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Background: Intellectual disability and mental health disorders constitute a major health problem globally with higher economic burden in low- and middle-income countries such as Bangladesh. In 2017, the World Bank estimated that 85% of the global population lived in low-middle-income countries. Limited research has explored health practitioner knowledge and/or confidence in the diagnosis and treatment of mental health issues in persons with intellectual disabilities (IDs) in low-income countries such as Bangladesh. Method: One hundred and ninety-seven Bangladeshi-based health practitioners were grouped into 7 main professional groups according the current Bangladeshi health hierarchy (psychiatrists; traditional healers and community workers; medical doctors; nurses; psychologists; allied health: speech therapists, occupational therapists, social workers; and others: teachers physiotherapists, administration staff). A 34-item online survey was completed, which included questions measuring symptoms of common mental health disorders with reference to the Psychiatric Assessment Schedule for Adults with Developmental Disabilities, and questions measuring confidence working with persons with IDs from the Therapy Confidence Scale-Intellectual Disabilities. Results: Participants demonstrated low knowledge of symptomology but were "confident" working with people with IDs. Kruskal-Wallis H tests indicated a significant effect of professional group on both overall knowledge and confidence levels, respectively. Traditional healers and community health workers had significantly more knowledge of symptoms than all other practitioners for obsessive-compulsive disorder, depression, psychosis, and hypomania. Conclusion: Participants demonstrated confidence, but low knowledge, in treating individuals with IDs. The development of training programs to address specific deficits in knowledge of mental health symptoms, and confidence in using assessment and assessment-based communication, is recommended.

Introduction: Intellectual disability (ID) and co-morbid mental health problems are more common in developing countries such as Bangladesh. However, little is known about how Bangladeshi health practitioners diagnose mental health disorders in people with an ID. Studies in developed countries have explored the impact of the diagnostic overshadowing bias (DOB): the tendency for health practitioners to misattribute mental health symptomology to a client's ID, rather than a separate mental health disorder. To date, no study has investigated the presence of the DOB in Bangladesh. Method: A range of Bangladeshi health practitioners (N = 243) were randomly assigned a clinical vignette describing a client displaying symptoms of a mental health disorder. Vignette 1 described a client with an IQ of 105 who graduated from secondary school. Vignette 2 described a client with an IQ of 55 who attended special education. All other details were identical. Participants rated the likelihood of seven mental health diagnoses on a 5-point Likert scale. Results: Practitioners were more likely to diagnose schizophrenia, drug problems and being bullied in people with a typical IQ compared to those with an ID. Doctors, psychiatrists, and psychologists appeared to be more affected by the DOB than community health workers, traditional healers, and allied health practitioners. Conclusion: Findings indicate that the bias may be present in Bangladesh healthcare professionals. The development and implementation of specific training programs to meet the differing needs of practitioners, across the health fields are recommended.

People with an Intellectual Disability (ID) are around 4 times more likely to suffer with a mental health disorder than IQ-typical people, however previous studies have shown they may be less likely to be diagnosed. One suggested cause of this is the diagnostic overshadowing bias: the tendency for practitioners to attribute unusual behaviour, thoughts or feelings to a person's ID and not a separate mental health disorder.In the current study N = 87 participants were randomly assigned 1 of 2 clinical vignettes describing a client who is displaying symptoms of mental health disorder. Vignette 1 described a client with an IQ of 105 who graduated from high school. Vignette 2 described a client with an IQ of 55 who attended special classes throughout school. All other details were identical. Participants then rated the likelihood of 7 diagnoses on a 5-point Likert scale.Contrary to our hypothesis participants were not less likely to diagnose a mental health disorder in people with an ID and this was found to exist across all profession types involved in the study.Although these findings indicate that the diagnostic overshadowing bias may not be present in Australia, several factors including a reported lack of confidence in working with clients with an ID suggest the inclusion of ID specific training may be beneficial.