
h
as
s
o
m
e
lim
itatio
n
s
.
T
h
e
m
ajo
r
lim
itatio
n
is
th
at
th
e
d
ata
wer
e
co
llecte
d
th
r
o
u
g
h
a
cr
o
s
s
-
s
ec
tio
n
al
s
u
r
v
ey
,
w
h
ich
m
ea
n
s
th
e
f
i
n
d
in
g
s
ar
e
co
r
r
elatio
n
al
r
ath
er
th
an
ca
u
s
al.
Ad
d
itio
n
ally
,
th
e
d
ata
wer
e
co
llected
f
r
o
m
o
n
ly
o
n
e
u
n
iv
e
r
s
ity
in
B
an
g
lad
esh
,
lim
itin
g
th
e
g
en
er
aliza
b
ilit
y
o
f
th
e
f
in
d
in
g
s
.
T
h
e
s
elf
-
r
ep
o
r
ted
d
ata
an
al
y
ze
d
in
th
is
s
tu
d
y
also
in
tr
o
d
u
c
e
th
e
p
o
s
s
ib
ilit
y
o
f
r
ec
all
b
ias.
Fu
r
th
er
m
o
r
e
,
we
co
u
ld
n
o
t
co
n
s
id
er
m
a
n
y
im
p
o
r
tan
t
f
ac
to
r
s
af
f
ec
tin
g
m
en
ta
l
h
ea
lth
,
in
clu
d
in
g
en
v
ir
o
n
m
en
tal
f
ac
to
r
s
,
d
u
e
to
th
e
lack
o
f
r
elev
a
n
t
v
ar
iab
les
i
n
th
e
s
u
r
v
e
y
.
Desp
ite
th
ese
li
m
itatio
n
s
,
th
e
s
tu
d
y
h
ig
h
lig
h
ts
th
e
p
o
o
r
m
e
n
tal
h
ea
lth
co
n
d
itio
n
s
o
f
u
n
iv
e
r
s
ity
s
tu
d
en
ts
in
B
an
g
lad
esh
,
n
ec
ess
itatin
g
atten
tio
n
f
r
o
m
b
o
th
u
n
iv
e
r
s
ity
au
th
o
r
ities
an
d
th
e
g
o
v
e
r
n
m
en
t
.
T
h
e
u
n
iv
er
s
ity
a
u
th
o
r
ity
m
ay
ar
r
an
g
e
m
o
r
e
s
e
s
s
io
n
s
ab
o
u
t
m
en
tal
h
ea
lth
in
r
esid
en
tial
h
alls
an
d
ea
ch
d
ep
ar
t
m
en
t.
Similar
ly
,
th
e
g
o
v
e
r
n
m
en
t
m
ay
g
iv
e
m
o
r
e
f
in
an
cial
an
d
l
o
g
is
tic
s
u
p
p
o
r
ts
to
th
e
u
n
i
v
er
s
ity
au
th
o
r
ity
to
a
r
r
an
g
e
s
u
c
h
p
r
o
g
r
am
s
.
4.
CO
NCLU
SI
O
N
T
h
e
cu
r
r
e
n
t
s
tu
d
y
f
o
u
n
d
th
at
‘
ten
s
io
n
f
o
r
f
u
tu
r
e
ca
r
ee
r
’
is
th
e
to
p
ch
r
o
n
ic
s
tr
ain
,
an
d
m
ajo
r
ity
o
f
th
e
p
ar
ticip
an
ts
r
ep
o
r
te
d
m
o
d
e
r
ate
ch
r
o
n
ic
s
tr
ain
s
(
6
6
.
4
%)
as
well
as
h
ig
h
s
elf
-
ef
f
icac
y
(
6
0
.
8
%).
T
h
e
s
tu
d
y
also
f
o
u
n
d
th
at
h
ig
h
c
h
r
o
n
ic
s
tr
ain
s
an
d
p
o
o
r
s
elf
-
ef
f
icac
y
ad
v
er
s
ely
af
f
ec
t
th
e
m
en
tal
h
ea
lth
o
f
u
n
iv
er
s
ity
s
tu
d
e
n
ts
in
B
an
g
lad
esh
.
