BackgroundLeishmaniasis is a neglected tropical parasitic disease endemic in South Asia, East Africa, Latin America and the Middle East. It is associated with low socioeconomic status (SES) and responsible for considerable mortality and morbidity. Reports suggest that patients with leishmaniasis may have a higher risk of mental illness (MI), psychosocial morbidity (PM) and reduced quality of life (QoL), but this is not well characterised. The aim of this study was to conduct a systematic review to assess the reported impact of leishmaniasis on mental health and psychosocial wellbeing.MethodsA systematic review of the literature was carried out. Pre-specified criteria were applied to identify publications including observational quantitative studies or systematic reviews. Two reviewers screened all of the titles, abstracts and full-studies and a third reviewer was consulted for disagreements. Data was extracted from papers meeting the criteria and quality appraisal of the methods was performed using the Newcastle-Ottawa Scale or the Risk of Bias in Systematic Review tool.ResultsA total of 14 studies were identified from 12,517 records. Nine cross-sectional, three case-control, one cohort study and one systematic review were included. Eleven assessed MI outcomes and were measured with tools specifically designed for this; nine measured PM and 12 measured QoL using validated measurement tools. Quality appraisal of the studies showed that six were of good quality. Cutaneous leishmaniasis and post kala-azar dermal leishmaniasis showed evidence of associated MI and PM including depression, anxiety and stigma, while all forms of disease showed decreased QoL. The findings were used to inform a proposed model and conceptual framework to show the possible links between leishmaniasis and mental health outcomes.ConclusionThere is evidence that leishmaniasis has an impact on MI, PM or QoL of patients and their families and this occurs in all the main subtypes of the disease. There are however large gaps in the evidence. Further research is required to understand the full extent of this problem and its mechanistic basis.

Objective: Abrupt life changes imposed by the lockdown measures, with a direct impact on teaching methodology and social interactions, as well as sleeping patterns, harmed university students' mental health. This study aimed to analyze the relationship between satisfaction with online teaching, social interaction with depression, anxiety symptomatology, and to analyze the effects of the pandemic and the lockdown in mental care access.Methods: The online survey collected demographic data, satisfaction with online teaching, and social interaction. We evaluated the depression and anxiety symptomatology using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder, respectively. For the PHQ-9, we used the cut-off 15 for moderately severe depressive symptoms, whereas for GAD-7, we recurred to the cut-off 10 for moderately severe anxiety symptoms. This study used three data points: October 2019, June 2020, and March 2021.Findings: The study included n = 366 participants from all university study fields, with a mean age of 21.71 (SD = 1.42) in the last survey, and 71.3% were women. Depressive symptoms increased significantly from October 2019 to June 2020, and the mean scores grew until March 2021. Anxiety symptoms also significantly increased from October 2019 to June 2020; however, from June 2020 to March 2021, there was a non-significant decrease in the proportion. Mean scores for satisfaction with online teaching were 38.23% in June 2020 and 34.25% in March 2021, a non-significant difference. Satisfaction with social interaction significantly decreased from 37.35% in 2020 to 24.41% in 2021. Participants with scores above the cut-off of moderately severe and severe depressive and anxiety symptoms showed significantly lower satisfaction with online teaching than students with lower depression and anxiety scores. Despite the significant increase in clinical symptomatology, help-seeking behaviors did not change accordingly, and more than 50% of the students with mild or severe depressive and anxiety symptomatology did not get treatment during the pandemic.Conclusion: The findings of this study suggest that most students are dissatisfied with online teaching and the type of social interaction they were forced to adopt because of the pandemic. The severity of depressive and anxiety symptomatology significantly increased between October 2019 and March 2021, but help-seeking behaviors did not increase accordingly.

