The relationship between leprosy, stigma and poor mental health is well recognized. The overall objective of this study was to help improve mental wellbeing in people affected by leprosy by gaining more insight into what factors related to cultural, social and personal life influence mental wellbeing amongst people affected by leprosy in the Terai region, Nepal. Methods: We adopted a qualitative approach with purposive sampling to include people affected by leprosy in the Terai region of Nepal. Fourteen people with various leprosy disability grades and two healthcare workers were recruited for in-depth interviews. We used a framework analysis method with characteristics of the Grounded Theory Approach. Predetermined themes were explored, and new themes brought up during the interviews were also analysed. Results: Leprosy-related stigma still persists in the Terai region, negatively influencing mental wellbeing. A higher disability grade can result in a poorer mental wellbeing. Additional key factors influencing mental wellbeing include: people's feelings and experiences regarding leprosy, family and community, work and culture. Conclusions: The mental wellbeing of the respondents was negatively influenced by direct and indirect consequences of being affected by leprosy. Stigma, disability grade, family, community, work and culture are very important factors that influence mental wellbeing in the Terai region, Nepal. We recommend that interventions should include a combination of strategies, including lay and peer counselling, socio-economic rehabilitation and involvement of community and family to improve the mental wellbeing

Background Leprosy, a leading cause of disability, remains endemic in southern Nepal. Alongside physical impairment and stigmatization, many people affected by leprosy suffer from mental health problems. Objectives This study had two objectives: (a) Establishing a baseline level of mental wellbeing and depression among people affected by leprosy in southern Nepal, and (b) Examining factors that influence mental wellbeing and depression in this target group. Methods A cross-sectional survey was conducted using three interview-administered questionnaires measuring level of depression (PHQ-9), mental wellbeing status (WEMWBS) and level of stigma (5-QSI-AP). Random clustering sampling was used to include leprosy-affected people from Self Help Groups (SHGs) and the reference group was matched based on socio-demographic characteristics. All participants were adults with no additional major morbidities. A sample of 142 persons affected by leprosy and 54 community controls were included. Results People affected by leprosy participating in SHGs had a significantly lower level of mental wellbeing and higher level of depression than the general population. Both mental wellbeing and depression were influenced by gender and the level of stigma. In addition, the level of depression was associated with the disability grade of leprosy-affected people. Conclusion Leprosy-affected people need mental health-care interventions at different organizational levels, with attention to identifying individuals at increased risk for mental health problems or with additional needs. These findings highlight the demand for further research on specific interventions to improve the mental health of leprosy-affected people.