T
h
is
in
d
icate
s
a
p
ath
way
lin
k
i
n
g
s
tr
ess
o
r
s
,
s
elf
-
ef
f
icac
y
,
a
n
d
m
e
n
tal
h
ea
lth
is
s
u
es.
I
t
is
im
p
o
r
tan
t
f
o
r
u
n
iv
er
s
it
y
au
th
o
r
ities
to
f
o
cu
s
o
n
im
p
r
o
v
in
g
th
e
m
en
tal
h
ea
lth
o
f
s
tu
d
en
ts
.
Ad
d
itio
n
ally
,
th
e
f
in
d
in
g
s
h
ig
h
lig
h
t
t
h
e
n
ee
d
f
o
r
in
cr
ea
s
ed
atten
tio
n
to
o
r
g
an
izin
g
m
o
r
e
ef
f
ec
tiv
e
co
u
n
s
elin
g
s
ess
io
n
s
f
o
r
s
tu
d
en
ts
an
d
th
e
p
r
o
v
is
io
n
o
f
a
d
eq
u
ate
s
o
cial
s
u
p
p
o
r
t
t
o
p
r
e
v
en
t
a
d
d
itio
n
a
l
d
if
f
icu
lties
d
u
r
in
g
th
eir
cr
u
cial
ac
ad
em
ic
p
er
io
d
.
Sin
ce
th
is
s
tu
d
y
co
v
er
s
o
n
ly
o
n
e
p
u
b
lic
u
n
iv
er
s
ity
,
in
th
e
f
u
t
u
r
e,
th
is
s
tu
d
y
ca
n
b
e
co
n
d
u
cted
in
b
r
o
a
d
er
c
o
n
te
x
t in
clu
d
in
g
m
o
r
e
p
u
b
lic
as we
ll a
s
p
r
iv
ate
u
n
iv
er
s
ities
.
ACK
NO
WL
E
DG
E
M
E
NT
S
Au
th
o
r
s
th
an
k
to
th
e
s
tu
d
y
p
a
r
ticip
an
ts
f
o
r
th
eir
v
o
lu
n
tar
y
p
ar
ticip
atio
n
an
d
p
r
o
v
id
in
g
th
eir
v
alu
ab
le
d
ata
f
o
r
c
o
m
p
letin
g
th
is
s
tu
d
y
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
e
au
th
o
r
s
r
ec
eiv
e
d
n
o
r
ese
ar
ch
g
r
an
t
f
r
o
m
an
y
f
u
n
d
in
g
ag
en
cy
f
o
r
th
e
r
esear
ch
.
T
h
is
s
tu
d
y
was
s
elf
-
f
u
n
d
ed
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
t
h
o
r
s
h
ip
d
is
p
u
tes,
a
n
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
R
ash
ed
Ho
s
s
ain
an
d
R
ash
ed
a
I
r
s
h
ad
Nasir
wer
e
eq
u
ally
co
n
t
r
ib
u
t
ed
to
th
e
c
o
n
ce
p
tu
aliza
tio
n
,
m
et
h
o
d
o
l
o
g
y
,
v
alid
atio
n
,
in
v
esti
g
atio
n
,
wr
itin
g
-
r
ev
iew
an
d
ed
itin
g
,
as
well
as
p
r
o
ject
ad
m
i
n
is
tr
atio
n
.
I
n
ad
d
itio
n
to
,
s
o
f
twar
e,
f
o
r
m
al
a
n
aly
s
is
,
r
eso
u
r
ce
s
,
d
ata
cu
r
atio
n
,
w
r
itin
g
-
o
r
ig
in
al
d
r
af
t,
an
d
v
is
u
aliza
tio
n
wer
e
d
o
n
e
b
y
R
ash
ed
H
o
s
s
ain
.