Depression stigma has been considered a significant barrier to treatment and rehabilitation. This study aimed to understand the effects of gender, previous mental health care, and symptomatology on depression stigma and analyze the impact of depression stigma on help-seeking attitudes. A total of 969 students with a mean age of 18.87 (SD = 1.49) were included in this study and completed the Depression Stigma Scale, the Attitude Toward Seeking Professional Psychological Help, the Patient Health Questionnaire-4 questionnaire, and a socio-demographic questionnaire. We analyzed data using SPSS 24.0, with a 95% confidence interval. Participants came from all University schools, and 64.6% were women. Personal stigma and help-seeking attitudes were affected by gender (β(male) = 5.65, CI = 4.07, 7.25) and previous access to mental healthcare services (β(previous help) = -4.35, CI = -5.89, -2.82). Perceived depression stigma was affected gender (β(male) = -2.67, CI = -5.00, -0.34) and symptomatology (β(no symptomatology) = -3.29, CI = -6.09, -0.49). Personal (r = -0.42, p<0.01) and perceived (r = 0.10, p<0.01) depression stigma correlated with help-seeking attitudes, but we detected no direct symptomatology effect on help-seeking attitudes. Personal depression stigma significantly affected help-seeking attitudes (β = -0.15, CI = -0.17, -0.12). Promoting literacy may decrease personal depression stigma and increase professional help-seeking attitudes and behaviors.

19Background: Leishmaniasis is a neglected tropical parasitic disease endemic in South 20 Asia, East Africa, South America and the Middle East. It is associated with low 21 socioeconomic status (SES) and responsible for considerable mortality and morbidity. 22Reports suggest that patients with leishmaniasis may have a higher risk of mental illness 23 (MI), psychosocial morbidity (PM) and reduced quality of life (QoL), but this is not 24 well characterised. The aim of this study was to conduct a systematic review to assess 25 the reported impact of leishmaniasis on mental health and psychosocial wellbeing. 26Methods: A systematic review of the literature was carried out. Pre-specified criteria 27 were applied to identify publications including observational quantitative studies or 28 systematic reviews. Two reviewers screened all of the titles, abstracts and full-studies 29 and a third reviewer was consulted for disagreements. Data was extracted from papers 30 meeting the criteria and quality appraisal of the methods was performed using the 31 Newcastle-Ottowa Scale or the Risk of Bias in Systematic Review tool. 32Results: A total of 14 studies were identified from 12,517 records. Nine cross-sectional, 33 three case-control, one cohort study and one systematic review were included. Eleven 34 assessed MI outcomes and were measured with tools specifically designed for this; nine 35 measured PM and 12 measured QoL using validated measurement tools. Quality 36 appraisal of the studies showed that six were of good quality. Cutaneous leishmaniasis 37 and post kala-azar dermal leishmaniasis showed evidence of associated MI and PM 38 including depression, anxiety and stigma, while all forms of disease showed decreased 39 QoL. The findings were used to inform a proposed model and conceptual framework to 40 show the possible links between leishmaniasis and mental health outcomes. 3 41 Conclusion: There is evidence that leishmaniasis has an impact on MI, PM or QoL of 42 patients and their families and this occurs in all the main subtypes of the disease. There 43 are however large gaps in the evidence. Further research is required to understand the 44 full extent of this problem and its mechanistic basis. 45 46 AUTHOR SUMMARY 47 Leishmaniasis is a parasitic disease prevalent in many low-and middle-income countries 48 worldwide. In this study the authors looked for evidence as to whether leishmaniasis 49 affected the mental health and quality of life of patients. To conduct the review, a wide 50 search of the literature was conducted, where a total of 14 full articles were included 51 and analysed. It was found that different forms of leishmaniasis (visceral leishmaniasis, 52 cutaneous leishmaniasis and post kala-azar dermal leishmaniasis) do cause a significant 53 impact on patients' mental health and quality of life through societal factors such as 54 stigma, lack of knowledge, culture and low self-esteem among others. However, no 55 evidence of biological mechanisms was found linking leishmaniasis to mental i...

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