B
esid
es,
R
ash
ed
a
I
r
s
h
ad
Nasir
s
u
p
er
v
is
ed
th
is
s
tu
d
y
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
R
ash
ed
Ho
s
s
ain
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
R
ash
ed
a
I
r
s
h
ad
Nasir
✓
✓
✓
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✓
C
:
C
o
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p
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M
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Va
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Fo
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Fu
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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:
2
2
5
2
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8
8
0
6
I
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t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
4
5
7
-
1
4
6
7
1466
CO
NF
L
I
C
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O
F
I
N
T
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R
E
S
T
ST
A
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M
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h
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au
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s
s
tated
n
o
p
o
ten
tia
l c
o
n
f
licts
o
f
in
ter
est.
DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
d
e
r
iv
ed
d
ata
s
u
p
p
o
r
tin
g
t
h
e
r
esu
lts
o
f
th
is
s
tu
d
y
ar
e
a
v
ailab
le
f
r
o
m
th
e
c
o
r
r
esp
o
n
d
i
n
g
a
u
th
o
r
,
[
R
H]
,
o
n
r
eq
u
est.
RE
F
E
R
E
NC
E
S
[
1
]
S
.
S
.
B
r
e
h
m,
S
.
M
.
K
a
ssi
n
,
a
n
d
S
.
F
e
i
n
,
S
o
c
i
a
l
p
sy
c
h
o
l
o
g
y
,
3
r
d
e
d
.
H
o
u
g
h
t
o
n
,
M
i
f
f
l
i
n
a
n
d
C
o
m
p
a
n
y
,
1
9
9
6
.
[
2
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
(
W
H
O
)
,
“
P
r
o
mo
t
i
n
g
m
e
n
t
a
l
h
e
a
l
t
h
:
c
o
n
c
e
p
t
s
,
e
m
e
r
g
i
n
g
e
v
i
d
e
n
c
e
,
p
r
a
c
t
i
c
e
,
”
W
H
O
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s:
/
/
w
w
w
.
w
h
o
.
i
n
t
/
p
u
b
l
i
c
a
t
i
o
n
s
/
i
/
i
t
e
m
/
9
2
4
1
5
6
2
9
4
3
[
3
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
(
W
H
O
)
,
“
M
e
n
t
a
l
d
i
s
o
r
d
e
r
s,”
W
H
O
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s:
/
/
w
w
w
.
w
h
o
.
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n
e
w
s
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o
m/
f
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t
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sh
e
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t
s
/
d
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t
a
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l
/
me
n
t
a
l
-
d
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s
o
r
d
e
r
s
[
4
]
M
.
Ez
a
r
i
k
,
“
S
t
u
d
e
n
t
m
e
n
t
a
l
h
e
a
l
t
h
s
t
a
t
u
s re
p
o
r
t
:
st
r
u
g
g
l
e
s,
st
r
e
ss
o
r
s
a
n
d
s
u
p
p
o
r
t
s,”
w
w
w
.
i
n
si
d
e
h
i
g
h
e
r
e
d
.
c
o
m
,
p
p
.
1
–
1
5
,
2
0
2
2
.
[
5
]
H
.
H
e
a
l
t
h
c
a
r
e
,
“
S
t
r
e
ss
,
t
h
e
‘
h
e
a
l
t
h
e
p
i
d
e
m
i
c
o
f
t
h
e
2
1
s
t
c
e
n
t
u
r
y
,
’
”
H
C
A
,
I
n
c
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
h
c
a
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.
[
6
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S
.
A
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A
.
M
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r
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T.
Z
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.
[
7
]
E.
V
e
n
k
a
t
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o
,
S
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I
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l
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1
.
[
8
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[
9
]
M
.
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1
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1
3
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.
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.
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[
1
4
]
M
.
L
.
P
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t
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[
1
5
]
M
.
R
.
N
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,
E.
R
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D
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[
1
6
]
T.
I
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m,
M
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[
1
7
]
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A
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,
T.
D
.
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.
[
1
8
]
N
.
L.
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.
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[
1
9
]
J.
M
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n
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t
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l
.
,
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P
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:
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o
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